Path Gallstones and Biliary diseases - mechanical cholestasis

Question 1

4 Fs

Answer 1

Female
Fat
Fertile
Fourties

Question 2

Gallstone risks

Answer 2

obesity
age
female sex
fasting
hemolysis
no EtOH

Question 3

EtOH risk factor for cholethiasis?

Answer 3

no

Question 4

Stone types (composition, causes)

brown

black

yellow-white

Answer 4

infectious - Calcium salts and deconjugated bilirubin , cytoeskeleton of bacteria, previous surgery, duodenal diverticula

Pure calcium bilirubinate, calcium copper, mucin glycoprotein. hemolysis.

Cholesterol Ca salts of bilirubin (most common, not seen by xray)

Question 5

enzyme & location for bile acid formation?

insufficiency result?

Answer 5

7alphahydroxylase in hepatocytes is RLS

deficiency -> cholesterol^, stones

Question 6

increased estrogen risk

Answer 6

cholesterol stones

Question 7

GI absorption of bile acids/salts

Answer 7

low absorption in jejunum – active and passive absorption in ileum

Question 8

3 causes of cholesterol bile stones

Answer 8

obesity/hypercholesterolemia
progestrone/birth control
estrogen excess

Question 9

supersaturation of cholesterol - pathalogic or physiologic?

Answer 9

physiologic until stone formation. micelles.

Question 10

delay in gallbladder emptying result?

Answer 10

stone formation

Question 11

4 risk factors for gall stone formation

Answer 11

Defective acidification of gallbladder bile

> pH higher precipitation of calcium salts

Gallbladder stasis can produce increase of mucin and interfere with mechanical emptying

Decreased response to CCK

Question 12

3 risks for brown gall stones

Answer 12

Bacterial infection (duodenum normally sterile - surg & diverticula are risks)

Decreasing biliary secretory IgA

High activity of B-glucuronidase

Question 13

describe biliary tree

Answer 13

RHD, LHD –> HD

HD & CD –> CBD –> PD –> sphincter of odi, ampulla of Vader

Question 14

biliary colic

Answer 14

intermittent pain

Question 15

acute cholecystitis symptoms

Answer 15

abd pain, fever

Question 16

choledocholithiasis w/cholangitis symptoms

Answer 16

abd pain, fever, jaundice

Question 17

biliary pancreatitis symptoms

Answer 17

abdominal pain, increased amylase

Question 18

% of pts w/cholecystectomy w/coledocholithiasis

Answer 18

12-15%

Question 19

emphysematous cholecystitis association

Answer 19

diabetic association

Question 20

Tx of gallstones

Answer 20

sphincterotomy, removal w/balloon

Question 21

2 types of cholestasis & causes

Answer 21

intrahepatic: PBC, drugs, malignancy, etc
extrahepatic: stones, obstruction (surg, primary sclerosing cholangitis, infection, chronic pancreatitis, transplantation stricture)

Question 22

hemobilia (definition, tx)

Answer 22

clots behaving like stones.

Tx is IR or open surg.