Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) 5 Practice Test

Gallstones commonly lead to biliary symptoms primarily through obstruction of the cystic duct. The cystic duct is the conduit that connects the gallbladder, where bile is stored, to the common bile duct. When gallstones form in the gallbladder, they can migrate into the cystic duct, causing blockage. This obstruction can lead to a backup of bile, resulting in symptoms such as biliary colic, jaundice, and potentially cholecystitis (inflammation of the gallbladder).

In contrast, the pancreatic duct is not directly involved in bile passage and would not typically be obstructed by gallstones in the context of biliary symptoms. The duodenal ampulla, where the pancreatic duct and common bile duct meet, can be affected indirectly, but obstruction there does not directly cause the symptoms attributed to gallstone disease. The common hepatic duct is also significant in bile flow from the liver but is less commonly the site directly obstructed by gallstones than the cystic duct. Thus, obstruction of the cystic duct is the most direct and common pathway to biliary symptoms associated with gallstones.