Gall Bladder

Question 1

Pigment Stones

Answer 1

-hemolytic anemia inc. risk for developing pigment stones

Question 2

Biliary Atresia

Answer 2

• pathology includes progressive destruction of biliary tree
• etiology remains unknown but may include infection, autoimmune destruction, or toxins
• histologic findings include cholestasis, bile duct proliferation, and variable inflammation and fibrosis
• tx: ursodeoxycholic acid is shown to slow progression and dec. need for liver transplant

Question 3

Primary Biliary Sclerosis

Answer 3

• autoimmune -> destruction of intralobular bile ducts
• classically seen in middle aged women
• pruritis
• AMA + (anti mitochondrial antibodies), including IgM
• associated with other autoimmune disease
• granulomatous lymphocytic cholangitis/florid duct lesion

Question 4

Primary Sclerosing Cholangitis

Answer 4

• associated with ulcerative cholitis
• male predominance
• onion skin bile duct fibrosis
• appears like rivers flowing between lakes on imaging
• hyper IgM
• cholangiography with large bile duct strictures
• MPO-ANCA, pANCA +
• cholestatic liver test profile

Question 5

Cholangiocarcinoma

Answer 5

• tumor of bile ducts
• malignant
• gland forming tumor with marked desmoplasia
• associated with primary sclerosing cholangitis