39. Diseases of the gallbladder

Question 1

What are the diseases of the gallbladder?

Answer 1

• cholelithiasis,
• cholecystitis,
• Cholangitis- choledocholithiasis- obstructive jaundice,
• Tumors of the gall bladder and the common bile duct

Question 2

Definition of choleithiasis?

Answer 2

1 or more calculi (gallstones) in the gallbladder.

Question 3

Prevalence + epidemiology + risk factors of cholelithiasis?

Answer 3

• Prevalence
◦ 20% of the older population (40-50) = common
◦ Mainly females

• Etiology :
◦ Risk factors : 3 F
▪ F= Female
▪ F= Forty
▪ F= Fatty (obesity, hyperlipidemia)

Question 4

Pathomechanism of gallstone formation?

Answer 4

◦ Cholesterol stones : most common. due to:
▪ High cholesterol content of bile
▪ Impaired gallbladder function

◦ Pigment bilirubin stone : Increased bilirubin in the gallbladder due to:
▪ Bile duct infections
▪ Hemolysis

◦ Stone goes the cystic duct :
▪ GB contract → bile goes out to biliary tree but there’s an obstruction → increased SM tension in wall of GBà it can not go out & causes pain

◦ Hormonal status:
▪ Female (FFF), gravidity (The state of being, or having been, pregnant)

Question 5

Symptoms of choleithiasis?

Answer 5

◦ Mostly asymptomatic (80%)
▪ Minor disconfort (abdominal distension)
▪ Uncertain epigastric pain

◦ Typical symptoms :
▪ Biliary colic → stone gets into cystic duct
• Right upper quadrant abdominal pain
• Irradiate to right scapular region
• (usually 1-2 hours after meals (fatty meal, eggs…)
▪ Nausea
▪ Vomitus
▪ No fever

Question 6

Diagnosis of choleithiasis?

Answer 6

◦ Ultrasound :
▪ Stone is shown by a shadow (no echo)

◦ No typical laboratory alterations (blood tests)
▪ Sometimes liver enzyme elevation following biliary colic)

Question 7

Treatment of choleithiasis?

Answer 7

◦ 1. Conservative treatment : diet, spasmolytics

◦ 2. Surgical treatment :
▪ Cholecystectomy (laparoscopy : camera)

◦ 3. Silent stones
▪ Waiting until symptoms appear
▪ One exception : diabetes mellitus : operate although no symptoms (sensory system impaired)

Question 8

Complications of choleithiasis?

Answer 8

◦ Cholecystitis

◦ Cholangitis → stone in common bile duct
▪ Inflammation in GB + other parts of biliary tree
▪ Sometimes stone get into papilla of Vater & flow stops → obstructive jaundice

◦ Biliary pancreatitis → bile duct occluded
▪ Major part of pancreas is inflamed

Question 9

What is acute cholecystitis?

Answer 9

acute inflammation of the gallbladder that develops over over hours usually due to gallstone obstructuion of the cystic duct

Question 10

Etiology of acute cholecystitis?

Answer 10

◦ Bacteria → gram -ve or anaerobes (inflammation w/o stone is very rare)

▪ Cholelithiasis → stones are necessary for it to happen
▪ Exception is diabetes mellitus → it can happen without stones

Question 11

acute cholecystitis symptoms?

Question 12

acute cholecystitis diagnosis?

Question 13

acute cholecystitis therapy?

Question 14

acute cholecystitis complications?

Question 15

chronic cholecystitis definition?

Question 16

chronic cholecystitis etiology?

Question 17

chronic cholecystitis pathophysiology?

Question 18

chronic cholecystitis symptoms?

Question 19

chronic cholecystitis diagnosis?

Question 20

chronic cholecystitis treatment?