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Self-Assessment Questions


Gallstones and Gallstone-Related Diseases: Review Questions

Douglas G. Adler, MD

Dr. Adler is Assistant Professor of Medicine and Director of Gastrointestinal Endoscopy, University of Texas Health Science Center at Houston.

Choose the single best answer for each question.

1. A 65-year-old woman with recurrent postprandial pain is found to have multiple gallbladder stones during an abdominal ultrasound examination. The patient takes postmenopausal estrogen therapy and sertraline for depression. The patient has lost 30 lb over the past year through diet and exercise. Which of these characteristics has NOT been shown to increase the risk of gallstone formation?
  1. Age greater than 60 years
  2. Estrogen therapy
  3. Female sex
  4. History of recent weight loss
  5. Use of sertraline
Click here to compare your answer.

Questions 2 and 3 refer to the following case study.

A 53-year-old man undergoes a laparoscopic cholecystectomy for symptomatic gallstone disease. The surgery is uneventful, but 2 days after the procedure the patient develops intense abdominal pain without fever. He has a bilirubin level of 4.2 mg/dL, a lipase level of 40 U/L, and an aspartate transaminase (AST) level of 225 U/L.

2. What is the most likely cause of this patient’s symptoms and laboratory abnormalities?

  1. Bile leak
  2. Pancreatitis
  3. Postoperative ileus
  4. Postoperative infection
  5. Retained stone
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3. What would be the next best step in the patient’s management?

  1. Intraoperative bile duct exploration to remove the gallstone
  2. Endoscopic retrograde cholangiopancreatography
  3. Endoscopic ultrasound of the bile ducts
  4. Magnetic resonance cholangiography of the bile ducts
  5. Percutaneous transhepatic cholangiography
Click here to compare your answer.

4. A 38-year-old woman presents with intermittent right upper quadrant abdominal pain after meals. Laboratory test results have been normal. The patient underwent cholecystectomy for similar pain 2 years ago and was found to have a normal gallbladder without stones at the time of surgery. A right upper quadrant ultrasound was performed at that time but was of limited value due to obesity. You would like the patient to undergo evaluation for a retained stone. What is the best test to evaluate this patient’s biliary tree?
  1. Computed tomography (CT) scan
  2. Endoscopic retrograde cholangiopancreatography
  3. Endoscopic ultrasound
  4. Magnetic resonance cholangiography
  5. Percutaneous transhepatic cholangiography
Click here to compare your answer.

5. A 60-year-old man undergoes a CT scan to evaluate his abdominal aorta. The images show a normal aorta, but his gallbladder contains several stones, and intramural calcification of the gallbladder wall also is noted. No other abnormal findings are seen. The patient has not had any symptoms and has normal liver chemistries. What is the most appropriate therapy for this patient?

  1. Cholecystectomy
  2. Cholecystojejunostomy
  3. Endoscopic retrograde cholangiopancreatography to evaluate the biliary tree
  4. Endoscopic ultrasound of the gallbladder and biliary tree
  5. Observation
Click here to compare your answer.

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