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Questions and Answers
What is the capacity of the gallbladder?
What is the capacity of the gallbladder?
25-30 ml
What is the primary function of bile salts and phospholipids?
What is the primary function of bile salts and phospholipids?
They digest and absorb lipids.
Name the hormone that stimulates gallbladder contraction and bile secretion into the duodenum.
Name the hormone that stimulates gallbladder contraction and bile secretion into the duodenum.
Cholecystokinin (CCK)
What is the percentage of bile salts that are reabsorbed in the terminal ileum?
What is the percentage of bile salts that are reabsorbed in the terminal ileum?
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What is the name of the dilation in the second part of the duodenum where the common bile duct and major pancreatic duct meet?
What is the name of the dilation in the second part of the duodenum where the common bile duct and major pancreatic duct meet?
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What is the term for the surgical removal of the gallbladder?
What is the term for the surgical removal of the gallbladder?
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What three structures make up the portal triad?
What three structures make up the portal triad?
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Which of the following are the five F's commonly associated with an increased risk of developing gallstones? (Select all that apply)
Which of the following are the five F's commonly associated with an increased risk of developing gallstones? (Select all that apply)
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What is the normal range for bile salts to cholesterol ratio?
What is the normal range for bile salts to cholesterol ratio?
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What is the name of the condition where a stone blocks the bile duct, causing a backflow of bile?
What is the name of the condition where a stone blocks the bile duct, causing a backflow of bile?
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What is the name of the syndrome where a gallstone is lodged in the cystic duct and compresses the common hepatic duct, causing jaundice?
What is the name of the syndrome where a gallstone is lodged in the cystic duct and compresses the common hepatic duct, causing jaundice?
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What are the three components of Charcot's triad, which are associated with cholangitis?
What are the three components of Charcot's triad, which are associated with cholangitis?
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Which of the following are among the possible causes of acute pancreatitis?
Which of the following are among the possible causes of acute pancreatitis?
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What is the name of the condition where a gallstone passes through the gallbladder and into the common bile duct?
What is the name of the condition where a gallstone passes through the gallbladder and into the common bile duct?
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What is the name of the condition where a gallstone perforates the gallbladder, leading to inflammation and infection?
What is the name of the condition where a gallstone perforates the gallbladder, leading to inflammation and infection?
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Inflammation of the gallbladder is usually caused by sterile bile.
Inflammation of the gallbladder is usually caused by sterile bile.
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E. coli is the most common bacterium found in cases of acute cholecystitis.
E. coli is the most common bacterium found in cases of acute cholecystitis.
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What is the term for the accumulation of mucus in the gallbladder, often associated with inflammation due to gallstones?
What is the term for the accumulation of mucus in the gallbladder, often associated with inflammation due to gallstones?
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What is the name of the condition that can occur when a gallstone obstructs the gallbladder's outlet, causing a buildup of pressure, ischemia, and eventually gangrene?
What is the name of the condition that can occur when a gallstone obstructs the gallbladder's outlet, causing a buildup of pressure, ischemia, and eventually gangrene?
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Acalcular acute cholecystitis typically occurs in individuals who are already in good health.
Acalcular acute cholecystitis typically occurs in individuals who are already in good health.
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What is the name of the condition where small gallstones pass from the gallbladder into the common bile duct, potentially causing obstructive jaundice or cholangitis?
What is the name of the condition where small gallstones pass from the gallbladder into the common bile duct, potentially causing obstructive jaundice or cholangitis?
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Small gallstones are less likely to cause problems than larger gallstones.
Small gallstones are less likely to cause problems than larger gallstones.
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What is the term for a buildup of bile in the gallbladder, which can contribute to the formation of gallstones?
What is the term for a buildup of bile in the gallbladder, which can contribute to the formation of gallstones?
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What is the name of the condition where the gallbladder wall becomes calcified due to chronic inflammation, often as a result of recurrent gallstone attacks?
What is the name of the condition where the gallbladder wall becomes calcified due to chronic inflammation, often as a result of recurrent gallstone attacks?
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What is the term for a complication that can occur after gallbladder removal, specifically a narrowing or blockage of the bile duct?
What is the term for a complication that can occur after gallbladder removal, specifically a narrowing or blockage of the bile duct?
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What is the name of a post-cholecystectomy complication characterized by persistent symptoms like pain, nausea, and indigestion, even after the gallbladder has been removed?
What is the name of a post-cholecystectomy complication characterized by persistent symptoms like pain, nausea, and indigestion, even after the gallbladder has been removed?
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A normal total bilirubin level is less than 1.1 mg/dL.
A normal total bilirubin level is less than 1.1 mg/dL.
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A direct bilirubin level of less than 30% of the total bilirubin level indicates a healthy liver function.
A direct bilirubin level of less than 30% of the total bilirubin level indicates a healthy liver function.
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In general, a dilated common bile duct (CBD) with a diameter greater than 6 mm indicates a possible stone passage.
In general, a dilated common bile duct (CBD) with a diameter greater than 6 mm indicates a possible stone passage.
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Hemolysis dark urine often accompanies obstruction in the bile duct.
Hemolysis dark urine often accompanies obstruction in the bile duct.
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Elective cholecystectomy is typically recommended within a few days after diagnosis.
Elective cholecystectomy is typically recommended within a few days after diagnosis.
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If a patient requires ERCP to remove a CBD stone, it's generally recommended to proceed with cholecystectomy the next day.
If a patient requires ERCP to remove a CBD stone, it's generally recommended to proceed with cholecystectomy the next day.
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A Murphy sign is positive if the patient experiences a sudden cessation of inspiration upon deep palpation in the right upper quadrant of their abdomen.
A Murphy sign is positive if the patient experiences a sudden cessation of inspiration upon deep palpation in the right upper quadrant of their abdomen.
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A HIDA scan is a highly sensitive but rarely used diagnostic tool for detecting gallbladder inflammation.
A HIDA scan is a highly sensitive but rarely used diagnostic tool for detecting gallbladder inflammation.
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MRCP is a noninvasive diagnostic tool that can only be used to detect stones within the common bile duct.
MRCP is a noninvasive diagnostic tool that can only be used to detect stones within the common bile duct.
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ERCP is an invasive procedure often used for both diagnostic and therapeutic purposes in managing gallstones.
ERCP is an invasive procedure often used for both diagnostic and therapeutic purposes in managing gallstones.
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While typically conservative treatment, such as NPO and fluids, is effective for the first three days of acute cholecystitis, surgical intervention may be necessary if symptoms don't improve.
While typically conservative treatment, such as NPO and fluids, is effective for the first three days of acute cholecystitis, surgical intervention may be necessary if symptoms don't improve.
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Study Notes
Gallbladder Anatomy
- Pear-shaped muscular tube
- Parts: fundus, body, neck, cystic duct
- Located in the right upper quadrant (RUQ)
- Cystic duct connects the gallbladder to the common bile duct
- Possible Hartmann's pouch (dilation in the GB neck before cystic duct)
- Cystic artery supplies arterial blood supply (from right hepatic artery)
Gallbladder Function
- Stores bile (25-30ml capacity) from the liver
- CCK (Cholecystokinin) stimulates contraction & bile release into the duodenum
- Bile concentration (reabsorption of water & electrolytes) – concentrates bile
- Bile composition: water (97%), conjugated bilirubin, bile salts, phospholipids & fatty acids
- Bile salts & phospholipids aid in lipid digestion & absorption
- Enterohepatic circulation (95% bile salts reabsorbed in the terminal ileum)
- Lack of bile salt reabsorption leads to gallstone formation
Biliary Tree
- Intrahepatic ducts → Right & left hepatic ducts → Common hepatic duct
- Cystic duct + Common hepatic duct = Common bile duct
- Common bile duct travels in the hepatoduodenal ligament
- Common bile duct joins with the pancreatic duct to form the hepatopancreatic ampulla (ampulla of Vater)
- Major duodenal papilla surrounded by Oddi's sphincter
Gallstones (Cholelithiasis)
- Most common biliary pathology (around 6% of population)
- Risk factors (5 F's): Fat (obese), Forty (middle age), Fertile (multipara), Female (F > M 3:1), Fair (more in Caucasian)
- Etiology: Cholesterol & mixed stones. Disturbance in bile salts to cholesterol ratio (normal 25:1). If 13:1 - lithogenic bile.
- Causes: Increased cholesterol (fatty diet, obesity, DM); Decreased bile salts (terminal ileum resection, cystic fibrosis, liver cirrhosis); Overabsorption of water
Gallbladder Stone Complications
- Chronic Cholecystitis: inflammation of the gallbladder wall (thickening, fibrosis)
- Acute Cholecystitis: inflammation due to obstruction by gallstone (common)
- Obstructive Jaundice: stone obstructs the flow of bile leading to increased pressure, inflammation, and infection. Can cause stone to pass into the bile duct (common)
- Ascending Cholangitis (serious): bacteria in the bile ducts → high fever, jaundice, pain in the upper right quadrant (RUQ).
- Acute Pancreatitis: stones can lodge in the ampulla of Vater, causing obstruction & pancreatitis.
- Gallstone Ileus: perforated stone enters the small intestine; intestinal obstruction (rare complication)
Gallstone Types
- Pure Cholesterol: Most common type (75%)
- Pigmented: 5% (calcum bilirubinate - hemolysis or infection)
- Mixed: Mixed cholesterol & calcium bilirubinate
Gallbladder Stone Diagnosis & Treatment
- Initial: Ultrasound (most sensitive).
- More invasive: CT Scan, HIDA Scan, ERCP (for bile duct problems).
- Treatment: Conservative approach (NPO, IV fluids) or early cholecystectomy (surgical removal of the gallbladder). ERCP & choledocholithothripty could be options if there is biliary obstruction.
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