Gallstones and Their Incidence

What is the role of pronucleating factors in gallstone formation?

Supply mucoprotein to paste the stones together
Stabilize cholesterol-laden phospholipid vesicles (correct)
Destabilize cholesterol-laden phospholipid vesicles
Provide nidi for crystallization of cholesterol

What is the composition of pigment stones?

White to light brown, 5-10 mm in diameter, and crystalline
Yellow to golden, 3-6 mm in diameter, and irregular
Black to dark brown, 2-5 mm in diameter, and amorphous (correct)
Red to pink, less than 1 mm in diameter, and smooth

Why do gallstones form almost exclusively in the gallbladder?

The gallbladder provides nidi for crystallization of cholesterol
The composition of hepatic bile is abnormal
The gallbladder supplies mucoprotein to paste the stones together
The gallbladder concentrates the bile (correct)

What is the effect of specific bile proteins on cholesterol crystal formation?

Stabilize cholesterol-laden phospholipid vesicles (B) Signup and view all the answers

What is the role of antinucleating factors in gallstone formation?

Glycoprotein, apolipoprotein, cytokeratin (A) Signup and view all the answers

What percentage of common duct stones are cholesterol stones?

60% (D) Signup and view all the answers

Which type of common duct stones is associated with more severe clinical manifestations?

Pigment stones (C) Signup and view all the answers

How many patients with choledocholithiasis may remain asymptomatic?

50% (B) Signup and view all the answers

What percentage of patients with gallbladder stones will have common duct stones?

15% (C) Signup and view all the answers

What might develop in patients with biliary tumors?

Truly huge ducts (A) Signup and view all the answers

What is the prognosis for death rate from gallstone ileus?

20% (A) Signup and view all the answers

What is the percentage of patients requiring interval cholecystectomy?

30% (D) Signup and view all the answers

What is the origin of most common duct stones?

Gallbladder (B) Signup and view all the answers

What is the percentage of patients with stones in the gallbladder harboring calculi within the bile ducts?

15% (C) Signup and view all the answers

What is the percentage of cases where the gallbladder is empty but there are duct stones?

5% (A) Signup and view all the answers

What is the primary composition of pigment gallstones?

Dense mixtures of bacteria and bacterial glycocalyx (A) Signup and view all the answers

Which factor is NOT listed as a predisposing factor for pigment gallstones?

Obesity (D) Signup and view all the answers

What is the radiopacity percentage of pigment gallstones?

50% (A) Signup and view all the answers

What role do bacteria likely play in the formation of pigment gallstones?

Converting soluble bilirubin to insoluble unconjugated bilirubin (B) Signup and view all the answers

Which ethnic group is mentioned as having a lower incidence of pigment stones?

American Indians (B) Signup and view all the answers

What is the primary composition of pigment stones?

Bacteria and bacterial glycocalyx (A) Signup and view all the answers

What role do bacteria play in the formation of pigment gallstones?

They deconjugate the soluble bilirubindiglucuronide into insoluble unconjugated bilirubin (A) Signup and view all the answers

What is a common predisposing factor for pigment gallstones?

Chronic hemolysis (C) Signup and view all the answers

What is the radiopacity percentage of pigment stones in the United States?

50% (A) Signup and view all the answers

What is the probable cause of sepsis being more common in patients with pigment gallstone disease than in those with cholesterol gallstone disease?

Increased bacterial βglucuronidase activity (B) Signup and view all the answers

What is the composition of the majority of gallstones in patients?

Cholesterol stones (C) Signup and view all the answers

How do cholesterol gallstones form in the body?

By precipitation of cholesterol from bile supersaturated with cholesterol (D) Signup and view all the answers

Where do the stones in cholesterol gallstone disease typically form?

Exclusively within the gallbladder (D) Signup and view all the answers

Which population group has the highest incidence of cholesterol gallstone disease?

American Indians (A) Signup and view all the answers

How does hormonal effect relate to the incidence of gallstones?

Increased estrogen levels are associated with greater cholesterol saturation of bile and increased incidence of gallstones (B) Signup and view all the answers

Which of the following is a common symptom of acute cholecystitis?

Right upper quadrant pain (D) Signup and view all the answers

What is a characteristic finding in sonographic imaging of acute cholecystitis?

Gallbladder distension (B) Signup and view all the answers

What is the primary cause of acute cholecystitis in 80% of cases?

Gallstone obstruction in the cystic duct (D) Signup and view all the answers

What is a common indicator of acute cholecystitis in laboratory tests?

Leukocytosis (D) Signup and view all the answers

What is a possible finding in a nonopacified gallbladder on radionuclide excretion scan?

Gallbladder shrinkage (D) Signup and view all the answers

What is a potential physical examination finding in acute cholecystitis?

Palpable gallbladder (D) Signup and view all the answers

In acute cholecystitis, what contributes to the creation of abdominal pain and tenderness?

Gallbladder inflammation and distention (D) Signup and view all the answers

What is a characteristic feature of the Sonographic Murphy sign in acute cholecystitis?