Chapter 18-Gallbladder

Question 1

What is the most common gallbladder anomaly

Answer 1

Phrygian cap

Question 2

Pigmented stones are composed of what

Answer 2

Bilirubin calcium salts

Question 3

Cholesterol stones are composed of what

Answer 3

Crystalline cholesterol mono hydrate

Question 4

Which areas of the world are more prone to gallstones

Answer 4

US and Western Europe

Question 5

Which patient populations are at a higher risk for gallstones

Answer 5

Native Americans

Question 6

What is the primary form of gallstones in the nondeveloped world and what is there cause

Answer 6

Pigmented stones, usually doe to a bacterial infection of the biliary tree

Question 7

Which age and sex are more likely to develop gallstones

Answer 7

White women

Question 8

Which environmental factors increase the risk fo gallstones

Answer 8

-Pregnancy, oral contraceptives, estrogen

Increases HMG-COA reductase activity

Question 9

Which genetic factor is associated with higher rates of gallstones

Answer 9

ABC protein G8 (ABCG8)

Question 10

What four biochemical situations cause the formation of gallstones

Answer 10

1-supersaturation of bile with cholesterol
2- hypomotility of the gallbladder
3- accelerated cholesterol crystal nucleation
4- hyper-secretion of mucus

Question 11

Which condition cause the increased changes of pigmented stones

Answer 11

1-elevated unconjugated-bilirubin
2-chronic hemolytic anemia
3-ileal dysfunction
4-bacterial infection

Question 12

How does infection lead to increased rates of pigmented stone

Answer 12

Bacterial enzyme Beta-glucuronidases converts and hydrolyzes bilirubin glucoronides

Question 13

Infection with which organisms leads to pigmented stones

Answer 13

• E.Coli
• Ascaris lumbricoides
• liver fluke C.sinensis

Question 14

What are the clinical presentions of gallstones

Answer 14

Most asymptomatic, but upon a fatty meal RUQ pain develops

Question 15

Which size of gallstones are likely to cause obstruction and pain

Answer 15

The small ones, as the large ones will not be able to get into the ducts

Question 16

What is the condition Bouveret syndrome

Answer 16

Aka gallstones lieus

Large stones may erode directly into an adjacent loop of small bowel

Question 17

Which cancer are gallstones associated with

Answer 17

Higher risk for gallbladder carcinoma

Question 18

Acute calculus cholecystitis is most commonly caused by obstruction of which ducts and what percentage

Answer 18

90% are obstruction of the neck or cystic duct by a stone

Question 19

Which condition may exacerbate acute calculous cholecystitis

Answer 19

DM who have symptomatic gallstones

Question 20

What are the conditions that can cause acute acalculous cholecystitis that do not involve a stone

Answer 20

Ischemia of gallbladder via the cystic artery:

• sepsis with Hypotensive organ failure
• immunosupression
• major trauma/burns
• DM
• Infection

Question 21

What is the condition of gallbladder empyema

Answer 21

When the exudate of the gallbladder is pure pus

Question 22

Which form of acute cholecystitis is more emergent of a situation

Answer 22

Acalculous, as gangrene is much higher

Question 23

Which bacteria can infect the gallbladder and cause acute acalculous cholecystitis

Answer 23

Staph and salmonella typhi

Question 24

What are Rokitansky-Aschoff sinuses and which condition are they seen in

Answer 24

Chronic cholecystitis and they are outpouching of the mucosal epithelium through the wall

Question 25

What condition is porcelain gallbladder associated with

Answer 25

Cancers

Question 26

What is xanthogranulomatous cholecystitis and what is the triggering event

Answer 26

Gallbladder has a massive thickened wall with chronically inflamed necrosis and hemorrhage. This is triggered by rupture of Rokitansky-Aschoff sinuses and results from the accumulation of macrophages that have become xanthomas cells as a result of engulfment of lipids

Question 27

What is the condition of hydrops of the gall bladder

Answer 27

Atropic, chronically obstructed, dilated gallbladder that only contains clear secretions

Question 28

What is the most common malignancy of the extrahepatic biliary tract

Answer 28

Carcinoma

Question 29

Which patient populations have a higher risk for gallbladder carcinoma

Answer 29

Native Americans and Hispanics

Question 30

Which gender is more likely to get gallbladder carcinoma

Answer 30

Women

Question 31

What is the most important risk factor for gallbladder cancer

Answer 31

Gallstones

Question 32

In gallbladder cancer, which gene is commonly upregulated

Answer 32

ERBB2 (Her-2)

Question 33

Which form of gallbladder carcinomas is most common

Answer 33

Infiltrating

Question 34

Most carcinomas of the gallbladder are what kind of origin

Answer 34

Adenocarcinoma

Question 35

Which form of gallbladder carcinomas have a better prognosis

Answer 35

Papillary tumors

Question 36

What are the common sites of seeding as a result of gallbladder cancer

Answer 36

Peritoneum, GI, Lungs