Biliary disease
Where does a gallstone typically obstruct when you get biliary colic?
As can be seen in the diagram the obstruction of the cystic duct causes the contraction of the gallbladder against a closed outlet which causes pain.
Cholesterol stones make up about what percentage of gallstones?
Most gallstones are made mainly of cholesterol. The other 20% are pigment stones from mainly calcium salts of unconjugated bilirubin. Not surprisingly people who break down red blood cells like sickle cell sufferers get pigment stones.
What is missing in the mnemonic for remembering a person with an increased risk of gallstones. Female, Fair, Fat, Forties,---
Estrogen causes more cholesterol to be secreted in the bile. Woman on Hormone Replacement therapy also have an increased risk of developing gallstones. More recently the 40 is being dropped and Familial put in its place as it has been shown to have a stronger association. Also the association with "Fair" is pretty iffy.
Which of these ultrasound signs are not associated with acute cholecystitis?
A positive ultrasound Murphys sign (that is you find the gallbladder and when you poke it with the probe it hurts) is an important ultrasound sign of an acutely inflamed gallbladder.
Which of the following well known people died of the complications of gallbladder surgery?
Well Pink and the Dalai Lama are still alive so that crosses them out. Marilyn Monroe died of a barbiturate overdose. Andy Warhol delayed his presentation to hospital because he was terrified of hospitals. He died within 24hrs of his operation.
This middle aged patient has a history of diabetes and presented to ED with a tender RUQ and sepsis. Bedside ultrasound showed gallstones. What does the CT slice show?
A life threatening condition, emphysematous gallbladder occurs generally in diabetic or immunocompromised patients. You can see the air extends past the gallbladder wall, showing a perforation.
What may a stone blocking the common bile duct cause.
Ascending cholangitis needs aggressive resuscitation and removal of the stone from the common bile duct ASAP. You will see obstructive liver function tests.
Twenty vets in Thailand removed this 1.7kg gallstone from an elephant. What is the heaviest gallstone removed from a human?
In 1952, in Charing Cross Hospital, London the enormous gallstone was removed from an 80yr old lady. Obviously not laparoscopically.
How would you expect this patient to present, given the stone has blocked the Sphincter of Oddi.
The obstruction to the main pancreatic duct will cause acute pancreatitis. Gallstones and alcohol are the top 2 causes of pancreatitis in Australia.
This CT shows a patient who has got the uncommon" Mirizzi Syndrome". What does it show?
Tough question. I had never heard of it. The syndrome is essentially where a gallstone in the gallbladder compresses the common bile duct. Often mistaken for a cholangiocarcinoma.