Sabiston Textbook of Surgery, The Biological Basis of Modern Surgical Practice, 18th Edition,
Ch 54. Available online through the library.
1. List the common types of gallstones and describe the pathophysiology involved in their
2. Describe the signs and symptoms in a patient with biliary colic. Contrast these symptoms
with those of acute cholecystitis.
3. List the tests commonly used in the diagnosis of calculus biliary tract disease. Describe
the indications for, limitations of, and potential complications of each.
4. List the complications which can occur from biliary calculi.
5. Outline the medical and surgical management of a patient with acute cholecystitis.
6. Describe the symptoms and signs of chloedocholithiaisis; describe the management of
7. Contrast the liver enzyme abnormalities in obstructive jaundice and viral hepatitis.
8. List the most common bacteria found in cholecystitis and cholangitis.
1. 58 year-old female is admitted with right upper quadrant pain. Her temperature is 101.2
with otherwise stable vital signs. White blood count is 12,300, bilrubin is 4, alkaline
phosphatase is 1½ times normal and ultrasound shows gallstones and dilated common
duct measuring 1.1 cm.
2. 70 year-old male with IDDM presents with nausea, vomiting, right upper quadrant pain
and fever. Abdominal series shows air in the wall of the gallbladder.
3. 40 year-old woman has recently undergone laparoscopic cholecystectomy. She now
presents 8 weeks postoperatively with right upper quadrant pain and nausea, the same
symptoms she had prior to her cholecystectomy.
4. 55 year-old female has intermittent right upper quadrant pain, nausea, and vomiting. She
has had an ultrasound that reported no gallstones ad an EGD negative for ulcer disease.