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Couldn't confirm presence of Flash 7 or higher because JavaScript was disabled.Get FlashI really do have Flash installed.Exercise by Michael A. Riccioli-2006
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Credits: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
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(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 1)

Formation or presence of calculi (gallstones) in the gallbladder.

Most clinical of the extrahepatic biliary tract related to . In the USA, 20% of > age 65 have gallstones, and each year > 500,000 cholecystectomy. Factors that the probability of gallstones include sex, obesity, increased , North American ethnicity, a Western , and a positive history.

Exercise by Michael A. Riccioli-2006
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Credits: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
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(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 2)

Formation or presence of calculi (gallstones) in the gallbladder.
Pathophysiology (Part 1)

Cholesterol, major component most gallstones, is highly insoluble water, and biliary cholesterol is solubilized bile salt-phospholipid micelles phospholipid vesicles, which greatly increase cholesterol-carrying capacity bile. Bile salt micelles are aggregates bile salts which water-soluble (ionic) regions the molecule face outward aqueous solution, while the water-insoluble (nonpolar) steroid nuclei face inward. Cholesterol is soluble side these spheroid micelles, and their cholesterol-carrying ability is further enhanced lecithin, a polar phospholipid. The amount of cholesterol carried micelles and vesicles varies with bile salt secretion rate.Exercise by Michael A. Riccioli-2006
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Credits: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================
(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 3)

Formation or presence of calculi (gallstones) in the gallbladder.
Pathophysiology (Part 2)

Supersaturation of cholesterol in bile is a condition, but not a cause, of cholesterol gallstone because supersaturation is frequent in the bile of persons without gallstones. The other critical in determining whether gallstones form is regulation of the process, cholesterol monohydrate crystal formation. In gallbladder bile that is lithogenic (ie, prone to formation), there is supersaturation of cholesterol and relatively nucleation of cholesterol crystals. The dynamic of forces for and against cholesterol crystal nucleation and growth in the gallbladder includes the actions of proteins or apoproteins, gallbladder mucin, and gallbladder stasis.

Virtually all form within the gallbladder, but stones may form in the duct after cholecystectomy or behind strictures as a result of stasis.Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
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N.B. Use the word given in capitals to form a word that fits in the space

(Chapter 48. Extrahepatic Biliary Disorders)

Cholelithiasis (Part 4)

Formation or presence of calculi (gallstones) in the gallbladder.

Symptoms and Signs (Part 1)

The clinical consequences of stone (FORM) in the gallbladder are exceedingly (VARY). Most patients remain asymptomatic for long periods, (FREQUENT) for life. Stones may traverse the cystic duct with or without symptoms of (OBSTRUCT). Transient cystic duct obstruction results in colicky pain, whereas (PERSIST) obstruction usually produces inflammation and acute cholecystitis. In contrast to other types of colic, biliary colic typically is constant, with pain progressively (RISE) to a plateau and falling gradually, lasting up to several hours. Nausea and (VOMIT) are often associated. Fever and chills are absent in uncomplicated gallbladder colic. Pain most often (OCCUR) in the epigastrium or right upper quadrant, radiating to the right lower scapula.Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================
N.B. Use the word given in capitals to form a word that fits in the space

(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Symptoms and Signs (Part 2)

Symptoms of dyspepsia and (FAT) food intolerance are often (INACCURATE) ascribed to gallbladder disease. (BELCH), bloating, fullness, and nausea are (ASSOCIATE) about equally with cholelithiasis, peptic ulcer disease, or (FUNCTION) distress. Such symptoms may disappear after cholecystectomy but should not be the only indication for operation. Postprandial fatty food intolerance is likely to be (CAUSE) by cholelithiasis if symptoms include right (UP) quadrant pain; however, the prevalence of postprandial functional distress is so high in the general population that symptoms alone are (SUFFICIENT) for diagnosis of gallbladder disease without (SUPPORT) clinical signs and diagnostic studies.Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================

(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Diagnosis

Few calculi escape detection, but relative accuracy, ease, safety, and cost diagnostic methods are subject change, to debate, and to local availability skills.

Real-time ultrasonography is method of choice diagnosing possible gallbladder calculi. Sensitivity (probability a positive test when disease is present) is 98%; specificity (probability a negative test when disease is absent) is 95%. Static B mode ultrasonography oral cholecystography are also sensitive specific. Further information on tests can be found Ch. 37.Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
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(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Treatment

Asymptomatic gallstones:

Because asymptomatic gallstones often discovered evaluation other problems, the question arises whether recommend observation elective cholecystectomy. Neither choice applies all circumstances. Although natural history is unpredictable, is a cumulative chance (about 2% year) that symptoms will develop. Most patients with clinically silent stones decide that discomfort, expense, and risk elective surgery are not worth removing organ that may never cause clinical illness, although potential complications represent serious disease. If symptoms appear, prompt therapy advisable.Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================

(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Symptomatic gallstones (Part 1):

Biliary colic recurs with , pain-free intervals of or months. Symptoms often do not in severity or , but neither do they cease. Symptomatic are at increased risk of complications, and cholecystectomy is indicated. Symptoms to the gallbladder can be expected to after cholecystectomy; nonspecific symptoms of postprandial dyspepsia also remit in patients who have colic. Recurring , even years later, should an evaluation for possible duct stones (choledocholithiasis). Cholecystectomy does not in nutritional , and no dietary are required .Exercise by Michael A. Riccioli-2006
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CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================
COLLOCATIONS

(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Symptomatic gallstones (Part 2):

The operation for gallbladder through a right subcostal or midline is open cholecystectomy. When performed during a period free of , the procedure is relatively , with a mortality of 0.1 to 0.5%. However, since its introduction in 1988, laparoscopic has been the treatment of choice for symptomatic . This technique was popularized largely because of a convalescence, decreased postoperative discomfort, and improved results. The procedure entails the insertion of specialized instruments and a video into the peritoneal through multiple small in the abdominal . After insufflation of the peritoneal , the gallbladder is removed under monitoring. cholecystectomy is converted to an open in approximately 5% of cases, usually because of an inability to identify the of the gallbladder or to manage a .
Exercise by Michael A. Riccioli-2006
********************************
CREDITS: With thanks from The Merck Manual of Diagnosis and Therapy, Edition 17, edited by Mark H. Beers and Robert Berkow. Copyright 1999 by Merck & Co., Inc., Whitehouse Station, NJ.
=============================================================================================

COLLOCATIONS

(Chapter 48. Extrahepatic Biliary Disorders)
Cholelithiasis (Part 5)
Formation or presence of calculi (gallstones) in the gallbladder.

Symptomatic gallstones (Part 3):

For patients declining treatment or for whom surgical is inappropriate, gallbladder may sometimes be dissolved in by giving bile orally for many . Stones must not be calcified, and demonstration of normal gallbladder on oral is essential. acid 10 mg/kg/day reduces biliary of cholesterol and decreases the cholesterol of bile, resulting in dissolution of cholesterol-containing stones in 30 to 40% of patients. Recurrence of is common after cessation of the drug. methods of stone (methyl-tert-butyl ether) or stone (extracorporeal shock lithotripsy) are now largely unavailable owing to greater patient of laparoscopic cholecystectomy. Make Your Own Quizzes