Pathophysiology of the Gall Bladder and Biliary Tree

Question 1

What are the two functions of the gallbladder?

Answer 1

• Store bile made by the liver

- Contract to deliver bile to the duodenum after a fatty meal

Question 2

Gallstones almost always develop in the ____________.

Answer 2

gallbladder

Question 3

What are gallstones most commonly composed of?

Answer 3

Cholesterol

There are also brown stones, which indicate infection.

Question 4

Describe the differences between the consistencies of cholesterol gallstones and pigment stones.

Answer 4

Cholesterol: like toothpaste
Pigment: brittle

Question 5

What are the five Fs of gallstone risk factors?

Answer 5

Fat
Forty
Female
Fertile (estrogen use) 
Family history

Question 6

An overweight, Hispanic female presents to your office with complaints of intermittent pain –particularly after fatty meals –that lasts for about five hours. What is the cause?

Answer 6

Movement of gallstones through the cystic duct and common hepatic duct

Question 7

How would you treat biliary colic?

Answer 7

Remove the gallbladder

Question 8

What causes cholecystitis?

Answer 8

There can be calculous and acalculous causes.

Calculous: duct is blocked by stone, gallbladder gets infected

Acalculous: usually ischemia (from sepsis, surgery, trauma, vasculitis, or hypotension)

Question 9

What distinguishes choledocholithiasis from calculous cholecystitis?

Answer 9

Choledocholithiasis is a stone in the common bile duct –meaning it blocks the liver, too. Patients will have jaundice.

Question 10

Bacterial infection of the bile duct is called ____________.

Answer 10

ascending cholangitis (almost always due to choledocholithiasis)

Question 11

A patient comes in with RUQ pain, fever, jaundice – (Charcot’s triad) – hypotension, and altered mental status – (Reynold’s pentad). What procedure will they likely need?

Answer 11

Urgent endoscopic retrograde cholangiopancreatography

Question 12

What transaminase pattern will be found in someone with biliary stricture?

Answer 12

ALTs greater than ASTs

Question 13

Cholangiocarcinoma is ___________.

Answer 13

adenocarcinoma of the bile duct

Question 14

Why do you need to regularly monitor patients with primary sclerosing cholangitis?

Answer 14

Because PSC increases risk of developing cholangiocarcinoma

Question 15

Pigment stones are primarily composed of ___________.

Answer 15

bilirubin

Question 16

Which kind of stones develop in the bile duct?

Answer 16

Brown stones

Question 17

What is biliary colic?

Answer 17

Pain resulting from irritation of the bile duct, usually due to passage of stones

Question 18

What is Mirizzi’s syndrome?

Answer 18

An occlusion of the cystic duct that leads to regional edema that causes blockage of the hepatic duct, as well

Question 19

How are biliary strictures treated?

Answer 19

ERGP with dilation

Biopsy for suspected malignancy

Question 20

Describe sphincter of Oddi dysfunction.

Answer 20

The SOD doesn’t open as much as it should or when it should, leading to symptoms that mimic choledocholithiasis. More common in women. Symptoms are intermittent.