Gallstones and Biliary Dz: Mechanical Cholestasis

Question 1

IfWhat is the function of bile acids in bile?

Answer 1

solubilization of cholesterol

Question 2

funcitno of phospholipid in bile

Answer 2

solubilization of cholesterol

Question 3

what do Ig A and M do in bile

Answer 3

bacteriostasis

Question 4

what do cholesterol stones look like

Answer 4

yellow white soft

Question 5

what are bloack stones

Answer 5

hemolysis

Question 6

what are brown stones?

Answer 6

bile duct surgery with bacteria

Question 7

what are risk factors for gall stones?

Answer 7

age (decreased num of enzymes)
obesity
estrogen

Question 8

what is the classic patient with gall stones

Answer 8

obese older woman

Question 9

Explain the enterohepatic circulation in general of bile

Answer 9

made in liver, stored and concentrated in gall bladder between meals, bile salts aid dispersion digestion and absorption of fat in small intestin, in ileum they are reabsorbed into portal venous blood to return to liver

Question 10

what are the three general pathophysiologic mechanisms of cholesterol tone formatino

Answer 10

cholesterol supersaturation
accelerated nucleation
gallbladder hypomotility

Question 11

What are various causes of cholesterol hypersecretion

Answer 11

obesity (hyperlipoproteinemia) progesterone etrogesn increased cholesterol synthesis (incrased hmgcoareductase) incease cholesterol free of stores, increased cholesterol uptake in diet

Question 12

what impt enzyme decreases with age in the cholesterol hypersecretion pathogenesis

Answer 12

decreased 7alfahydroxylase

Question 13

does a drastic weight gain predispose you to gall stones?

Answer 13

yes, because of mobilization of tissue cholesterol

Question 14

Is bile normally supersaturated with cholesterol

Answer 14

yes, which is why increased beyond physiologic levels is baaaad

Question 15

what are pigment gallstones

Answer 15

black stones from hemolysis advancing age, long term tpn??, cirrhosis

Question 16

what are clinical risk factors for black pigment gallstone dz

Answer 16

gallbladder stasis crohns dz increased bili secretion, decreased bili solubilizers

Question 17

what are brown stones

Answer 17

bacterial infxn stones from decreased biliary secretory IgA, also due to high activity of b-glucuronidase

Question 18

What populations ahve higher incidence of cholelithiasis?

Answer 18

latin american countries, asian countries

Question 19

what are clinical manifestations of gallstones?

Answer 19

biliary colic, abdominal pain, acute cholecystitis (abd pain , fever)
choledocholithiasis with cholangitis: abdominal pain fever juanidce
biliary pancreatitis: abd pain, increased amylase