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Old 11-03-2012
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Arrow Billy Step 1 Questions # 73



A 50-year-old Native-American woman comes to her physician because she has had colicky right upper quadrant pain for the past week. She has nausea, but no vomiting or diarrhea. On physical examination, she is afebrile. There is marked tenderness of the right upper quadrant. The liver span is normal. Her height is 160 cm (5 feet 3 inches), and her weight is
90 kg (body mass index 33). An abdominal ultrasound scan shows calculi within the lumen of the gallbladder, and the gallbladder wall appears thickened. Intrahepatic and extrahepatic bile ducts appear normal. The patient's gallbladder is removed by laparoscopic cholecystectomy and golden stones are found. Which of the following mechanisms
is most likely to play the greatest role in development of this disease?


□ (A) Antibody-mediated RBC lysis
□ (B) Ascaris lumbricoides within bile ducts
□ (C) Biliary hypersecretion of cholesterol
(D) Decreased renal excretion of phosphate
□ (E) Hepatocyte infection by HBV
□ (F) Increased duodenal absorption of iron
□ (G) Ingestion of foods rich in fat
□ (H) Involvement of the terminal ileum by Crohn disease

Last edited by billy; 11-03-2012 at 02:53 PM.
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  #2  
Old 11-03-2012
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  #3  
Old 11-03-2012
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Cant paste the pic
Edited the question
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Old 11-03-2012
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i think it's C) cholesterol gall stones

thanks
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Old 11-03-2012
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Default my answer :)

(C) Biliary hypersecretion of cholesterol
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  #6  
Old 11-04-2012
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Correct Answer C is correct

Cholesterol stones are pale yellow(Golden), but acquire a variegated appearance by trapping bile pigments. In comparison, pigment stones are uniformly dark. Risk factors for such stones include Native- American descent, female sex, obesity, and increasing age. These factors cause secretion of bile that is supersaturated in cholesterol. Patients with RBC hemolysis develop pigment stones, whether the hemolysis is antibody-mediated (autoimmune hemolytic anemia), or whether it is caused by intrinsic RBC abnormalities (hemoglobinopathies such as sickle cell anemia). Infection of the biliary tract (Escherichia coli, Ascaris worms, or liver flukes) can lead to increased
release of β-glucuronidases that hydrolyze bilirubin glucuronides, favoring pigment stone formation. Severe ileal dysfunction, as occurs in Crohn disease, also can predispose to pigment stones. Renal failure with phosphate retention can be a cause of secondary hyperparathyroidism with hypercalcemia, which increases the risk of gallstone formation; these stones are mixed stones. Viral hepatitis is not a risk factor for stone formation. Iron is not involved in stone formation. Fatty foods may trigger the biliary colic, but diet does not play a direct role in stone formation.
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The above post was thanked by:
Drew (08-16-2013), subbi (11-04-2012), venky2600 (11-04-2012)



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