Gi - Gallstones

Front 1

Acute cholecystisis

Back 1

Results from persistent obstruction of the cystic duct. Acute inflammation of the gallbladder is caused by calculous obstruction of the cystic duct in >90% of cases. Bacterial infection may supervene. This causes a parietal type epigastric or right upper quadrant pain that increases with jarring or respiration. Positive for Murphy's sign.

In up to 75% of patients, symptoms resolve spontaneously within 72 hours after onset, presumably due to disimpacts or passes through the cystic duct.

Front 2

Biliary colic

Back 2

The most common presenting symptom of gallstones. The pain is a steady, severe aching or pressure-type sensation in the epigastrium or RUQ, and often radiates to the infrascapular area or right scapula. The pain occurs suddenly and lasts about 1-3 hours. It is thought that sudden transient obstruction of the cystic duct by a calculus produces increased intraluminal pressure and distension of the gallbladder, leading to this visceral type pain.

Front 3

Ascending cholangitis

Back 3

An infection with aerobic or anaerobic organisms, most frequently E. coli, due to common bile duct obstruction from a gallstone. The classical clinical triad includes fever, pain, and jaundice. Pain is RUQ.

Front 4

Asymptomatic gallstones

Back 4

80% of people with gallstones. Gallstones require no treatment until they become symptomatic, unless the patient has sickle cell disease, lives in a remote area where urgent care is not possible, or the patient also has "porcelain gallbladder".

Front 5

Black pigment stones

Back 5

Consist of polymers of calcium bilirubinate, with large amounts of mucoprotein. Usually contain less than 10% cholestrol. Contain between 30 and 60% unconjugated bilirubin by weight. 50% are radiopaque. Are common in patients with cirrhosis and chronic hemolytic conditions, such as thalassemias and possibly sickle cell anemia, in which bilirubin excretion is increased.

Front 6

Boas' sign

Back 6

Tenderness is the scapula area; less common than Murphy's sign in acute cholescystitis.

Front 7

Brown pigment stones

Back 7

Ca salts of unconjugated bilirubin which are usually primary bile duct stones. They are associated with biliary infection. More prevalent in Asians.

Front 8

Cholecystectomy

Back 8

Standard surgical technique for removal of the gallbladder via a laproscope inserted through a small incision in the umbilicus.

Front 9

Cholestrol-7-hydroxylase

Back 9

The key regulatory enzyme in bile acid synthesis.

Front 10

Cholesterol stones

Back 10

75-80% of gallstones in the US. Almost all are radiolucent. Usually greater than 70% cholesterol by weight. Cholesterol saturated bile is the prerequisite for the formation of cholesterol gallstones. Anything that causes a decrease in bile salts, an increase in cholestrol, or a decrease in lecithin will create relative insolubility of cholestrol in solution.

Front 11

Chronic hemolytic condition

Back 11

Thalassemias and sickle cell anemia; Bilirubin excretion is increased and black pigment gallstones are common.

Front 12

Endoscopic ultrasound

Back 12

Can detect gallbladder and common bile duct stones and has been used in patients with gallbladder type symptoms and negative ultrasound and HIDA scans.

Front 13

ERCP

Back 13

Endoscopic retrograde cholangiography

If stones are found, an electrocautery cutting instrument can be inserted into the ampulla to enlarge the opening of the bile duct into the duodenum (sphincterotomy). Stones can consequently be removed by means of balloons or baskets. Treatment of choice for retained or new bile duct stones after cholecystectomy.

Front 14

Estrogen-replacement therapy

Back 14

Increases the chances of getting gallstones.

Front 15

Gallbladder hypomotility

Back 15

Largely influences the growth stage of cholesterol gallstone formation.

Front 16

Gallbladder sludge

Back 16

Thickened gallbladder mucoprotein with tiny entrapped cholestrol crystals. It is thought to be the precursor to gallstones. Sludge may also occur in asymptomatic patients with prolonged fasting or TPN, spinal cord injuries and prolonged treatment with octreotide.

Front 17

Hepatobiliary scan

Back 17

Relies upon hepatic uptake and excretion into bile of an IV radioactive compound. Images of the biliary tree are recorded by a gamma camera. Reliable study of obstruction and of gallbladder muscular funciton.

Front 18

HMG-CoA reductase

Back 18

The rate limiting step in cholesterol synthesis. Stimulated by insulin and food intake, obesity

Front 19

Microlith

Back 19

Microscopic gallstone

Front 20

Lecithin

Back 20

Cholesterol is generally insoluble but is made soluble through association with phospholipids (lecithin) and bile salts forming vesicles and micelles.

Front 21

MRI/MRCP

Back 21

An excellent imaging modality to assess for common bile duct stones.

Front 22

Mucin glycoprotein

Back 22

The most important pronucleator identified in gallstone formation.

Front 23

Murphy's sign

Back 23

Inspiration during palpation of the right upper quadrant producing increased tenderness and inspiratory arrest.

Front 24

Nucleation

Back 24

The precipitation of cholestrol into crystals. In this case, cholesterol saturation has increased beyond the limits of vesicle and micelle formation.

Front 25

Octreotide

Back 25

Somatostatin analogue which can cause gallstone formation.

Front 26

Porcelain gallbladder

Back 26

Calcification of the gallbladder wall, which is considered a premalignant condition.

Front 27

Primary bile duct stones

Back 27

Stones formed in the biliary tree as the result of bile stasis. They are composed predominately of calcium bilirubinate and minor amounts of cholestrol or fatty acids. These stones may be found in the intrahepatic or extrahepatic bile ducts.

Front 28

Secondary bile duct stones

Back 28

Stones found in the bile ducts associated with gallbladder stones, either having migrated out of the gallbladder or having formed concomitantly in the bile ducts.

Front 29

Somatostatin

Back 29

One of the possible causes of gallstones.

Front 30

TPN

Back 30

Total parenteral nutrition, one of the possible causes of gallstones.

Front 31

Ultrasonography

Back 31

The initial imaging test for gallstones. Can also detect signs of acute cholecystitis and give information regarding the bile ducts.

Front 32

Unconjugated bilirubin

Back 32

One of the components of brown pigment stones.