Gih Week 1: Gallbladder And Biliary Tract Holliman

Front 1

Angulation or kinking of the gallbladder fundus can cause an expanded bulbous tip known as a...?

Back 1

phyrangian cap
(congenital anomoly)

Front 2

What are the 3 primary constituents that form gallstones?

Back 2

1. Cholesterol
2. Calcium bilirubinate
3. Calcium carbonate

Front 3

What type of people are most likely to get cholesterol gall stones?

Back 3

Fat, fertile females

Front 4

When cholesterol is mixed with other stone constituents, how many stones are likely to develop--solitary or multiple?

Back 4

Multiple stones are likely to develop when cholesterol is mixed with other compounds

(A solitary stone is more likely to form when the stone is pure cholesterol)

Front 5

What is the most common type of gall stone?

Back 5

Cholesterol stones

Front 6

Black gall stones are encountered in diseases which produce excessive amounts of what compound?

Back 6

Bilirubin
(Hemolytic anemia, pernicious anemia, malaria, chemical toxicity to RBCs)

Front 7

Why do brown gall stones usually develop?

Where do these stones develop? (anatomical position)

Back 7

Due to bacterial or parasitic infection of the biliary system

Form within the ducts rather than in the gallbladder

Front 8

Does jaundice develop from obstruction of the cystic duct?

Back 8

No.
Cystic duct obstruction does not interfere with bile flow from the liver to the intestine, so there is no sign of jaundice

Front 9

What types of biliary duct obstructions generally result in jaundice?

Back 9

1. Common bile duct
2. Ampulla

Front 10

What symptoms are associated with obstruction of the cystic or common bile duct?

Back 10

1. Nausea
2. Vomiting
3. Severe epigastric RUQ or substernal pain--> biliary colic
4. Pain may radiate to right shoulder

Front 11

How do gall stones enter the small intestine?

Back 11

Although rare, they may erode the wall of the gallbladder as well as the adherent intestinal loops, resulting in cholecystointestinal fistulas.

Front 12

What region of the small intestine is most likely to be obstructed by large ileus gallstones?

Back 12

Ileocecal region

(smaller gallstones may pass unnoticed through the stools)

Front 13

Chronic cholecystitis is most often seen in what type of individuals?

Back 13

Obese females
(almost all cases are associated with cholelithiasis)

Front 14

Term for out-pouching of the mucosa through the wall of the gallbladder.

Back 14

Rokitansky-Aschoff sinuses

(found in ~90% of chronically inflamed gallbladders and should not be confused with carcinomatous invasion of the wall)

Front 15

Term used to describe small cystic spaces formed when the mucosal epithelium of a gallbladder gets trapped in the lamina propria by fibrous tissue

Back 15

Cholcystitis glandularis
*May occur in chronic cholecystitis

Front 16

In chronic cholecystitis, the fibrotic gallbladder wall occasionally develops dystrophic calcification and is known as a __________.

Back 16

Porcelain gallbladder

Front 17

Progressive unremitting mid-epigastric pain which may radiate to the right shoulder is known as?

Back 17

Biliary colic

Front 18

What is the symptomatic presentation of chronic cholecystitis?

Back 18

Repeated episodes of biliary colic
Excessive belching and flatus

Front 19

What condition generally begins with an episode of biliary colic associated with fever, nausea, vomiting, and elevated WBC count?

Back 19

Acute cholecystitis

(With time, the pain localizes to the RUQ and the abdominal wall becomes rigid).

Front 20

What causes acute cholecystitis?

Back 20

Biliary obstruction can lead to chemical irritation/inflammation of the gallbladder mucosa due to progressive concentration of bile.

*Bacterial infection, when present, is usually secondary

Front 21

If the inflammatory response compromises the blood supply to the gallbladder in acute cholecystitis, what condition may develop?

Back 21

Gangrenous cholecystitis

Front 22

In acute cholecystitis, a large majority of the cases involve gall stones obstructing which anatomical structures?

Back 22

Neck of gallbladder or cystic duct

Front 23

What form of cholecystitis develops without any gallbladder or duct obstruction?

Back 23

Acalculous cholecystitis
(usually seen in serious ill, debilitated, or elderly patients)

*Has a high mortality rate

Front 24

What sort of gallbladder complication involves the histological presentation of edema, leukocytic infiltration, vascular congestion, and gangrenous necrosis?

Back 24

Acute cholecystitis

Front 25

What is the lumen of the gallbladder filled with in acute cholecystitis?

Back 25

1. Blood
2. Pus
3. Bile
4. Additional stones

Front 26

What gallbladder complication is also referred to as "strawberry gallbladder?"

Why?

Back 26

Cholesterolosis

Lipid-laden macrophages accumulate in the tips of the mucosal folds and resemble the pale yellow-gray seeds that punctuate the surface of a strawberry

Front 27

T or F.

Cholesterolosis rarely causes clinical symptoms.

Back 27

TRUE

Front 28

Does cholesterolosis predispose an individual to cholecystitis?

Back 28

No.
It is not thought to predispose to cholecystitis and is unrelated to blood levels of cholesterol.

Front 29

Xanthogranulomas may form as a result of which gallbladder complication?

Back 29

Cholesterolosis
(xanthogranuloma is an inflammatory reaction of white, giant cells and fibroblasts. This inflammatory response is induced by ruptured histiocytes in mucosal folds of gallbladder)

Front 30

What is the most frequent type of gallbladder malignancy?

Back 30

Adenocarcinomas
(a small number are squamous cell carcinomas)

Front 31

In the majority of cases of gallbladder carcinoma, what other 2 conditions are also present?

Back 31

1. Cholelithiasis
2. Chronic cholecystitis

Front 32

Most gallbladder neoplasms develop within the fundus and neck of the gallbladder and are generally asymptomatic until they spread where?

Back 32

To the adjacent bile ducts

Front 33

Gallbladder carcinomas are seen most frequently in what type of people?

Back 33

Adult females

Front 34

Carcinoma of the bile ducts and ampulla of vater are seen most frequently in what type of people?

Back 34

Adult men

Front 35

What specific type of carcinoma is most frequent in malignancies of the bile ducts and ampulla of vater?

Back 35

Adeninocarcinoma

Front 36

What portion of the common bile duct is most often involved in carcinoma?

Back 36

Distal portion

Front 37

What type of infection can be associated with increased incidence of biliary carcinoma?

Back 37

Ascaris (intestinal nematodes) and some of the biliary trematodes (flukes).

Front 38

What are some signs/symptoms caused by obstructive jaundice?

Back 38

1. Pruritis
2. Acholic stools (absence of bile)
3. Bile-stained urine
4. Cholangitis (infection of bile duct)
5. Biliary cirrhosis

Front 39

The exocrine function of the pancreas resides in which pacreatic tissue?

Back 39

Acinar tissue

Front 40

Digestive pancreatic enzymes are synthesized in an inactive form and stored in ....?

Back 40

Zymogen granules of the acinar cells.

Front 41

Which duodenal hormone stimulates the release of pancreatic enzymes?

Back 41

Cholecystokinin
(which is stimulated by presence of amino acids and fats in the duodenum)

Front 42

Which duodenal hormone stimulates columnar cells in the pancreatic ducts to secrete mucin and bicarbonate?

Back 42

Secretin
(stimulated by presence of acid in duodenum)

Front 43

Which enzyme converts trypsinogen to trypsin?

Back 43

Enterokinase
(brushborder enzyme in duodenum)

Front 44

The ventral embryologic pancreas ultimately forms which portion of the adult pancreas?

Back 44

Head of pancreas

Front 45

The dorsal embryologic pancreas ultimately forms which portions of the adult pancreas?

Back 45

Body and tail

Front 46

What type of position anomly typically occurs when the ventral pancreatic bud rotates improperly?

What is the clinical significance?

Back 46

Annular pancreas

*May predispose to duodenal obstruction (especially in children)

Front 47

What is "heterotopic" or "ectopic pancreas" referring to?

Back 47

Nodules of aberrant, but histologically normal pancreatic tissue-- sometimes seen in the submucosal tissue of the stomach or duodenum.

(little or no clinical significance)

Front 48

Which portion of the pancreas lies in the loop of the duodenum?

Back 48

Head

Front 49

What is the mild form of acute pancreatitis?

Back 49

Acute edematous pancreatitis

Front 50

What is the more severe form of acute pancreatitis?

Back 50

Acute hemorrhagic pancreatitis, acute pancreatic necrosis

(Diffuse enzymatic destruction of pancreatic tissue; constitutes medical emergency)

Front 51

List 4 possible causes of acute pancreatitis.

Back 51

1. Inappropriate activation of zymogens
2. Injury to acinar cells
3. Biliary duct obstruction
4. Pancreatic duct obstruction

Front 52

Pancreatitis is particularly common in what type of people?

Back 52

Alcoholics

Front 53

What sort of enzymes are activated and liberated in acute pancreatitis?

What is the result?

Back 53

Proteases, lipases, amylases, elastases

*Results in enzymatic fat necrosis, hemorrhage, and autodigestion of the pancreas. Seen in acute pancreatitis.

Front 54

What causes chalky, white precipitates to form throughout the abdomen in acute pancreatitis?

Back 54

Enzymatic fat necrosis

Front 55

What is the likely predisposing factor for acute pancreatitis in males?

In females?

Back 55

alcohol--> males

gallstones--> females

Front 56

Which pancreatic enzyme rises within the first 24 hours of acute pancreatitis?

Which enzyme level rises 2-3 days later?

Back 56

Amylase (first 24 hours)

Lipase (2-3 days later)

Front 57

Which pancreatic enzyme is more specific for a diagnosis of acute pancreatitis?

Back 57

Lipase

Front 58

Why is hypocalcemia seen in severe cases of acute pancreatitis?

Back 58

Calcium leaves blood stream and is deposited in the necrotic tissue

*Poor prognostic sign

Front 59

Chronic pancreatitis is most common in which individuals?

Back 59

Middle-aged men

Front 60

What type of clinical symptoms are seen in acute pancreatitis?

Back 60

Sudden onset of pain ranging from mild to excruciating and unrelenting

*Pain frequently radiates sharply into the back

Front 61

What symptoms are associated with chronic pancreatitis?

Back 61

Symptoms of mild destruction -->
asymptomatic OR mild to moderate abdominal pain

Symptoms of severe destruction -->
steatorrhea, malabsorption

Front 62

What signs are associated with initial and more progressive attacks of chronic pancreatitis?

Back 62

Initial attacks --> pain, fever, jaundice, slight elevation of serum amylase and alkaline phosphatase

As it progresses --> weight loss, hypoalbuminemia, steatorrhea, and diabetes.

*Pain is the initial symptom, while function of pancreas remains in tact. Pain will actually get better as the condition progresses, while function gets worse, leading to pancreatic insufficiency.

Front 63

What type of structure is solitary, unilocular, and has a massive collection of fluid and necrotic debris in the pancreas?

Back 63

Pseudocyst

Front 64

How are pseudocysts distinguished between the less common true pancreatic cysts?

Back 64

Absence of an epithelial lining

Front 65

Benign neoplasm arising from the ductal epithelium of the pancreas.

Back 65

Cystadenoma

Front 66

Cystademonas occur most frequently in which portion of the pancreas?

Back 66

Tail

Front 67

What are the two types of cystadenomas?

Back 67

Serous and mucinous
(serous forms are less common, but almost always benign)

Front 68

Pancreatic adenocarcinomas arise from what tissue?

Back 68

Exocrine ductal epithelium

Front 69

What factors are involved in the development of pancreatic adenocarcinomas?

Back 69

1. Environmental (cigarette smoking, diet..)
2. Genetic (p53 mutations)

Front 70

The majority of adenocarcinomas occur in which portion of the pancreas?

Back 70

Head

Front 71

Adenocarcinomas found in which portion of the pancreas tend to be hard, irregular masses that infiltrate contiguous structures and have distant metastases?

Back 71

Body and tail.

Front 72

What are the most common presenting symptoms of pancreatic adenocarcinoma?

Back 72

1. Anorexia
2. Weight loss
3. Abdominal and/or back pain
4. Symptoms of metastatic disease

*Late onset of symptoms due to long interval of "silent growth."

Front 73

What is Trousseau's sign of malignancy?

Back 73

Migratory thrombophlebitis

(Patients may have Trousseau's sign when pancreatic adenocarcinoma is present)

Front 74

Tumors of which portion of the pancreas tend to be small with infiltrative margins that invade the duodenum or biliary structures?

Back 74

Head of pancreas

Front 75

What clinical sign might be seen by tumor formation in the pancreatic head?

Back 75

Jaundice
(tumor may impinge upon biliary tract structures)