Sketchy Path: Gallbladder and Biliary Disorders

Question 1

Cholesterol stones are what color?

Answer 1

Yellow

Question 2

Besides cholesterol, what other gallbladder stones exist?

Answer 2

Billirubin (Black)

Question 3

What other form does cholesterol take in bile?

Answer 3

Bile salts

also free cholesterol in bile

Question 4

What enzyme converts cholesterol to bile salts?

Answer 4

7 alpha hydroxylase

rate limiting enzyme

Question 5

What molecule makes bile more soluble?

Answer 5

Phophatidlycholine

Question 6

What are the classic risk factors to developing cholesterol stones?

Answer 6

The four F's
Fat
Forty
Female
Fertile
(HIGH ESTROGEN)

Question 7

How does estrogen effect cholesterol synthesis?

Answer 7

Increases the rate liming enzyme in cholesterol synthesis which is HMG-CoA reductase

Question 8

What occurs during pregnancy to enhance the formation of cholesterol gallstones?

Answer 8

Progesterone decreases bile motility (increases water reabsorption from bile which concentrates cholesterol)

Question 9

What GI hormone decreases the motility of the gallbladder?

Answer 9

Somatostatin

Question 10

What form of nutrition increases the risk of cholesterol stones?

Answer 10

TPN esp in kids

Gallbladder does not work efficiently since not being stimulated

Question 11

What state increases the risk of gallbladder stones? (Fast or Fed)

Answer 11

Fasting

Question 12

Black stones occur mostly in what type of pathologies?

Answer 12

Excessive hemolysis causing an increase in conjugated billirubin

Question 13

Brown stones are a result of what?

Answer 13

Infection of the billiary tree

Question 14

What causes stones to be brown?

Answer 14

Bacteria from infection unconjugated billirubin causing brown stones

Question 15

What IBD increases your risk for gallstones?

Answer 15

Crohn’s Disease

esp patients with lesion in the terminal ileum/ileum resection

Question 16

Which enzyme stimulates the gallbladder to contract?

Answer 16

CCK

Question 17

Inflammation of the gallbladder due to stone persistently obstructing gallbladder outlet is called?

Answer 17

Acute Cholecystitis

Question 18

What causes gallbladder ischemia in acute cholecystitis?

Answer 18

Gallbladder distension leads to increase intraluminal pressure which compresses vasculature

Question 19

What is the classic sign in cholecystitis called? How is it performed?

Answer 19

Murphy’s

Pt expires compeletly and you palpate the gallbladder then ask to take deep breath- pain on deep inspiration

Question 20

Acalculous cholecystitis is seen mostly in what types of patients?

Answer 20

Critically ill - ICU pts

caused by stasis without obstruction of the gallbladder

Question 21

How is chronic cholecystitis diagnosed?

Answer 21

Histology finding of Rokitansky-Aschoff sinus which is a herniation of gallbladder mucosa into muscular wall

Question 22

What is the term for obstruction of the common bile duct by stone?

Answer 22

Choledocholithiasis

Question 23

what enzymes will be elevated in cholestasis?

Answer 23

Alk Phos (nonspecific)
GGT (sensitive not specific)
Billirubin (specific)

Question 24

What is the number one cause of acute pancreatitis?

Answer 24

Gallstones getting caught in the ampulla of vater

Question 25

Ascending Collangitis presents with what symptoms?

Answer 25

Charcot’s Triad
Jaundice
Fever
RUQ

Question 26

Finding of air in the billiary tree is pathopneumonic for what diagnosis?

Answer 26

Gallstone Ileus

Question 27

What is the most common malignancy of the gallbladder?

Answer 27

Adenocarcinoma

RARE

Question 28

What is the progression to carcinoma in the gallbladder?

Answer 28

Chronic inflammation causes dystropic calcification leading to Porcelain Gallbladder