Week 7 - Disorders of the Biliary Tract

Question 1

list 3 disorders of the biliary tract

Answer 1

• cholelithiasis
• cholecystitis
• gallbladder cancer

Question 2

what is cholelithiasis

Answer 2

gall stones

Question 3

what causes cholelithiasis

Answer 3

• occurs when solutes in the bile become so concentrated that they no long stay in the solution
  = form stone

Question 4

what are the 2 types of gallstones

Answer 4

• cholestrol stones within or without calcium

- bilirubin stones

Question 5

what are the 2 categories of risk factors for gallstones

Answer 5

• altered bile composition

- impaired gallbladder mobility

Question 6

list 5 risk factors for cholestrol stones

Answer 6

• dietary cholestrol
• obesity
• oral contraceptives
• DM
• dyslipidemia

4 Fs

• Fat
• Fertile (previous pregnancies, oral contra)
• Female
• Forty

Question 7

how are oral contraceptives a risk factor for gall stones

Answer 7

• contain estrogen which increases the risk of gallstones

- also alters the character of bile

Question 8

how is obesity a risk factor for gall stones

Answer 8

• linked to high lvls of cholestrol

Question 9

how does DM increase the risk of gallstones

Answer 9

• can cause hyperlipidemia = more cholestrol in bile = greater risk of precipitation

Question 10

list 2 risk factors for bilirubin stones

Answer 10

• hemolytic anemias

- parasitic infection (ex. malaria)

Question 11

is there a greater risk factor of gallstones in men or women? why?

Answer 11

• women r/t estrogen

Question 12

peak incidence occurs in women at what age? men?

Answer 12

• women = 50

- men = 60

Question 13

describe the effect of pregnancy on gallstones

Answer 13

• prior pregnancies increasesd the risk r/t estrogen

Question 14

how does rapid weight loss effect gallstones?

Answer 14

• increases the risk

- causes increased disposal of cholestrol in the bile

Question 15

what can gallstones cause

Answer 15

• obstruction of the cystic & common bile duct

Question 16

what is cholecystitis

Answer 16

• inflammation of the gall bladder

Question 17

what are symptoms of gallstones like

Answer 17

• most are asymptomatic

- but if it causes cholecystitis or cholangitis, it become symptomatic

Question 18

what is the most common clinical presentation of cholelithiasis

Answer 18

• cholecystitis

Question 19

how do gallstones cause cholecystitis

Answer 19

• when the gallstones cause obstruction

Question 20

cholecystitis can be…

Answer 20

• acute or chronic

- or an acute episode during chronic disease

Question 21

what type of jaundice can gallstones cause

Answer 21

• obstructive jaundice

Question 22

what is cholangitis

Answer 22

• inflammation of the common bile duct

Question 23

what other disorders can gallstones cause (5)

Answer 23

• cholecystitis
• cholangitis
• peritonitis (thru causing cholecystitis)
• obstructive jaundice
• pancreatitis

Question 24

how can cholecystitis cause peritonitis

Answer 24

• the inflamed gallbladder can become infected, necrotic, and rupture

Question 25

how can gallstones cause pancreatitis

Answer 25

• if the stone becomes obstructive and fail to clear the sphincter of Odi & block the pancreatic duct

Question 26

what determines the symptoms of gallstone

Answer 26

if the gallstones are:

• stationary or mobile
• obstructing or not

Question 27

what are manifestations of gallstones (5)

Answer 27

• biliary colic
• tachycardia
• diaphoresis
• prostration
• symtpoms of obstructive jaundice if it causes obstruction

Question 28

what is biliary colic

Answer 28

• way to describe a “gall bladder attack”
• pain that occurs when a stone is lodged in a duct, causing painful spasms
• different for everyone

Question 29

what causes tachycardia & diaphoresis during gallstones

Answer 29

• the pain

Question 30

what is prostration

Answer 30

• weakness

Question 31

what causes exacerbations of biliary colic

Answer 31

• after high-fat meals

- laying down

Question 32

describe biliary colic; where does it occur? what does it feel like? does it radiate?

Answer 32

• different for everyone
• severe upper right quadrant, epigastric, or lower back pain
• radiates to the R shoulder
• can be cramping, dull, sharp

Question 33

how do symptoms of gallstones change if they cause obstruction?

Answer 33

• get symptoms related to bile blockage

Question 34

what are the manifestations of obstrcuted bile flow

Answer 34

• obstructive jaundice (and all of its symptoms)

- intolerance of fatty foods

Question 35

what are the symptoms of obstructive jaundice (6)

Answer 35

• dark amber urine
• no urobilinogen in the urine
• clay or pale colored stools
• pruritis
• bleeding tendencies (due to vitamin K deficiency)
• steatorrhea

Question 36

what symptoms occur due to intolerance of fatty foods

Answer 36

• nausea
• sensation of fullness
• anorexia

Question 37

what are symptoms of cholecystitis (8)

Answer 37

• pain
• fever
• leukocytosis
• NV
• restlessness
• diaphoresis
• abdominal rigidity
• jaundice (bc often caused by obstruction)

Question 38

what is the pain like during cholecystitis

Answer 38

• vary from indigestion to mod to sever pain

- pain in the RUQ

Question 39

how is symptomatic cholelithiasis treated?

Answer 39

• cholecystectomy (removal of the gall bladder) = treatment of choice if symptomatic
• extracorporeal shock wave lithotripsy
• ERCP (clears stones)