Gallbladder/Biliary Tract Disorders

Question 1

Hormone responsible for release of bile into duodenum

Answer 1

CCK

Question 2

Which duct temporarily stores bile in the gallbladder?

Answer 2

cystic duct

Question 3

formation of gallstones (choleliths) which are solid concretions of varying quantities of cholesterol, ca+, and bilirubin which usually form in the GB

Answer 3

cholelithiasis

Question 4

What leads to the formation of cholesterol stones?

Answer 4

Supersaturation of bile with cholesterol and GB hypomotility

Question 5

How do you differentiate between polyp and gallstone on ultrasound?

Answer 5

stone will cast a shadow whereas a polyp will not

Question 6

Treatment for symptomatic cholelithiasis

Answer 6

cholecystectomy

Question 7

stone erodes through GB wall and develops a cholecystoenteric fistula leading to obstruction of narrowest segment of bowel

Answer 7

gallstone ileus

Question 8

Known protective factor for gallstones

Answer 8

statins

Question 9

The presence of gallstones within the CBD. LFT’s (ALT, AST) are elevated, bilirubin and alk phos may be elevated

Answer 9

choledocholithiasis

Question 10

Treatment recommendation of choledolithiasis to prevent acute cholangitis, acute pancreatitis, and hepatic abscesses

Answer 10

removal of all bile duct stones

Question 11

Gold standard for diagnosis of CBD stones, and sphincter of Oddi dysfunction

Answer 11

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Question 12

Detects choledocholithiasis, neoplasms, strictures, biliary dilations. Minimally invansive, but cannot sample bile, test cytology, remove stone

Answer 12

Magnetic resonance cholangiopancreatography (MRCP)

Question 13

A syndrome of RUQ pain that may radiate to right shoulder, fever, and leukocytosis associated with gallbladder inflammation usually caused by cystic duct obstruction. often occurs after fatty meal

Answer 13

acute cholecystitis

Question 14

main cause of acute cholecystitis

Answer 14

impacted gallstone

Question 15

Physical exam manuever that is useful for differentiating pain in the right upper quadrant. positive in cholecystitis, but negative in choledocholithiasis

Answer 15

Murphy’s sign

Question 16

The imaging modality of choice for the gallbladder. fast, real-time, non-invasive, and does not utilize ionizing radiation

Answer 16

abdominal ultrasound

Question 17

What does slow uptake of HIDA indicate?

Answer 17

hepatic parenchymal disease

Question 18

What does filling of GB/CBD w/delayed or absent filling of intestine with HIDA indicate?

Answer 18

obstruction of ampulla

Question 19

What does non-visualization of GB w/ filling of the CBD and duodenum with HIDA indicate?

Answer 19

cystic duct obstruction and acute cholecystitis

Question 20

Describe a normal HIDA scan

Answer 20

Early filling of the GB at 15 minutes and complete filling by 25 minutes

Question 21

Preferred treatment for acute cholecystitis

Answer 21

laproscopic cholecystectomy

Question 22

A rare form of acute cholecystitis, which occurs when air appears in the GB wall 2ndry to infection w/ gas forming anerobes. Associated with DM

Answer 22

emphysematous cholecystitis

Question 23

Gender differences between emphysematous cholecystitis and acute cholecystitis

Answer 23

Men are affected twice as commonly as women in emphysematous cholecystitis, where as the reverse is true in most cases of acute cholecystitis

Question 24

RUQ pain that comes and goes, may be referred to right shoulder or right scapula, subsides in 30 minutes. Usually precipitated by a fatty meal. N/V but no fever and WBC normal

Answer 24

chronic cholecystitis

Question 25

Extensive calcium encrustation of the gallbladder wall and blue appearance of gallbladder. common manifestation of chronic cholecystitis

Answer 25

porcelain gallbladder

Question 26

Cancer associated with porcelain gallbladder

Answer 26

adenocarcinoma

Question 27

Primarily cause of acute cholangitis

Answer 27

bacterial infection

Question 28

Most important presdisposing factor for acute cholangitis

Answer 28

biliary obstruction and stasis secondary to biliary calculi (CBD stone) or benign stricture

Question 29

What are the components of Charcot's triad?

Answer 29

RUQ pain, jaundice, and fever/chills

Question 30

life threatening sepsis this is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture

Answer 30

septic cholangitis

Question 31

A chronic inflammatory cholestatic disease. Progressive destruction of bile ducts may progress to cirrhosis, end-stage liver disease. Closely associated with ulcerative colitis. Increased risk of cholangiocarcinoma, gallbladder CA, colon CA and hepatocellular carcinoma

Answer 31

sclerosing cholangtitis

Question 32

How is diagnosis of sclerosing cholangitis made in addition to ANCA?

Answer 32

characteristic multifocal stricturing and dilation of intrahepatic and/or extrahepatic bile ducts on ERCP

Question 33

Treatment for sclerosing cholangitis

Answer 33

Balloon dilation or stenting. Only liver transplant has shown improved survival

Question 34

Slowly progressive autoimmune liver disease. 90% females. Portal inflammation and autoimmune destruction of intrahepatic bile ducts. Leads to cirrhosis and liver failure

Answer 34

primary biliary cirrhosis (PBC)

Question 35

Antibody test that is positive in 90-95% of primary biliary cirrhosis (PBC)

Answer 35

antimitochondrial antibody (AMA)

Question 36

Treatment for primary biliary cirrhosis (PBC) that reduces risk of liver transplantation and death over 4 years, reduces bilirubin, LFT’s, cholesterol and IgM. Delays fibrosis and varices

Answer 36

UDCA (ursodiol)

Question 37

Usually first sign of carcinoma of the biliary tract (Cholangiocarcinoma)

Answer 37

progressive jaundice

Question 38

Prognosis for cholangiocarcinoma

Answer 38

For non-resectable cases, the 5-year survival rate is 0%. Overall median duration of survival is less than 6 months

Question 39

Cancer with High incidence in S America (Chile) maybe due to high prevalence of gallstones and/or salmonella infection

Answer 39

gallbladder cancer

Question 40

Most common histology of gallbladder cancer

Answer 40

adenocarcinoma

Question 41

formed by the union of the pancreatic duct and the common bile duct. specifically located at the major duodenal papilla

Answer 41

ampulla of Vater

Question 42

Where does cancer of the intestinal mucosa most commonly occur (when it does occur)?

Answer 42

ampulla of Vater

Question 43

considered the standard approach for ampullary cancer

Answer 43

Whipple operations

Question 44

Bound to albumin because insoluble in water. Transported into hepatocyte & conjugated

Answer 44

unconjugated bilirubin

Question 45

The most common hereditary cause of increased bilirubin. Produces an elevated level of unconjugated bilirubin in the bloodstream. Caused by a 70-80% reduction in the glucuronidation activity of the UGT1A1 enzyme

Answer 45

Gilbert's syndrome

Question 46

Bilirubin lab results for Gilbert's syndrome

Answer 46

elevated unconjugated bilirubin (indirect) bilirubin, while conjugated (direct) bilirubin is usually WNL