Gallbladder

What is the etiology of acute gallbladder hydrops in infants and children?
1. Kawasaki's
2. Leptospirosis
3. Sepsis
4. Scarlet fever
True or false. Cholecystectomy is the mainstay of treatment for acute GB hydrops in infants and children.
1. True
2. False
What conditions are associated with acalculus cholecystitis?
1. Gallbladder stasis
2. Adynamic ileus
3. Dehydration
4. All of he above
What are the indications for operation in acalculus cholecystitis?
1. Persistent mass
2. Increasing GB distention
3. Clinical deterioration
4. A and C
5. All of the above
Gallbladder infarction has been observed after what systemic disease?
1. Kawaski's
2. Salmonella
3. Yerisinia
4. Rickettsial fever
Which of the following racial groups have the highest risk of developing cholecystitis and/or cholelithiasis?
1. African-American
2. Caucasian
3. Hispanic
4. Native Americans
Which is NOT on of the 3 classifications of gallstones?
1. Mixed
2. Cholesterol
3. Pigmented
4. Oxalate
What is the solubility of cholesterol directly dependent upon?
1. Lethicin
2. Lipoprotein A
3. Bilirubin
4. Fat micelles
Why do cholesterol stones develop?
1. Stasis
2. Nucleating factors
3. Bile cannot solubilize cholesterol
4. All of the above
True or false: cholesterol stones are usually noted in children and adolescents in the absence of hematologic disorders?
1. True
2. False
Describe pigmented stones.
1. Brwon stones more common in Orientals
2. Black stones come from Ca bilirubinate as result of infection
3. Three
4. Black stones often associated with hemolytic processes
Children who develop gallstones as a result of interruption of the normal enterohepatic circulation usually get what kind of stones?
1. Mixed
2. Pigmented
3. Cholesterol
What conditions are associated with the development of cholelithiasis in neonates in young infants?
1. Hemolytic disorder
2. Ileal resection
3. Diuretics
4. Prematurity
True or false. Acute cholecystitis is more commonly seen than chronic cholecystitis or cholelithiasis in children.
1. True
2. False
What is the incidence of gallstone pancreatitis in children with stones?
1. Under 3 percent
2. About 10 percent
3. 25 percent
4. 50 percent
What may cause falsely abnormal findings in cholescintigraphy with technetium 99m.
1. Fasting
2. Pancreatitis
3. Renal failure
Is intravenous morphine useful prior to cholescintigraphy?
1. Yes
2. No
What test is the most sensitive in diagnosing cholelithiasis and cholecystitis?
1. CT
2. US
3. ERCP
4. Cholescintigraphy
True or false. Cholesterol stones may spontaneously resolve after cessation of TPN therapy.
1. True
2. False
What is the incidence of gallstone development in children receiving long-term TPN?
1. 10 percent
2. 20 - 25 percent
3. 40 - 45 percent
4. 60 percent
Describe the management of the neonatal patient with cholelithiasis.
1. Cholecystectomy even if adymptomatic
2. ERCP, follwed by elective cholecystectomy
3. Observation for non-Ca++, asymptomatic TPN-related stones
Does phototherapy increase the risk of gallstones?
1. Yes
2. Yes, but only with inadequate hydration
3. No
What is the approximate chance of spontaneous resolution in an infant with cholestatic jaundice and choledocholithiasis?
1. 10 percent
2. 20 percent
3. 50 percent
4. 75 percent
A patient with sickle cell disease presents with abdominal pain. What test should be performed to differentiate between sickle crisis and cholelithiasis?
1. US
2. CT
3. GB Scintigraphy
4. Any of the above
What percentage of African-Americans carry the gene for sickle cell disease?
1. 10 percent
2. 20 percent
3. 50 percent
4. 75 percent
True or false. Prophylactic cholecystectomy has no role in a patient with sickle cell anemia and asymptomatic cholelithiasis.
1. True
2. False
How should be sickle cell anemia patients be managed preoperatively with regard to their risk of sickling?
1. Keep Hgb S under 30%
2. In major cases, Hgb is kept above 12
3. Hydration is critical
4. A and C
5. All of the above
What is the incidence of gallstones in children with thalassemia major vs. age?
1. 5 percent
2. 10 - 15 percent
3. 25 - 30 percent
4. 50 percent
True or false: the risk of gallstones is decreasing in children with thalassemia because of hypertransfusion therapy?
1. True
2. False
What is the incidence of gallstones in hereditary spherocytosis?
1. 10 - 20 percent
2. 20 - 40 percent
3. 40 - 60 percent
4. 60 - 80 percent
When is cholecystectomy recommended in patients with thalassemia major or hereditary spherocytosis?
1. Asymptomatic patients
2. Asymptomatic patients undergoing splenectomy
3. Symptomatic patients only
True or false. The risk of cholelithiasis is increased in children undergoing treatment for WilmÂ’s tumor, neuroblastoma, and lymphoma (Hodgkin's and non-Hodgkin's)?
1. True
2. False
What is the normal ejection fraction of the gallbladder?
1. 5 - 10 percent
2. 15 percent
3. 35 percent
4. 50 percent
Which are TRUE regarding biliary dyskinesia?
1. Poor GB contractility
2. May be early stage of cholesterol GB stones
3. Cholesterol crystals in the bile
4. All of the above
How successful is gallbladder dissolution therapy for stones?
1. 10 - 15 percent
2. 20 - 25 percent
3. 50 percent
4. 75 percent

Gallbladder

Quiz