20: Gallbladder Pathology

Question 1

Cholestasis

Answer 1

Decrease in bile flow due to impaired hepatocyte secretion/ obstruction of bile flow thru bile ducts

Question 2

Two major functions of bile

Answer 2

1. Emulsify dietary fat

2. Eliminate bilirubin, excess cholesterol, xenobiotics, and trace metals

Question 3

What is bilirubin?

Answer 3

Toxic end product of heme degradation

Question 4

Normal serum bilirubin levels

Answer 4

0.301.2 mg/dL

Question 5

Two mechanisms that lead to excess unconjugated bilirubin

Answer 5

Excess production + defective conjugation

Question 6

Unconjugated bilirubin is mostly bound to what?

Answer 6

Albumin in blood

Question 7

Three major causes of conjugated hyperbilirubinemia (everything else likely unconjugated)

Answer 7

1. Canalicular membrane transport deficiency (Dubin-Johnson, Rotor)
2. Hepatocellular disease (cirrhosis, hepatitis)
3. Impaired bile flow from obstruction or PBC/PSC

Question 8

Three major causes of cholestasis

Answer 8

Stones, tumors, strictures

Question 9

What can long-term cholestasis cause? (Five things)

Answer 9

1. Biliary cirrhosis (fibrotic gallbladder)
2. Sepsis
3. Intrahepatic infection
4. Ischemia
5. Primary hepatolithiasis

Question 10

Two major types of bacteria that can cause ascending cholangitis

Answer 10

1. Coliforms

2. Enterococci

Question 11

Single most frequent cause of death from liver disease in early childhood (when not treated)

Answer 11

Biliary atresia