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Gastrointestinal Module > Gall Bladder Pathology > Flashcards

Gall Bladder Pathology Flashcards

1
Q

Cholelithiasis

A

Gall stone formation

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2
Q

Percentage of silent gall stone

A

80%

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3
Q

Types of gallstones

A

Cholesterol stones
Pigment stones
Mixed

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4
Q

Cholesterol stones risk factors

A 
Age
Female sex hormones ( oral contraceptives, pregnancy ) 
Clofibrate (anticholesterol) 
Obesity 
Rapid weight loss
Gall bladder stasis 
Inborn disorder of bile salt synthesis 
Hyperlipidemia
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5
Q

Pigment stones causes

A

Chronic hemolytic anemia
Biliary infections (e coli, ascaris, opisthorchis sinensis)
Severe iléal disease
Cystic fibrosis I’m pancreatic insufficiency

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6
Q

Cholesterol gall stones pathogénies

A

Supersaturation of bile by cholesterol
Excess Cholesterol precipitates
Nucleation of insoluble cholesterol
Accretion - cholesterol crystals form stones

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7
Q

Pigment stone formation

A

Calcium salts of unconjugated bilirubin form

Hemolysis increases unconjugated bilirubin

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8
Q

Cholesterol stones main location

A

In gall bladder

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9
Q

Pure Cholesterol stones gross morphology

A 
Pale yellow 
Round to oval 
Fine
Hard external surface 
Solitary in general
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10
Q

Cholesterol stones histology morphology

A

Soapy to touch with low specific gravity
Glistening appearance with radiating crystalline palisades
No laminations

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11
Q

Pigment stone type

A

Black

Brown

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12
Q

Black pigment stone

A

Sterile bile gall bladder forming stone

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13
Q

Brown pigment stone

A

Infected bile in intra or extra hepatic bile ducts forming stones

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14
Q

6Fs of risk factors for cholesterol gallstones

A 
Female 
Forty
Fertile (multiparous)
Fat
Flatulent 
Familial
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15
Q

How do you know that a cholesterol stone was combined

A

Laminated cortex

black grey core with cholesterol

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16
Q

How do you know that a stone is mixed

A

If wholly laminated

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17
Q

When cholesterol forms majority of stone is it radiolucent or radio opaque

A

Radiolucent

At low cholesterol level it is radioopaque

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18
Q

Black pigment stone gross morphology

A 
50 to 75% radio opaque
Calcium salts of unconjugated bilirubin
 calcium carbonate 
calcium phosphate 
mucin
 multiple stones in general 
Crumbles if pressed
Spiculated
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19
Q

Brown stonepigment morphology

A 
Smooth surface 
Moulded 
multifaceted 
multiple stones 
bile pigment and cholesterol salts 
few centimeters size 
Inflammation with  exudate  or pus
Can fill entire  gallbladder
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20
Q

Clinical presentation of gall stones

A 
Asymptomatic most cases
 biliary colic ( abdominal pain, spasm ) 
Mirrizis syndrome (Large stone in Hartmans pouch with compression of common hepatic duct causing jaundice and impairment of liver function)
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21
Q

Complications of gall stones

A 
Cholecystitis
Cholangitis 
 cholestasis 
Empyaema of gallbladder
 perforation 
fistula 
pancreatitis
Gall stone ileus (after cholecystitis and fistula to small intestine, stone erodes in small intestine and obstruction)
Mucocoele of GB
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22
Q

Can gallstone lead to cancer

A

Yes

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23
Q

Cholecystitis definition

A

Inflammation of the gallbladder

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24
Q

Cholecystitis types

A

Acute calculous
acute acalculous
chronic cholecystitis

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25
Q

Acute calculous cholecystitis

A

90% Acute inflammation by obstruction of gallbladder neck or cystic duct by stone

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26
Q

Most common reason for cholecystectomy

A

Acute calculus cholecystitis

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27
Q

Acute calculous cholecystitis incidence

A

40+ years

mostly females

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28
Q

Acute calculus cholecystitis Clinical presentation

A

Progressive spasmodic right upper quadrant abdominal pain or epigastric pain

Mild fever 
anorexia
 tachycardia 
Vomiting 
 tender right upper abdomen
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29
Q

When do you have jaundice in a cute calculus cholecystitis

A

When additional Obstruction of common bile duct, Leucytosis increased serum ALP

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30
Q

acute calculous cholecystitis

pathogenesis

A

initial inflammation is chemical
secondary infection occurs

Chemical irritation and inflammation of gallbladder
obstruction to bile flow 
release of mediators of inflammation 
GB dysmotility 
distention 
ischemia
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31
Q

acute calculous cholecystitis

gross morphology

A

Enlarged, tense gallbladder
subserosal hemorrhages fibrin & suppuration
Obstructive stone in neck or cystic duct
cloudy and turbid bile (may be frank pus) hemorrhage in the wall
Empyaema of gallbladder

gangrenous cholecystitis (green black necrotic gallbladder)

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32
Q

acute calculous cholecystitis

complications

A

Cholangitis ->septicemia
perforation with abscess formation
gallbladder rupture-> diffuse peritonitis
biliary enteric fistula

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33
Q

acute calculous cholecystitis

prognosis

A

Good

Mortality less than 1%

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34
Q

Treatment of acute calculous cholecystitis

A

Surgical

35
Q

Acute acalculous cholecystitis

A

5-13% of acute cholecystitis

No stone in gall bladder

36
Q

Acute acalculous cholecystitis Predisposing condition

A 
Post op after major non-biliary surgery 
severe trauma 
severe burns 
multi system organ failure 
septicemia 
 prolonged intravenous hyperalimentation 
postpartum
37
Q

How do you differentiate Acute acalculous cholecystitis from Acute calculous cholecystitis

A

More insidious

Marked by primary disease

38
Q

Acute acalculous cholecystitis pathogenesis

A

Ischemic damage to gall bladder

39
Q

Causes of Acute acalculous cholecystitis

A

Dehydration and multiple blood transfusion increasing pigments

gallbladder stasis ,accumulation of biliary sludge, viscous bile gallbladder mucus -> obstruction in absence of stone

Inflammation and edema of wall-> reduced blood flow
Bacterial contamination of bile from gut with generation of lysolecithin

40
Q

Mortality Acute acalculous cholecystitis

A

10%

50% in critically ill

41
Q

Morphology of Acute acalculous cholecystitis

A

Same as Acute calculous cholecystitis but no stones

42
Q

Acute acalculous cholecystitis complications

A

High incidence of perforation and gangrene

43
Q

What bacteria can cause acute emphysematous cholecystitis

A

Clostridia

44
Q

When can you have chronic cholecystitis

A

Sequel to mild to severe acute cholecystitis

De novo

90% associated with gallstones

45
Q

Organisms associated with chronic cholecystitis

A

E. coli

Enterococci

46
Q

Symptoms of chronic cholecystitis

A

Same as In acute

47
Q

Gross morphology of chronic cholecystitis

A

Normal or contracted gall bladder size due to fibrosis or enlarged gall bladder due to obstruction

serosa normal or dull
Invariably Thick wall
lumen generally with stones
Mucosa preserved but atrophy may be present

48
Q

Micro morphology of chronic cholecystitis

A

Inflammation of wall
infiltration by lymphocytes, plasma cells , macrophages
cholesterol laden macrophages in lamina propria

fibrosis presents
outpouching of epithelium through wall -> rokitansky-aschoff sinuses

49
Q

What happens if numerous calcification in chronic cholecystitis

A

Porcelain gallbladder which is associated with increased incidence of carcinoma

50
Q

What is a hydrops

A

Gallbladder filled with clear fluids

shows atrophy , inflamed mucosa, and obstructed cystic duct

51
Q

Choledocholithiasis and ascending cholangitis

A

Stones in biliary tree

52
Q

Most common form of stones in Africa

A

Pigment

53
Q

Clinical presentation Choledocholithiasis and ascending cholangitis

A

Asymptomatic

Obstruction pain

54
Q

Disease associated with Choledocholithiasis and ascending cholangitis

A 
Pancreatitis 
Cholangitis 
Hepatic abscess 
Secondary biliary cirrhosis 
Acute calculus cholecystitis
55
Q

CHolangitis definition

A

Infection of bile ducts

56
Q

Cholangitis causes

A 
Lesion obstructing blood flow 
Choledocholithiasis 
Catheterization 
Tumors
Acute pancreatitis 
Strictures
Fungi, bacteria, virus, parasites
57
Q

Cholangitis clinical presentation

A

Fever
Chills
Abdominal pain
Jaundice

58
Q

Cholangitis micro morphology

A

Acute inflammation of the wall of bile ducts
Neutrophils in lumen
May be suppurative
Hepatic abscess if infection get there

59
Q

Why is cholangitis difficult to diagnose

A

Symptoms mostly from infection and not from cholestasis

60
Q

Biliary atresia incidence

A

1:10,000 births

1/3 of infants presenting with jaundice

61
Q

The most important cause of death from liver disease in children

A

Biliary atresia

62
Q

Most common cause for liver transplant

A

Biliary atresia

63
Q

What disease progresses rapidly to secondary biliary cirrhosis

A

Biliary atresia

64
Q

Biliary atresia pathogenesis

A

Mostly children born intact with biliary tree which becomes inflamed and and destruction in few weeeks

Few casss where baby born with already damaged biliary tree

65
Q

Biliary atresia cause

A

Unknown

66
Q

Factors included in biliary atresia

A

Viral infection (reovirus, CMV, rubella)
Genetic
Anomalous embryonic development

Polysplenism
CDV defects
Malrotation of bowel
Bowel atresia

67
Q

Morphology of biliary atresia

A

Inflammation and fibrosis of hepatic or common bile duct

Periductular inflammation.

Destruction of intrahepatic biliary tree

Florid bile duct destruction

Portal tract edema and fibrosis

68
Q

Type 1 biliary atresia

A

Limited to common bile duct

69
Q

Type 2 biliary disease

A

Limited to hepatic bile ducts

70
Q

Type 3 biliary atresia

A

90% cases

Obstruction of bile ducts at or above the porta hepatis

71
Q

Which type of biliary atresia is correctible and which one is not

A

Type 1 and 2 surgically correctable

Type 3 non correctible

72
Q

Clinical presentation of biliary atresia

A

Neonatal cholestasis

Normal birth weight and postnatal gain weight

Normal stool at first, later acholic

73
Q

Bio chem of biliary atresia

A

High bilirubin
Transaminase
High alkaline phosphatase

74
Q

Biliary atresia prognosis

A

Death within 2 years if no correction

Transplant

75
Q

Choledochal cysts

A

Congenital dilatation of common bile ducts

76
Q

Presentation of Choledochal cysts

A

Jaundice
Recurrent abdominal pain

Carolis disease in adulthood

77
Q

Choledochal cyst morph

A

Segmental or cylindrical dilatation of CBD

Choledochocoeles - Cystic lesiosn that can protrude into lumen of duodenum

78
Q

Complication of choledochal cysts

A 
Stone formation 
Stenosis 
Stricture
Pancreatitis 
Obstructive bile complications in liver 
Bile duct carcinoma
79
Q

Benign epithelial tumor of gall bladder

A

Adenomas - tubular, papillary, tubulopapillary

80
Q

Gall bladder adenomas morphology

A

Sessile
Pedunculated
Less than 1cm in diameter

81
Q

Carcinoma of gall bladder prognosis

A

Bad because of late discovery

Less than 1% survival over 5years

82
Q

Gall bladder carcinoma morphology

A

Infiltrating or fungating

Infiltrating in fundus and neck of gall bladder

83
Q

Histology of gall bladder carcinoma

A

Adenoca 90%

Squamous cell ca 5%

Carcinoid 1%

84
Q

Gall bladder ca presentation

A

Insidious onset of jaundice

Abdominal pain

Anorexia

Vomiting

Gastrointestinal Module (15 decks)

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