Gall Bladder Diseases Flashcards
(58 cards)
What is cholelithiasis?
Presence of gallstones in the gallbladder.
What is choledocholithiasis?
Presence of gallstones within the biliary tract.
What are the two major types of gallstones?
Cholesterol stones (80%) and Pigment stones (20%).
What is the composition of cholesterol stones?
80% cholesterol monohydrate, calcium salt, bile pigment, fatty acid & protein.
What is the composition of black pigment stones?
Calcium bilirubinate. Associated with hemolysis, cirrhosis & alcoholism.
What is the composition of brown pigment stones?
Calcium bilirubinate & calcium palmitate. Usually seen in Asians and associated with bacterial infection, parasitic infections & biliary tract stasis.
List 5 risk factors for cholesterol gallstone formation.
Fat, Forty, Fertile, Female, Fair (Caucasian), Genetic factors, Gall bladder stasis, Rapid weight loss.
Describe the pathophysiology of cholesterol gallstone formation.
- Liver cells secrete cholesterol into bile along with phospholipid. 2. Bile salt in bile dissolves cholesterol vesicle in the gall bladder. 3. When cholesterol is in excess or bile salt/acid is deficient, the unilamellar vesicle of cholesterol is not dissolved properly. 4. When bile is supersaturated with cholesterol & cholesterol monohydrate, crystals form.
What is the pathophysiology of pigment gallstone formation?
- Bilirubin is usually in conjugated form in bile. - Unconjugated bilirubin tends to form insoluble precipitate with calcium. - In situations of high heme turnover (e.g., hemolysis or cirrhosis), there is an increase in unconjugated bilirubin.
How does bacteria contribute to brown pigment stone formation?
- Presence of bacteria in bile hydrolyzes conjugated bilirubin to unconjugated bilirubin, leading to an increase in calcium bilirubinate crystal. - Bacteria also hydrolyzes lecithin (phospholipid) to replace fatty acid, allowing palmitic acid to fatty acid that combines with calcium ion to form calcium palmitate.
What percentage of patients with gallstones are asymptomatic?
80% are asymptomatic.
What is the mnemonic for clinical presentation of symptomatic cholelithiasis? List all symptoms.
BILIARY: Bloating, Indigestion (especially after fatty meals), Localized pain (RUQ or epigastric), Intermittent colicky pain, Associated nausea/vomiting, Radiating pain (to right shoulder or back), Yellowish tinge (if complicated by cholestasis).
What are the clinical presentations of choledocholithiasis?
Jaundice, PFD (Pale Feces & Dark urine), Pruritus & Pain (RUQ pain), Fever.
What sign is used to differentiate cholelithiasis from cholecystitis?
Murphyโs sign is used to differentiate cholelithiasis from cholecystitis. Positive Murphyโs sign (inspiratory arrest on deep palpation of RUQ) is highly suggestive of cholecystitis.
What are the complications of gallstones?
- Acute cholecystitis - Acute cholangitis - Acute pancreatitis - Gall stone ileus - Cancer of the gall bladder - Choledochocholangiocarcinoma - Acute ulcer disease - Appendicitis
List the investigations for gallstone disease.
- FBC - Prothrombin time - CA19-9 - LFT - Plain abdominal X-ray - Hepatobiliary ultrasound - Endoscopic ultrasound - CT scan - MRI - Endoscopic retrograde cholangiopancreatography - Percutaneous transhepatic cholangiography
What are the treatment options for gallstones?
- Cholecystectomy (laparoscopic, laparotomy) - Common bile duct stone is treated with endoscopic papillotomy & stone extraction with laparoscopic cholecystectomy - Antibiotics (ciprofloxacin, 500mg IV every 12 hours)
What is cholecystitis?
Inflammation of the gallbladder.
What are the two types of acute cholecystitis?
Calculous (due to obstruction by gallstones) and Acalculous (due to ischemia, infection or stasis with no gallstones).
What percentage of acute cholecystitis cases are acalculous?
5-10% of acute cholecystitis cases.
What are the three types of inflammatory response in cholecystitis?
(i) Mechanical inflammation (ii) Chemical inflammation (iii) Bacterial inflammation (80-85%) โ E. coli, Klebsiella, Strep, Clostridium.
What are common causes of acalculous cholecystitis?
Ischemia, infections or stasis. Common in critically ill patients (trauma, burns), after surgery, prolonged fasting, and DM patients.
What is the pathophysiology of acute cholecystitis?
Obstruction โ Gall bladder distension โ Block blood flow & lymphatic compromise โ Mucosal ischemia โ Necrosis. Mucosal damage leads to phospholipase release & conversion to lysolecithin (toxin) โ Edema of gall bladder โ Ischemia โ Gangrene โ Perforation.
What is chronic cholecystitis?
Chronic inflammation of gallbladder, almost always associated with gallstones. Results from repeated episodes of sub-acute or acute cholecystitis or persistent mechanical irritation.
