Gall Bladder 01 Flashcards
What parts of the GI (layers) does the gallbladder not contain?
muscularis mucosae
submucosa
What’s to the most common gallbladder anomaly?
folded fundus “Phrygian Cap”
95% of biliary tract disease is attributable to what?
gallstones
What are the predisposing conditions that would cause one to have gallstones? (cholesterol stones)
fat
female
fertile
forty
fair
flatulence (has to do with digestion)
What are risk for having pigment stones?
chronic hemolytic syndromes
infection
Describe pathology behind how cholesterol stones are formed.
- Supersaturation of the bile with cholesterol
- Hypomotility of the gallbladder (stasis)
- Accelerated cholesterol crystal nucleation
- Mucus hypersecretion to trap the crystals
List the pathogenesis of pigment stones.
- Hemolytic anemias
- Infections of the biliary tract
Are most cholesterol stones radiolucent or radiopaque?
radiolecent
What are the 2 types of pigment stones?
black stones
brown stones
What is the composition of black pigment stones?
oxidized polymers of calcium salts of UC bilirubin(UCB) mostly
Are black stones radiolucent or radiopaque?
radiopaque
What are brown pigment stones caused by?
infected intrahepatic or extrahepatic ducts
Are brown pigment stones radiolucent or radiopaque?
radiolucent some sources say radiopaque
What are some clinical features of cholelithiasis?
excruciating pain, either constant or “colicky” (spasmodic), often follows a fatty meal,
localized to the right upper quadrant/epigastrium, may radiate to shoulder/back.
Name for inflammation of the gallbladder?
cholecystitis
Complications caused by cholelithiasis?
empyema, Perforation, Fistulae, Inflammation of biliary tree, and Obstructive cholestasis or Pancreatitis
Gallstone ileus meaning.
large stone erodes directly into an adjacent loop of small bowel causing intestinal obstruction (Bouveret’s syndrome)
Describe empyema gall bladder.
Secondary infection of the gallbladder in which it is filled with pus due to a calculus impacting outlet of the gallbladder (cystic duct)
What is acute calculous cholecystitis?
inflammation of the gallbladder due to stones
Pathogenesis of acute calculus cholescystitis?
The protective mucus layer of the gallbladder is disrupted and the mucosal epithelium exposed to harsh bile salts.
Prostaglandins released creating an inflammatory response.
Distention and increased intraluminal pressure compromise blood flow to the mucosa.
These events initially occur in the absence of bacterial infection, but later in the course bacterial infection may be superimposed and exacerbate the inflammatory process.
What are risk factors for acute non-calculous cholecystitis?
- Sepsis with hypotension and multisystem organ failure
- Immunosuppression;
- Major trauma and burns
- Diabetes mellitus
- Infections
What are major indications of acute cholecystitis?
Steady or Colicky pain (progressive right upper quadrant or epigastric pain that last > 6 hours) + Fever + Leukocytosis,
No jaundice
Is a prerequisite of obstruction to gallbladder outflow necessarily needed to have chronic cholecystitis?
no; but it is associated with cholelithiasis in over 90% of cases.
What is the best way to diagnose chronic cholecystitis?
Ultrasonography
What is porcelain gallbladder?
- Uncommon manifestation of chronic cholecystitis, characterized by extensive dystrophic calcification within the gallbladder wall
Is porcelain gallbladder considered metastatic calcification?
yes
Describe the appearance of xanthogranulomatous cholecystitis.
- Abundant macrophages filled with lipids are admixed with fibrosis
- Can be confused macroscopically with a malignant neoplasm
What is cholesterolosis?
excess cholesterol in bile
forms excess cholesterol deposits in macrophages (seen as yellow, speckled mucosal surface)
What is “strawberry gall bladder” and indication of?
excess cholesterol in bile; cholesterol deposits in macrophages producing a yellow, speckled mucosal surface
What is hydrops of the gallbladder?
distended gallbladder caused by chronic obstruction of the cystic duct
Describe appearance of hydrops of the gallbladder
- Distended GB with atrophy of the mucosa/muscle
- Clear secretions
How is hydrops of the gallbladder treated?
surgically
Right upper quadrant pain + fever + absolute neutrophilic leukocytosis with left shift.
acute cholecystitis
Right upper quadrant pain + jaundice (increased serum AST/ALP + serum bilirubin >4 mg/dL, usually indicates a stone in common bile duct .
choledocholithiasis
Right upper quadrant pain + jaundice + fever (Charcot triad)
ascending cholangitis
Be able to reproduce this chart.
