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What do you know about the pathology of the gallbladder? Do you think you could pass this quiz? Gallbladder disease is common, and it has to be considered as a differential diagnosis of upper abdominal pain and jaundice. The most common disorder in the gallbladder is the existence of calculi. Inflammation causes most of the gallbladder disease. See how much you know about the pathology of the gallbladder by trying this quiz.
Questions and Answers
1.
Check all that apply to Sonographic Non-Visualization of the GB:
A.
Porcelain GB
B.
Overlying bowel gas
C.
Chronic cholecystitis
D.
Not NPO
E.
S/p chole
F.
Congenitally absent
G.
Contracted GB with stones
H.
Hepatitis and cirrhosis
I.
Courvoiser's GB
J.
Sludge filled GB
K.
Ectopic GB
L.
IV hyperalimentation
M.
GB neoplasms that completely fill lumen
Correct Answer(s)
A. Porcelain GB B. Overlying bowel gas C. Chronic cholecystitis D. Not NPO E. S/p chole F. Congenitally absent G. Contracted GB with stones J. Sludge filled GB K. Ectopic GB M. GB neoplasms that completely fill lumen
Explanation The correct answer choices for Sonographic Non-Visualization of the GB are: porcelain GB, overlying bowel gas, chronic cholecystitis, not NPO, s/p chole, congenitally absent, contracted GB with stones, sludge filled GB, ectopic GB, and GB neoplasms that completely fill lumen. These conditions can cause the gallbladder to not be visualized on a sonogram.
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2.
Hepatitis and Cirrhosis increase GB volume due to decreased bile production due to hepatocyte injury.
A.
True
B.
False
Correct Answer
B. False
Explanation hepatitis and cirrhosis DECREASE GB volume due to decreased bile production due to hepatocyte injury
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3.
Check all that apply to having a small GB:
A.
Not NPO
B.
Congenital hypoplasia
C.
Courvoisiers GB
D.
Hepatitis and cirrhosis
E.
Cystic duct obstruction
F.
Prolonged fasting
G.
Chronic cholecystitis
Correct Answer(s)
A. Not NPO B. Congenital hypoplasia D. Hepatitis and cirrhosis G. Chronic cholecystitis
Explanation Having a small GB can be associated with several conditions. One possible explanation is congenital hypoplasia, which means the GB is abnormally small since birth. Another possible explanation is hepatitis and cirrhosis, which can cause inflammation and scarring of the liver, leading to a smaller GB. Chronic cholecystitis, which is a long-term inflammation of the GB, can also result in a smaller GB. However, the statement "not NPO" does not provide a clear explanation as to why having a small GB is applicable. Therefore, this answer choice is incorrect.
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4.
Check all that apply to an enlarged GB:
A.
IV hyperalimentation
B.
Prolonged fasting
C.
Adenomyomatosis
D.
Acute cholecystitis
E.
Cystic duct obstruction
F.
Courvoisers GB
G.
Diabetes
H.
AIDS
I.
Post vagotomy
Correct Answer(s)
A. IV hyperalimentation B. Prolonged fasting E. Cystic duct obstruction F. Courvoisers GB G. Diabetes I. Post vagotomy
Explanation An enlarged GB can be caused by several factors. IV hyperalimentation and prolonged fasting can lead to an enlarged GB due to the accumulation of bile in the gallbladder. Cystic duct obstruction can also cause the GB to become enlarged as bile cannot flow properly. Courvoisier's GB, which is characterized by an enlarged GB and jaundice, can be caused by obstruction of the bile duct by a tumor. Diabetes can lead to an enlarged GB due to impaired gallbladder function. Lastly, post vagotomy, a surgical procedure that involves cutting the vagus nerve, can cause the GB to become enlarged due to impaired nerve function.
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5.
GB wall thickness is considered normal if it is less than ____mm.
Correct Answer(s) 3 three
Explanation The given correct answer is "3, three". This suggests that the normal wall thickness for GB (presumably referring to a specific object or material) is considered to be less than 3mm. The mention of "three" in the answer reinforces the numerical value of 3 as the appropriate measurement for the normal wall thickness.
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6.
A physiologic cause of GB wall thickening is a contracted GB after eating.
A.
True
B.
False
Correct Answer
A. True
Explanation A contracted gallbladder after eating can cause thickening of the gallbladder wall. This is because when the gallbladder contracts, it can appear thicker on imaging studies. This physiological response is a normal occurrence after a meal and is not indicative of any pathological condition. Therefore, the statement is true.
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7.
Check all the extrinsic causes of GB wall thickness:
A.
Chronic hepatitis
B.
CHF (right sided heart failure)
C.
Renal failure
D.
Acute hepatitis
E.
AIDS
F.
Chronic cholecystitis
G.
Sepsis
H.
Adenomyomatosis
I.
Polyp
J.
Ascites due to hypoalbumenia
Correct Answer(s)
B. CHF (right sided heart failure) C. Renal failure D. Acute hepatitis E. AIDS G. Sepsis J. Ascites due to hypoalbumenia
Explanation The given answer includes various extrinsic causes of GB wall thickness. CHF (right sided heart failure) can cause congestion and increased pressure in the liver, leading to thickening of the gallbladder wall. Renal failure can result in fluid overload and increased pressure in the abdominal cavity, leading to gallbladder wall thickening. Acute hepatitis, AIDS, and sepsis can cause inflammation and infection, leading to gallbladder wall thickening. Ascites due to hypoalbuminemia can also cause increased pressure in the abdominal cavity, leading to gallbladder wall thickening. These conditions can all contribute to the thickening of the gallbladder wall.
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8.
Check all the intrinsic causes that apply to GB wall thickening:
A.
Acute cholecystitis
B.
Polyp
C.
GB cancer (primary or metastatic)
D.
Chronic cholecystitis
E.
Sludge
F.
Hepatitis
G.
Adenomyomatosis
H.
Cirrhosis
I.
Emphysematous cholecystitis
J.
Gangrenous cholecystitis
Correct Answer(s)
A. Acute cholecystitis B. Polyp C. GB cancer (primary or metastatic) D. Chronic cholecystitis G. Adenomyomatosis I. EmpHysematous cholecystitis J. Gangrenous cholecystitis
Explanation The correct answer includes acute cholecystitis, polyp, GB cancer (primary or metastatic), chronic cholecystitis, adenomyomatosis, emphysematous cholecystitis, and gangrenous cholecystitis. These are all intrinsic causes that can lead to GB wall thickening. Acute cholecystitis is inflammation of the gallbladder, polyps are abnormal growths, GB cancer refers to primary or metastatic cancer in the gallbladder, chronic cholecystitis is long-term inflammation, adenomyomatosis is a benign condition characterized by hyperplastic changes in the gallbladder wall, emphysematous cholecystitis is a rare form of acute cholecystitis with gas formation, and gangrenous cholecystitis is a severe form of acute cholecystitis with tissue death.
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9.
This is the classification of calcium-bilirubin granules and cholesterol crystals.
Correct Answer(s) sludge
Explanation The correct answer is "sludge". Sludge refers to a mixture of calcium-bilirubin granules and cholesterol crystals. These substances can combine in the gallbladder to form a thick, viscous material known as sludge. Sludge can lead to various gallbladder problems, including inflammation and the formation of gallstones.
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10.
Patients with sludge may be asymptomatic or present with symptoms similar to gallstone pain.
A.
True
B.
False
Correct Answer
A. True
Explanation Patients with sludge may be asymptomatic or present with symptoms similar to gallstone pain. Sludge refers to thickened bile that can accumulate in the gallbladder. It is composed of cholesterol crystals, calcium salts, and other substances. When sludge becomes symptomatic, it can cause pain similar to that caused by gallstones. This pain typically occurs in the upper abdomen and may radiate to the back or shoulder. Therefore, the statement that patients with sludge may be asymptomatic or present with symptoms similar to gallstone pain is true.
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11.
Organization of sludge into round, mobile, echogenic, non-shadowing balls is referred to as ________ _______.
Correct Answer sludge balls
Explanation The organization of sludge into round, mobile, echogenic, non-shadowing balls is commonly known as "sludge balls". This term is used to describe the specific formation of sludge particles in a compact and spherical shape, which can be easily observed and identified through medical imaging techniques. The presence of sludge balls can indicate certain conditions or diseases within the body, such as gallstones or biliary sludge.
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12.
Longstanding obstruction that results in sludge that does not move, in which resembles a pseudo-tumor or GB neoplasm, is known as __________ _______.
Correct Answer tumefactive sludge
Explanation Tumefactive sludge refers to a long-standing obstruction in the gallbladder that causes the formation of sludge that does not move. This sludge resembles a pseudo-tumor or a neoplasm in the gallbladder.
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13.
Sludge can be caused by:
A.
Cystic duct obstruction
B.
Gangrenous cholecystitis
C.
Hyperalimentation
D.
Contracted GB
E.
Overlying bowel gas
F.
Acute or chronic cholecystitis
G.
Biliary stasis secondary to prolonged fasting
Correct Answer(s)
A. Cystic duct obstruction C. Hyperalimentation F. Acute or chronic cholecystitis G. Biliary stasis secondary to prolonged fasting
Explanation The given answer includes various factors that can cause sludge. Cystic duct obstruction can lead to the accumulation of bile and formation of sludge. Hyperalimentation, which is the excessive administration of nutrients, can cause changes in bile composition and contribute to sludge formation. Acute or chronic cholecystitis, which is inflammation of the gallbladder, can also result in sludge formation. Biliary stasis, which occurs due to prolonged fasting, can cause the bile to become stagnant and form sludge. Therefore, these factors can all contribute to the development of sludge in the gallbladder.
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14.
Artifacts that mimic sludge will move.
A.
True
B.
False
Correct Answer
B. False
Explanation artifacts will not move , where as sludge will
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15.
Sonographic appearance of sludge can be characterized as , non- __________, mobile, low level _______ within the GB lumen.
Correct Answer shadowing, echoes
Explanation The sonographic appearance of sludge in the gallbladder can be characterized as non-shadowing and echoes. This means that it does not create a shadow on the ultrasound image and produces echoes, indicating its presence within the gallbladder lumen.
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16.
Gallstones are composed of __________, calcium __________, and calcium ____________.
Explanation Gallstones are formed when there is an imbalance in the substances present in the bile, a fluid produced by the liver to aid in digestion. The correct answer states that gallstones are composed of cholesterol, bilirubinate, and carbonate. Cholesterol is a fatty substance that can accumulate in the gallbladder and form stones. Bilirubinate is a pigment formed from the breakdown of red blood cells, and its presence in the bile can contribute to stone formation. Carbonate refers to the presence of calcium carbonate, which can also be a component of gallstones. These three substances together can form solid deposits in the gallbladder, leading to the development of gallstones.
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17.
Approximately 75% of gallstones in the USA are primarily cholesterol.
A.
True
B.
False
Correct Answer
A. True
Explanation Approximately 75% of gallstones in the USA are primarily composed of cholesterol. This means that the majority of gallstones found in the US population are made up of cholesterol rather than other substances. This information suggests that high cholesterol levels may be a significant risk factor for developing gallstones in the USA.
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18.
One of the risk factors of cholelithiasis is the 6 F's. List all of the 6 F's (alphabetically)
Explanation The 6 F's that are risk factors for cholelithiasis are fair, fat, female, fertile, flatulent, and forty. These factors indicate that individuals who are fair-skinned, overweight or obese, female, of childbearing age, prone to flatulence, and over the age of forty are more likely to develop cholelithiasis. These risk factors may be associated with hormonal changes, increased cholesterol levels, and a sedentary lifestyle, all of which can contribute to the formation of gallstones.
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19.
Check all the risk factors that apply to cholelithiasis:
A.
Parity
B.
Pregnancy
C.
Hypertension
D.
Estrogen therapy
E.
Bowel gas
F.
Diet
G.
Gestational diabetes
H.
Oral contraceptives
I.
6 F's
Correct Answer(s)
A. Parity B. Pregnancy D. Estrogen therapy F. Diet G. Gestational diabetes H. Oral contraceptives I. 6 F's
Explanation Cholelithiasis, also known as gallstones, is a condition characterized by the formation of stones in the gallbladder. The risk factors for cholelithiasis include parity (having given birth multiple times), pregnancy, estrogen therapy, diet (particularly high in cholesterol and low in fiber), gestational diabetes, oral contraceptives, and the 6 F's (fair skin, female gender, fat, fertile, forty years old or above, family history). These risk factors increase the likelihood of developing gallstones by influencing the composition of bile and the functioning of the gallbladder.
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20.
With non-obstructive gallstones, lab values are usually abnormal.
A.
True
B.
False
Correct Answer
B. False
Explanation lab values are normal
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21.
ALT may be elevated if CD or CBD are obstructed.
A.
True
B.
False
Correct Answer
B. False
Explanation ALP may be elevated if CD or CBD are obstructed.
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22.
What are the 3 characteristics of gallstones that MUST BE present in order to diagnose gallstones:
Correct Answer strongly echogenic, posterior shadowing, mobile strongly echogenic structure, posterior shadowing, mobile
Explanation The correct answer is "strongly echogenic, posterior shadowing, mobile". These three characteristics are necessary to diagnose gallstones. "Strongly echogenic" refers to the high reflectivity of the gallstones on ultrasound imaging. "Posterior shadowing" indicates that the gallstones cause a dark area behind them due to the blocking of sound waves. "Mobile" means that the gallstones can move within the gallbladder or biliary ducts. Therefore, all three characteristics must be present for a definitive diagnosis of gallstones.
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23.
Gallstones may be solitary or multiple.
A.
True
B.
False
Correct Answer
A. True
Explanation Gallstones can occur as a single stone or multiple stones in the gallbladder. This means that a person can have either one large stone or several smaller stones. Therefore, the statement "Gallstones may be solitary or multiple" is true.
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24.
Check all that apply to symptoms of Gallstones:
A.
Asymptomatic
B.
May have RUQ pain that radiates to right shoulder
C.
Pain mimics chest pain
D.
Diarrhea
E.
Nausea and vomiting
F.
Bowel gas
Correct Answer(s)
A. Asymptomatic B. May have RUQ pain that radiates to right shoulder C. Pain mimics chest pain E. Nausea and vomiting
Explanation Gallstones can present with various symptoms. Some individuals may be asymptomatic, meaning they do not experience any noticeable symptoms. However, others may experience RUQ (right upper quadrant) pain that radiates to the right shoulder, which is a common symptom of gallstones. Additionally, the pain caused by gallstones can sometimes mimic chest pain. Nausea and vomiting are also associated symptoms of gallstones. Therefore, the correct answers for symptoms of gallstones are asymptomatic, may have RUQ pain that radiates to right shoulder, pain mimics chest pain, and nausea and vomiting.
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25.
There is a high incidence of gallstones associated with ___________ of the GB.
Correct Answer(s) carcinoma
Explanation The correct answer is carcinoma. Carcinoma refers to a type of cancer that can develop in the gallbladder. Carcinomas can cause various changes in the structure and function of the gallbladder, leading to a higher risk of developing gallstones. This association between carcinoma and gallstones suggests that the presence of carcinoma in the gallbladder can increase the likelihood of developing gallstones.
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26.
One-third of patients with cholelithiasis will develop acute calculous cholecystitis.
A.
True
B.
False
Correct Answer
A. True
Explanation Cholelithiasis refers to the presence of gallstones in the gallbladder. Acute calculous cholecystitis is a complication that can occur in patients with cholelithiasis, where the gallbladder becomes inflamed due to blockage of the cystic duct by a gallstone. The statement suggests that one-third of patients with cholelithiasis will develop this complication, indicating that it is a common occurrence in this population. Therefore, the answer is true.
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27.
False Positives: structures that mimic a gallstone may include:
A.
Bowel gas
B.
GB edge shadowing
C.
Valves of Heister
D.
Tumefactive sludge
E.
Sludge balls
F.
Junctional folds
G.
Post cholecystectomy
Correct Answer(s)
A. Bowel gas B. GB edge shadowing C. Valves of Heister F. Junctional folds G. Post cholecystectomy
Explanation The given answer lists various structures that can mimic a gallstone. These include bowel gas, GB edge shadowing, Valves of Heister, junctional folds, and post cholecystectomy. These structures can appear similar to gallstones on imaging studies, leading to false positive diagnoses.
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28.
A low fat diet tends to lessen the frequency of GB attacks.
A.
True
B.
False
Correct Answer
A. True
Explanation A low fat diet can help reduce the frequency of gallbladder (GB) attacks. This is because a high fat diet can stimulate the gallbladder to release more bile, which can trigger attacks in individuals with gallbladder issues. By consuming less fat, the gallbladder is not stimulated as much, leading to fewer attacks. Therefore, it is true that a low fat diet tends to lessen the frequency of GB attacks.
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29.
What is the most common treatment for cholelithiasis:
Correct Answer cholecystectomy
Explanation Cholecystectomy is the most common treatment for cholelithiasis, which is the presence of gallstones in the gallbladder. Cholecystectomy involves the surgical removal of the gallbladder, which eliminates the source of the gallstones and prevents further complications. This procedure is considered a safe and effective treatment option for cholelithiasis, especially when the gallstones cause symptoms such as abdominal pain, nausea, and vomiting. Additionally, cholecystectomy may be recommended if the gallstones are large, causing inflammation or infection, or if there is a risk of complications like gallbladder cancer.
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30.
It is preferred to perform cholecystectomy procedures during the ______ attack, since early intervention _________ morbidity and mortality rates, as well as requires _______ hospitalization.
Correct Answer acute, decreases, shorter
Explanation Performing cholecystectomy procedures during the acute attack is preferred because early intervention decreases morbidity and mortality rates and requires shorter hospitalization. This means that operating on the patient during the acute phase of the attack leads to better outcomes and a quicker recovery, compared to delaying the surgery.
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