Flashcards in Diseases of the Gallbladder and Biliary System Deck (21)
Name the radiologic procedure of choice for diagnosing cholelithiasis.
ULTRASONOGRAPHY has a high sensitivity and specificity for gallstones and should be performed as the diagnostic study of choice when evaluating biliary colic or or cholecystitis.
Define "acalculous cholecystitis"
~10% of Gallbladders with all of the pathologic findings of acute cholecystitis contain no gallstones. This is referred to as ACALCULOUS Cholecystitis - associated mortality is high
Presence of stones within the biliary tree
Acute inflammation of the walls of the bile ducts
Inflammation of the gallbladder
Gall stones in the gallbladder lumen
What are the most common kind of gallstones?
What are the risk factors for cholesterol gall stones?
What is is the most comon manifestation of symptomatic gallstones?
Biliary Colic - pain lasts less than 3 hours
Where does biliary colic pain radiate?
To the right shoulder or scapula
Symptoms characterized by acute onset of right upper quadrant pain, fever and leukocytosis.
As in biliary colic, pain may radiate to right shoulder.
It is an arrest in inspiration during direct palpation of the right upper quadrant
Acute cholecystitis develops because a gallstone (or gallstones) usually obstructs what?
What characterizes the type of gallstone that is more likely to cause acute cholecystsis?
Small gravel like stone
What are potential complications of acute cholecystitis?
Perforation of gallbladder
Cholecystoenteric fistula (fistula formatoin between gallbladder and the intestine
HIDA scan uses technetium labeled hepatic iminodiacetic acid (HIDA) tracer which is injeced intravenously and is then taken up by hepatocytes and excreted in bile. If the cystic duct is patent, the tracer will enter the gallbladder leading to its visualization.
Long standing chronic inflammation (ie chronic cholecystitis) may lead to extensive CALCIFICATION of the gallbladder wall.
Porcelain gallbladders are particularly prone to developing gallbladder cancer (adenocarcinoma)
What is the most common clinical presentation of extra-hepatic cholangiocarcinomas?
One of the most common micro-organisms cultured from bile in the setting of acute cholangitis
Gallstones may serve as a persistent nidus of infection and risk for chronic carriage of this organism.