1.Which best describes the role of the gallbladder?
Correct answer:
D. The gallbladder stores, concentrates, and secretes bile. Its structure allows for easy absorption of fluid and electrolytes, leaving behind highly concentrated bile that is needed for fat digestion.
Unlike the appendix, the gallbladder does have a well known physiologic function. The gallbladder is responsible for storage, concentration, and secretion of bile however, bile is synthesized in the liver. The gallbladder does not make CCK, instead, it is stimulated via CCK and the vagus nerve to contract and expel bile into the cystic duct. Bile then makes its way to the intestine to function in the digestion of lipids.
2. Which of the following is NOT considered a differential diagnosis for acute cholecystitis?
Correct answer:
B. Irritable bowel syndrome
Acute pancreatitis, peptic ulcer disease, and appendicitis are all possible differential diagnoses of acute cholecystitis. Irritable bowel syndrome does not have the same patient presentation, symptoms, or contributing risk factors as the other pathological processes.
3. Symptoms of gallbladder disease often resemble those of other GI diseases. Which group of symptoms suggest cholecystitis?
Correct answer:
D. Pain in the right upper quadrant that radiates to the right shoulder or back, positive Murphy’s sign, low-grade fever
Common symptoms of cholecystitis include pain in the right upper quadrant that radiates to the right shoulder or back, positive Murphy’s sign, rebound tenderness, nausea, vomiting, fever, and leukocytosis. Bloody stool is not a symptom of cholecystitis.
4. G.B. is concerned about the need for additional medical workup. She asks, “Why do I need to have a CT scan. Is there not a simple blood test that could confirm my diagnosis?” What is the most appropriate way to respond to Mrs. G.B.’s question?
Correct answer:
C. While some blood tests may be able to help with diagnosis, there is not a definitive blood test for detecting cholecystitis. Imaging provided by a CT will enable a more accurate diagnosis because the medical team can evaluate for the presence of gallbladder inflammation and stones which can help differentiate from other possible causes of your symptoms.
While blood work can show leukocytosis, which is commonly seen in patients with cholecystitis, it is not a definitive test. Many other pathological processes involve leukocytosis. A CT scan can show inflammation of the gallbladder and the presence of stones, this can help diagnose and differentiate cholecystitis from other disease processes. Additional tests such as a HIDA scan may or may not be necessary.
5. G.B.’s family history reflects a maternal history of gallbladder disease. True or false: family history is the ONLY risk factor for cholecystitis seen in G.B.’s case.
Correct answer:
B. False, she presents with additional risk factors for cholecystitis.
While maternal family history of gallbladder disease can be a risk factor for cholecystitis, G.B. presents with many risk factors. These include female gender, obesity, age nearing 40, multiparity, gestational diabetes, and sedentary lifestyle. All of these factors can contribute to the development of cholecystitis.
