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Questions and Answers
What is the medical term for gallstone disease?
What is the medical term for gallstone disease?
Which component is NOT found in bile?
Which component is NOT found in bile?
What happens if the balance of bile components is disrupted?
What happens if the balance of bile components is disrupted?
Which condition occurs if a gallstone obstructs the neck of the gallbladder?
Which condition occurs if a gallstone obstructs the neck of the gallbladder?
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What is the most common type of gallstones?
What is the most common type of gallstones?
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What diagnostic method is primarily used to detect gallstones in modern practice?
What diagnostic method is primarily used to detect gallstones in modern practice?
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What can occur if a gallstone blocks the common bile duct?
What can occur if a gallstone blocks the common bile duct?
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In which age group are cholesterol gallstones most commonly found?
In which age group are cholesterol gallstones most commonly found?
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What does ERCP stand for?
What does ERCP stand for?
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What is the primary purpose of injecting dye into the biliary tree during an ERCP?
What is the primary purpose of injecting dye into the biliary tree during an ERCP?
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What condition occurs when a large gallstone erodes through the gallbladder wall into the small intestine?
What condition occurs when a large gallstone erodes through the gallbladder wall into the small intestine?
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What imaging technique can show air in the biliary tree, indicating a possible gallstone ileus?
What imaging technique can show air in the biliary tree, indicating a possible gallstone ileus?
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What is a common complication of a gallstone when it obstructs the common bile duct?
What is a common complication of a gallstone when it obstructs the common bile duct?
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What type of cancer can develop from chronic inflammation of the gallbladder?
What type of cancer can develop from chronic inflammation of the gallbladder?
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Which organism is associated with a carrier state that can increase the risk of gallbladder carcinoma?
Which organism is associated with a carrier state that can increase the risk of gallbladder carcinoma?
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What can cause pancreatitis aside from gallstones?
What can cause pancreatitis aside from gallstones?
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What is typically the result when a gallstone obstructs pancreatic enzyme flow?
What is typically the result when a gallstone obstructs pancreatic enzyme flow?
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What is an essential characteristic that distinguishes air in the biliary tree from normal anatomy?
What is an essential characteristic that distinguishes air in the biliary tree from normal anatomy?
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What type of gallstones are at risk of formation due to extra vascular hemolysis?
What type of gallstones are at risk of formation due to extra vascular hemolysis?
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What is the primary treatment to resolve gallstone disease?
What is the primary treatment to resolve gallstone disease?
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Which clinical feature is a hallmark sign of acute cholecystitis?
Which clinical feature is a hallmark sign of acute cholecystitis?
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What causes brown pigment stones to form in the gallbladder?
What causes brown pigment stones to form in the gallbladder?
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Which of the following symptoms is characteristic of biliary colic?
Which of the following symptoms is characteristic of biliary colic?
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How does ursodeoxycholic acid help in managing gallstones?
How does ursodeoxycholic acid help in managing gallstones?
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What is a common complication of choledocholithiasis?
What is a common complication of choledocholithiasis?
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When a gallstone obstructs the cystic duct, what condition does this lead to?
When a gallstone obstructs the cystic duct, what condition does this lead to?
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Which of the following can lead to an increase in bilirubin levels, resulting in gallstone formation?
Which of the following can lead to an increase in bilirubin levels, resulting in gallstone formation?
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What is a significant finding on ultrasound that suggests acute cholecystitis?
What is a significant finding on ultrasound that suggests acute cholecystitis?
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Which demographic is least likely to present with gallstone symptoms?
Which demographic is least likely to present with gallstone symptoms?
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What usually triggers symptoms of biliary colic?
What usually triggers symptoms of biliary colic?
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What is a significant cause of increased cholesterol levels in bile that can lead to gallstone formation?
What is a significant cause of increased cholesterol levels in bile that can lead to gallstone formation?
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What is the relationship between bilirubin conjugation and liver function in patients with cirrhosis?
What is the relationship between bilirubin conjugation and liver function in patients with cirrhosis?
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What factor related to pregnancy contributes to the risk of cholesterol gallstones?
What factor related to pregnancy contributes to the risk of cholesterol gallstones?
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What happens to the gallbladder during acute cholecystitis as a result of obstruction?
What happens to the gallbladder during acute cholecystitis as a result of obstruction?
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Which condition is associated with an underproduction of bile salts, contributing to the risk of cholesterol gallstones?
Which condition is associated with an underproduction of bile salts, contributing to the risk of cholesterol gallstones?
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Rapid weight loss contributes to gallstone risk because it affects which of the following?
Rapid weight loss contributes to gallstone risk because it affects which of the following?
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What condition increases the risk of gallstones due to inflammation of the ileum?
What condition increases the risk of gallstones due to inflammation of the ileum?
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What role do bile acids play in cholesterol gallstone formation?
What role do bile acids play in cholesterol gallstone formation?
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Which medication class is known to inhibit bile acid synthesis and increase gallstone risk?
Which medication class is known to inhibit bile acid synthesis and increase gallstone risk?
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When unconjugated bilirubin levels rise, what type of gallstones are more likely to form?
When unconjugated bilirubin levels rise, what type of gallstones are more likely to form?
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Which of the following results in decreased absorption of bile salts and increases gallstone risk?
Which of the following results in decreased absorption of bile salts and increases gallstone risk?
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What is the primary composition of pigment stones?
What is the primary composition of pigment stones?
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Why are cholesterol gallstones termed 'radiolucent'?
Why are cholesterol gallstones termed 'radiolucent'?
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What lifestyle factor increases the risk of gallstones by leading to obesity?
What lifestyle factor increases the risk of gallstones by leading to obesity?
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Why might a person taking bile acid resins be at risk for developing gallstones?
Why might a person taking bile acid resins be at risk for developing gallstones?
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What symptom occurs when a gallstone blocks the common bile duct?
What symptom occurs when a gallstone blocks the common bile duct?
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What is the risk associated with chronic cholecystitis?
What is the risk associated with chronic cholecystitis?
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What finding is characteristic of a porcelain gallbladder?
What finding is characteristic of a porcelain gallbladder?
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What typically causes acalculous cholecystitis?
What typically causes acalculous cholecystitis?
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Which of the following pathogens is primarily responsible for AIDS cholangiopathy?
Which of the following pathogens is primarily responsible for AIDS cholangiopathy?
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What classic symptom triad is associated with ascending cholangitis?
What classic symptom triad is associated with ascending cholangitis?
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What laboratory finding is characteristic of cholestasis in ascending cholangitis?
What laboratory finding is characteristic of cholestasis in ascending cholangitis?
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What condition might show elevated eosinophil levels as part of its diagnosis?
What condition might show elevated eosinophil levels as part of its diagnosis?
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Which procedure is commonly used to drain the biliary tree in cases of cholangitis?
Which procedure is commonly used to drain the biliary tree in cases of cholangitis?
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What is a common cause for thickening of the gallbladder wall observable via imaging?
What is a common cause for thickening of the gallbladder wall observable via imaging?
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Which of the following antibiotic combinations is appropriate for treating ascending cholangitis?
Which of the following antibiotic combinations is appropriate for treating ascending cholangitis?
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What might happen if a gallstone migrates into the cystic duct?
What might happen if a gallstone migrates into the cystic duct?
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What condition is commonly seen in critically ill patients with no gallstones visible but evidence of cholecystitis?
What condition is commonly seen in critically ill patients with no gallstones visible but evidence of cholecystitis?
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What can cause biliary sludge in the gallbladder?
What can cause biliary sludge in the gallbladder?
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The medical name for gallstone disease is ______.
The medical name for gallstone disease is ______.
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Bile contains bilirubin, bile salts, and ______.
Bile contains bilirubin, bile salts, and ______.
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If the gallstone obstructs the neck of the gallbladder, this condition is called ______.
If the gallstone obstructs the neck of the gallbladder, this condition is called ______.
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Cholesterol gallstones are usually not visible on x-ray and are referred to as ______.
Cholesterol gallstones are usually not visible on x-ray and are referred to as ______.
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The primary method used to diagnose gallstone disease in the modern era is ______.
The primary method used to diagnose gallstone disease in the modern era is ______.
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Gallstones made up of cholesterol commonly occur in people in their ______.
Gallstones made up of cholesterol commonly occur in people in their ______.
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When a gallstone obstructs pancreatic juice flow, it can lead to acute ______.
When a gallstone obstructs pancreatic juice flow, it can lead to acute ______.
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If a gallstone is very large and enters the intestines, it can cause intestinal ______.
If a gallstone is very large and enters the intestines, it can cause intestinal ______.
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When bile can't flow through the common bile duct, it allows bacteria to ascend and infect the ______.
When bile can't flow through the common bile duct, it allows bacteria to ascend and infect the ______.
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If a gallstone gets stuck in the cystic duct, it can cause acute ______.
If a gallstone gets stuck in the cystic duct, it can cause acute ______.
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Chronic cholecystitis may result in calcium deposition, leading to a finding known as ______ gallbladder.
Chronic cholecystitis may result in calcium deposition, leading to a finding known as ______ gallbladder.
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The presence of biliary sludge may be seen in cases of ______ cholecystitis.
The presence of biliary sludge may be seen in cases of ______ cholecystitis.
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AIDS cholangiopathy is a rare complication of end-stage ______ infection.
AIDS cholangiopathy is a rare complication of end-stage ______ infection.
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The classic presentation of ascending cholangitis includes fever, abdominal pain, and ______.
The classic presentation of ascending cholangitis includes fever, abdominal pain, and ______.
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In the case of ascending cholangitis, confusion and hypotension indicate the development of ______ from the infection.
In the case of ascending cholangitis, confusion and hypotension indicate the development of ______ from the infection.
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Lab values in ascending cholangitis often include a high white count and elevated ______ levels.
Lab values in ascending cholangitis often include a high white count and elevated ______ levels.
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A rare cause of cholangitis is the helminth ______ sinensis, known as the Chinese liver fluke.
A rare cause of cholangitis is the helminth ______ sinensis, known as the Chinese liver fluke.
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Antibiotics for cholangitis treatment need to cover gram negatives and ______.
Antibiotics for cholangitis treatment need to cover gram negatives and ______.
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Patients with AIDS cholangiopathy often present with right upper quadrant ______ due to biliary strictures.
Patients with AIDS cholangiopathy often present with right upper quadrant ______ due to biliary strictures.
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The flow of ______ is crucial for preventing bacterial migration up the biliary tree.
The flow of ______ is crucial for preventing bacterial migration up the biliary tree.
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Murphy sign can be indicative of ______ but may not involve gallstones in acalculous cases.
Murphy sign can be indicative of ______ but may not involve gallstones in acalculous cases.
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An elderly patient presenting with symptoms of gallstones could have a rare gallbladder ______.
An elderly patient presenting with symptoms of gallstones could have a rare gallbladder ______.
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Cholesterol gallstones are more likely to occur if you have increased levels of ______.
Cholesterol gallstones are more likely to occur if you have increased levels of ______.
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With ascending cholangitis, lab results typically show an increase in both conjugated and total ______.
With ascending cholangitis, lab results typically show an increase in both conjugated and total ______.
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Bile acids and bile salts keep cholesterol ______ in the bile.
Bile acids and bile salts keep cholesterol ______ in the bile.
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Pregnancy is associated with increased levels of ______, which promotes cholesterol synthesis.
Pregnancy is associated with increased levels of ______, which promotes cholesterol synthesis.
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Obesity leads to increased total body cholesterol stores, putting individuals at risk for ______.
Obesity leads to increased total body cholesterol stores, putting individuals at risk for ______.
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Patients with ______ disease cannot reabsorb bile salts properly and are at higher risk for gallstones.
Patients with ______ disease cannot reabsorb bile salts properly and are at higher risk for gallstones.
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Cirrhosis can lead to decreased synthesis of bile salts, contributing to ______ gallstones.
Cirrhosis can lead to decreased synthesis of bile salts, contributing to ______ gallstones.
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Pigment stones are also known as ______ stones because they originate from excess bilirubin.
Pigment stones are also known as ______ stones because they originate from excess bilirubin.
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Patients who experience fat malabsorption may lose more bile acids in their ______.
Patients who experience fat malabsorption may lose more bile acids in their ______.
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The primary class of medication that inhibits bile acid synthesis and increases gallstone risk is ______ drugs.
The primary class of medication that inhibits bile acid synthesis and increases gallstone risk is ______ drugs.
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The liver produces bile salts, but about ______% of them are reabsorbed in the terminal ileum.
The liver produces bile salts, but about ______% of them are reabsorbed in the terminal ileum.
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A significant cause of increased cholesterol levels in bile is ______, which can lead to stone formation.
A significant cause of increased cholesterol levels in bile is ______, which can lead to stone formation.
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Estrogen promotes cholesterol synthesis and is one reason ______ are at greater risk for cholesterol gallstones.
Estrogen promotes cholesterol synthesis and is one reason ______ are at greater risk for cholesterol gallstones.
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Cholesterol gallstones are termed 'radiolucent' because they are not ______ on x-ray.
Cholesterol gallstones are termed 'radiolucent' because they are not ______ on x-ray.
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ERCP involves using an endoscope to inject dye into the ______ tree.
ERCP involves using an endoscope to inject dye into the ______ tree.
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A large gallstone creating a connection between the gallbladder and the small intestine is known as ______ ileus.
A large gallstone creating a connection between the gallbladder and the small intestine is known as ______ ileus.
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When a gallstone blocks the common bile duct, it can lead to ______.
When a gallstone blocks the common bile duct, it can lead to ______.
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Chronic inflammation of the gallbladder can result in ______ carcinoma.
Chronic inflammation of the gallbladder can result in ______ carcinoma.
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Air in the biliary tree typically indicates the presence of a ______ in its wall.
Air in the biliary tree typically indicates the presence of a ______ in its wall.
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ERCP utilizes a combination of endoscopy and ______.
ERCP utilizes a combination of endoscopy and ______.
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The classical finding on imaging for gallstone ileus is the presence of ______ in the biliary tree.
The classical finding on imaging for gallstone ileus is the presence of ______ in the biliary tree.
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Salmonella typhi can remain in the gallbladder in a ______ state.
Salmonella typhi can remain in the gallbladder in a ______ state.
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During ERCP, a ______ is inserted through the mouth into the duodenum.
During ERCP, a ______ is inserted through the mouth into the duodenum.
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Gallstones can lead to complications such as ______ obstruction if they are large enough.
Gallstones can lead to complications such as ______ obstruction if they are large enough.
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Patients with extra vascular hemolysis are at risk for these types of gallstones due to excess ______.
Patients with extra vascular hemolysis are at risk for these types of gallstones due to excess ______.
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The mainstay treatment for gallstone disease is surgical removal of the ______.
The mainstay treatment for gallstone disease is surgical removal of the ______.
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Biliary colic is characterized by episodic pain that classically radiates to the right ______.
Biliary colic is characterized by episodic pain that classically radiates to the right ______.
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Acute cholecystitis occurs when a stone obstructs the ______ duct.
Acute cholecystitis occurs when a stone obstructs the ______ duct.
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Patients with gallstones may be asymptomatic and often discover them incidentally during ______.
Patients with gallstones may be asymptomatic and often discover them incidentally during ______.
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Brown pigment stones tend to have more ______ compared to black stones.
Brown pigment stones tend to have more ______ compared to black stones.
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The structural formula of the bile acid used in gallstone therapy is ______.
The structural formula of the bile acid used in gallstone therapy is ______.
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A classic sign of acute cholecystitis is a positive ______ sign.
A classic sign of acute cholecystitis is a positive ______ sign.
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Cholecystitis can result from a stone blocking the ______ outflow of bile.
Cholecystitis can result from a stone blocking the ______ outflow of bile.
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Unconjugated bilirubin is less soluble and tends to ______ out, forming gallstones.
Unconjugated bilirubin is less soluble and tends to ______ out, forming gallstones.
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Patients suffering from ______ may have impaired liver function affecting bilirubin conjugation.
Patients suffering from ______ may have impaired liver function affecting bilirubin conjugation.
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A gallstone that migrates into the common bile duct can result in symptoms such as ______.
A gallstone that migrates into the common bile duct can result in symptoms such as ______.
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Gallstones can lead to a serious condition called ______ when inflammation occurs.
Gallstones can lead to a serious condition called ______ when inflammation occurs.
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One of the enzymes produced by bacteria that can convert conjugated bilirubin back into its unconjugated form is called ______.
One of the enzymes produced by bacteria that can convert conjugated bilirubin back into its unconjugated form is called ______.
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Symptoms of gallstone disease can include right upper quadrant pain and ______ associated with inflammation.
Symptoms of gallstone disease can include right upper quadrant pain and ______ associated with inflammation.
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Study Notes
Gallstone Disease: Overview
- Cholelithiasis: Medical term for gallstone disease.
- Bile Composition: Bile contains bilirubin (heme breakdown product), bile salts (fat absorption), and cholesterol (body's cholesterol elimination). A delicate balance is crucial to prevent precipitation.
- Gallstone Formation: Imbalance in bile components leads to solid substance precipitation, accumulation, and stone formation.
- Biliary Tree Anatomy: Bile forms in the liver, gets concentrated in the gallbladder, and is released into the duodenum when eating. Gallstones can obstruct bile flow.
Types of Gallstones
- Cholesterol Gallstones: Most common type, often not visible on X-ray (radiolucent), diagnosed with ultrasound.
-
Risk Factors (Cholesterol Gallstones):
- Age: 40s most common, rare in children/elderly; elderly patient with symptoms warrants cancer consideration.
- Increased Cholesterol: Excess estrogen (women, pregnancy), obesity, rapid weight loss.
- Decreased Bile Salts: Liver underproduction, poor absorption (terminal ileum issues like Crohn's disease, cystic fibrosis), certain medications (clofibrate, bile acid resins).
-
Pigment Gallstones (Bilirubin Stones): Contain excess bilirubin, composed of calcium bilirubinate, visible on X-ray (radiopaque), black/brown color.
- Risk Factors: Increased unconjugated bilirubin (hemolysis, cirrhosis, biliary infections, bacterial glucuronidase).
Clinical Syndromes
- Asymptomatic Gallstones: Often discovered incidentally.
- Biliary Colic: Episodic RUQ pain radiating to right shoulder blade, usually after eating a fatty meal (gallbladder contract against a stone).
-
Acute Cholecystitis: Inflammation of the gallbladder due to cystic duct obstruction by a stone, resulting in localized pain, fever, and elevated white blood cell count.
- Murphy's Sign: Sharp pain on deep breath during RUQ palpation.
- Choledocholithiasis: Gallstone in the common bile duct, obstructing bile flow, leading to jaundice, elevated Alk Phos (more than AST/ALT), potentially cholangitis.
- Chronic Cholecystitis: Untreated acute cholecystitis, with chronic inflammation and calcium deposition (porcelain gallbladder), high risk of gallbladder cancer.
- Acalculous Cholecystitis: Acute cholecystitis without gallstones, due to gallbladder ischemia/bile stasis (critically ill patients). Characterized by biliary sludge.
- AIDS Cholangiopathy: Rare complication of end-stage HIV infection (low CD4 count), chronic infection (cryptosporidium, CMV), biliary tree strictures.
- Ascending Cholangitis: Bacterial infection of the biliary tree from blocked bile flow and ascending bacteria from GI tract, includes fever, abdominal pain, jaundice (Charcot's triad). Sepsis and shock (Reynolds pentad). Gram-negative bacteria, rarely Clonorchis sinensis.
- Gallstone Ileus: Large gallstone erodes through gallbladder wall into small intestine. Presents with bowel obstruction and air in biliary tree on imaging.
Treatments
- Cholecystectomy: Surgical gallbladder removal, the mainstay treatment for most gallstone-related problems.
- Ursodeoxycholic Acid (UDCA): Bile acid, used sometimes medically as a therapy for cholesterol stones (but not pigment stones), less effective, used in patients who decline surgery.
- ERCP Endoscopic retrograde cholangiopancreatography, uses endoscope with camera to look at biliary tree and treat obstructions such as gallstones or strictures. Allows for stone extraction or stent placement.
Additional Disorders
- Acute Pancreatitis: Gallstones obstructing pancreatic ducts can trigger pancreatitis.
- Gallbladder Carcinoma: Rare malignancy of the gallbladder, often associated with chronic cholecystitis (porcelain gallbladder or chronic salmonella infection).
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Description
Explore the essentials of gallstone disease including causes, types, and the anatomy of the biliary tree. Understand the formation of cholesterol gallstones and the risk factors associated with their development. Perfect for students and health professionals looking to deepen their knowledge on this topic.
