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Gallbladder Disease
Rad M. Agrawal, Suzanne Morrissey,
and Shyam Thakkar
Questions and Answers
1. Features of acalculous cholecystitis include:
A.Ileus
B.Hyperamylasemia
C.Pruitus
D.Fever of unknown origin
E.Raised serum amylase, abnormal lifer function tests
and fever of unknown origin
Answer: E
Acute acalculous cholecystitis typically has a more progressive course compared to calculous cholecystitis.
Approximately half the patients will have a complication
such as gangrene, perforation, or empyema by the time
the diagnosis is made. Unfortunately, the classic features
of fever, right upper quadrant pain, Murphy’s sign, and
leukocytosis are often lacking to some degree in elderly
patients. An elevated serum amylase or fever of unknown
origin may be the only abnormal findings. Abnormal liver
function tests are more common in acalculous than calculous cholecystitis and can include a rise in bilirubin, alkaline phosphatase, and transaminases. The most complete
answer is the combination of abnormal tests and fever.
2. The pathogenesis of emphysematous cholecystitis is:
A.Fistulous tract between the colon and gallbladder
B.Fistulous tract between the small bowel and gallbladder
C.Infection of the gallbladder wall with gas-forming
bacteria
D.Free perforation of the gallbladder wall
Answer: C
Emphysematous cholecystitis commonly affects men in
their fifth to seventh decade of life, with approximately
one third to one half of these patients being diabetic.
Emphysematous changes are caused by secondary infec-
tion of the gallbladder wall with gas-forming organisms,
including Clostridium welchii, Escherichia coli,
Pseudomonas, and Klebsiella. Crepitus may be detectable
in the abdominal wall adjacent to the gallbladder.
Unconjugated hyperbilirubinemia caused by hemolysis
from Clostridial infection may be noted.
3. The potential complications of emphysematous cholecystitis include:
A.Gastrointestinal bleeding
B.Ascites
C.Small bowel obstruction
D.Gangrene with perforation
Answer: D
Emphysematous cholecystitis often progresses to gangrene and perforation. It is the result of secondary infection of the gallbladder wall with gas-forming organisms.
Abdominal wall crepitus may be elicited overlying the
gallbladder.
4. Which one of the following is not considered a risk factor
for gallbladder cancer?
A.Ethnicity
B.Gallbladder polyps more than 10 mm size
C.Porcelain gallbladder
D.History of pancreatitis
Answer: D
Risk factors for developing gallbladder cancer include presence of gallstones, gallbladder polyps, porcelain gallbladder, or an anomalous pancreatico-biliary junction.
Additionally, individuals who are typhoid carriers, obese, or
of Native American, Hispanic, or Alaskan Native descent
are at increased risk of developing gallbladder cancer.
History of acute pancreatitis is not a risk factor for gall bladder cancer. Gallbladder polyps over 10 mms in size are considered an indication for prophylactic cholecystectomy.
C.S. Pitchumoni and T.S. Dharmarajan (eds.), Geriatric Gastroenterology,
DOI 10.1007/978-1-4419-1623-5_42, © Springer Science+Business Media, LLC 2012
453
454
5. Charcot’s Triad does not include the following.
A.Right upper quadrant abdominal pain
B.Jaundice
C.Fever
D.Hypotension and mental confusion
R.M. Agrawal et al.
Answer: D
In 1877, Charcot described patients with pyogenic cholangitis with fever, right upper quadrant pain, and jaundice.
Hypotension and mental confusion may be seen in severe
cholangitis and are components of Reynold’s Pentad.