1. Recognize the normal anatomy of the biliary tree.

2. Discuss the mechanisms for the stimulation of bile secretion and the
    hormonal mediators of this response.

3. Describe the physicochemical characteristics of normal bile, its production
    and the physiologic mechanism of bile salt reabsorption.

Acute and Chronic Gallbladder Disease, Carcinomas of the Biliary Tract

1. Identify the common types of gallstones and describe the pathophysiology
    involved in their formation.

2. Recognize the mechanisms by which risk factors predispose to gallstone
    formation.

3. List the tests commonly used in the diagnosis of calculous biliary tract
    disease. Describe the indications for, limitations of and potential
    complications of each.

4. Describe the probable natural history of a young patient with asymptomatic
    gallstones.

5. Know the complications that can occur from biliary calculi and describe the
    history, physical examination and laboratory findings for each.

6. Outline the management of a patient with acute cholecystitis.

7. Describe the symptoms and signs of choledocholithiasis; construct the
    management of this problem.

8. Outline a diagnostic and management plan for a patient with acute right upper
    quadrant pain.

9. Describe the diagnostic evaluation and management of a patient with fever,
    chills and jaundice.

10. Describe the following:
       a. Murphy's sign
       b. Courvoisier's sign
       c. Gallstone ileus

11. Contrast carcinomas of the gallbladder, bile duct and ampulla of Vater with
      regard to presenting features and survival.

Diagnostic Studies in Biliary Tract Disease

1. Contrast the liver enzyme abnormalities in cholestasis and viral hepatitis.

2. Identify the most common bacteria found in cholecystitis and cholangitis.

3. Describe the indications for and risks of oral cholecystogram, transhepatic
    cholangiogram and ERCP.

4. Accurately interpret an abnormal ultrasonogram of the gallbladder, oral
    cholecystogram, transhepatic cholangiogram and ERCP.

Skills

1. Given a patient with acute cholecystitis, demonstrate the right upper quadrant
    physical findings that indicate this diagnosis.