7. Diseases Of The Gallbladder And Bile Ducts

Question 1

What color is a healthy gallbladder?

Answer 1

Robin’s egg blue

Question 2

Chemical that stimulates gallbladder contraction.

Answer 2

CCIK

Question 3

This chemical mediated the relaxation of the sphincter of Oddi.

Answer 3

CCK

Question 4

WHat does relaxation of the sphincter of Oddi allow?

Answer 4

Biliary and pancreatic secretions to enter the duodenum.

Question 5

Composition of micelles of bile salts.

Answer 5

Cholesterol

Phospholipids

Question 6

Main component of bile pigments

Answer 6

Bilirubin

Question 7

Type of gallstone that is mostly calcium bilirubinate (black and brown).

Answer 7

Pigment (associated w/chronic infection or disease states w/ chronic hemolysis)

Question 8

________secretes bile acids.

Answer 8

Hepatocytes

Question 9

The 5 F’s: Risk factors for Cholelithisasis

Answer 9

Fat (BMI >30)
Female
Fertile
Forty >40
Fair
*Familial

Question 10

Composition of biliary sludge

Answer 10

Cholesterol crystals
Calcium bilirubinate
Mucin gels

Question 11

Presence of sludge means: (two things)

Answer 11

1) normal balance deranged

2) Nucleation

Question 12

Stone and sludge in the gallbladder can cause these 3 main issues: (there are more)

Answer 12

1) Cholelithiasis-stones present, no sx
2) Acute cholecystitis- inflammation
3) Chronic cholecystitis-“great imitator”

Question 13

This produces increased intraluminal pressure and distension of the gallbladder viscous that CANNOT be relieved by repeated biliary contractions.

Answer 13

Obstruction of the cystic duct OR CBD by stone

Question 14

A patient presents with SEVERE pain in RUQ that radiates to right shoulder. Consider:

Answer 14

Biliary colic

Question 15

Big factor that should make you suspicious of acute cholecystitis?

Answer 15

Long duration of pain (>5 hrs)

Question 16

Precipitating factors for biliary colic:

Answer 16

Fatty meal
Meal after fasting
Any meals

Question 17

When does biliary colic usually occur?

Answer 17

Nocturnal, w/in a few hrs of retiring

Question 18

Arrest of inspiration on palpation of gallbladder.

Answer 18

Murphy’s sign

Question 19

First step in evaluation for gallbladder disease.

Answer 19

Ultrasound

Question 20

If ultrasound of gallbladder is inconclusive and patient is NOT acutely ill, what would be your next step?

Answer 20

HIDA scan

• fast 4 hrs prior
• evaluated bile-excreting function of liver and gallbladder EF

Question 21

If pt. Is acutely ill, what else would you test for?

Answer 21

CBC (leukocytosis?)

Hepatic panel

Question 22

_________% of people with asymptomatic gallstones will remain asymptomatic-25yrs.

Answer 22

60-80

Question 23

Gallbladder polyps occur in _____% of pop.

Answer 23

5

Question 24

A patient comes in for an ultrasound (not gallbladder related) and you find an 11mm polyp. She is 59 yrs old. What should you do?

Answer 24

Cholestystectomy

Question 25

A 49 yr old patient comes in for a routine RUQ ultrasound (not sure what for), she has no pain, fever etc. You find a 9mm polyp. What should you do?

Answer 25

Monitor

Question 26

A patient comes with SUDDEN RUQ pain, 101 fever, and leukocytosis. Consider:

Answer 26

Acute cholecystitis

Question 27

3 sources of inflammation of the gallbladder wall in acute cholecystitis.

Answer 27

1) Mechanical inflammation (distention)
2) Chemical inflammation (local tissue factors)
3) Bacterial inflammation (E. Coli, Strep etc)

Question 28

Acute inflammation of the gallbladder wall following obstruction of the cystic duct by a stone.

Answer 28

Acute cholecystitis

Question 29

Steps for acute cholecystitis work up.

Answer 29

1) Ultrasound!
2) Hepatic panel
3) CBC

*gen. Surg

Question 30

A pt. Comes in with no current pain, but said they recently had a “EXTREME bout of pain in the RUQ” a few days ago in the middle of the night. Next steps?

Answer 30

Ultrasound>Gen Surgery

*tell them to go to ER next time this happens

Question 31

What kind of drugs can induce sphincter of Oddi spasms?

Answer 31

Morphine-based

Question 32

If a patient is in severe pain, high fever and leukocytes, what would you do?

Answer 32

1) Medically stabilize.
* NPO, IV FLUIDS, Fix electrolytes, NSAIDS, IV Antibiotics

2) Lap Cholecystitis

Question 33

Alternative to lap chol for extremely ill pt’s.

Answer 33

Percutaneous cholecystostomy tube (* gen surg decides)

Question 34

What would you used to evaluate for common bile duct stones during a lap choke

Answer 34

Intraoperative cholangiogram (IOC)

Question 35

During a lap choke what would you use to retrieve small CBD stones?

Answer 35

ERCP

Question 36

A post-cholecystectomy complains of severe diarrhea, what could give them?

Answer 36

Bile acid sequestration like Cholestyramine (Questran)

Question 37

A patient presents with severe abdominal pain, jaundice, and a high fever with chills. What is the called and what might be happening?

Answer 37

Charcot’s triad

Bile Duct Leak

Question 38

How would you evaluate a build duct leak?

Answer 38

ERCP

*Stent CBD

Question 39

When gallstones pass into the CBD:

Answer 39

Choledocholithiasis

Question 40

When bile ducts are partially to completely obstructed and bacteria begins to climb the biliary tree into the liver:

Answer 40

CHOLANGITIS

Question 41

Type of cholangitis in which pus is under pressure in a completely obstructed ductal system.

Answer 41

Suppurative cholangitis

*Mortality rate approaches 100%

Question 42

Tx for cholangitis

Answer 42

Empiric antibiotics (IV)
ERCP or surgical drainage

Question 43

What drug would you use to dissolve cholesterol type stones?

Answer 43

Ursodeoxycholic acid (UCDA)