Gallbladder disorders: Clinical

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Gallbladder disorders: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 46-year-old woman is brought to the hospital for evaluation of constant and stabbing abdominal pain that began 28 hours ago. In addition, the patient has had several episodes of emesis. Medical history is notable for type II diabetes mellitus and hyperlipidemia, for which she is taking atorvastatin and gemfibrozil. She immigrated from Thailand nine years ago. Temperature is 38.6°C (101.5°F), blood pressure is 119/72 mmHg, and pulse is 83/min. Physical exam is notable for tenderness in the right upper abdominal quadrant. No abdominal distention is observed. Examination of the eyes reveals scleral icterus. The patient has dry mucosal membranes and a delayed capillary refill time. Laboratory testing reveals the findings shown below. Which of the following pathogens is most likely responsible for this patient’s condition?  

Laboratory Value   Result (U.S. conventional units)  Results (SI units)    Result (U.S. conventional units)  Results (SI units)  
 Hemoglobin  13.5 g/dL  135 g/L 
 Leukocyte Count  15,200/mm3  15.2*109/L 
 Neutrophils  88%  88% 
 Eosinophils  3%  3% 
 Lymphocytes  7%  7% 
 Total Bilirubin  5.1 mg/dL  87.21 µmol/L 
 Conjugated Bilirubin  4.6 mg/dL  78.66 µmol/L 
 Aspartate Aminotransferase  93 U/L  93 U/L 
 Alanine Aminotransferase  85 U/L  85 U/L 
 Lipase*  38 U/L  38 U/L 
*Reference range: 12-70 U/L


The gallbladder is a small, pouch-like organ that stores the bile produced by the liver.

After a fatty meal, the gallbladder contracts and releases bile to help break down fats in the diet.

Bile is made up mostly of water, bile salts, bilirubin and fats, as well as cholesterol.

Now, the most common gallbladder diseases have to do with an imbalance in bile fluid composition, which leads to the formation of stones either in the gallbladder or somewhere along the biliary tree.

The biliary tree is made up of the left and right hepatic duct which come together and form the common hepatic duct, as well the cystic duct, which unites with the common hepatic duct to form the common bile duct, also known as choleducus duct.

Finally, the common bile duct joins with the main pancreatic canal to open in the second part of the duodenum.

Now, most gallbladder diseases are related to either the presence of stones in the gallbladder or in the common bile duct, and whether those locations are infected as the result of an obstruction caused by the gallstones.

A gallstone in the gallbladder is called cholelithiasis, and a gallstone in the common bile duct is called choledocolithiasis, and both are associated with mild inflammation. But, if the gallstones block the normal bile flow this can cause severe inflammation in the biliary tree.

When there’s a lot of inflammation, the gallbladder and common bile duct tissue becomes extremely susceptible to infection. An infection of an obstructed gallbladder is called cholecystitis, and an infection of an obstructed common bile duct is called cholangitis, or ascending cholangitis.


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