Gall Bladder Pathology Flashcards
1
Q
Cholelithiasis
A
Gall stone formation
2
Q
Percentage of silent gall stone
A
80%
3
Q
Types of gallstones
A
Cholesterol stones
Pigment stones
Mixed
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
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
6
Q
Cholesterol gall stones pathogénies
A
Supersaturation of bile by cholesterol
Excess Cholesterol precipitates
Nucleation of insoluble cholesterol
Accretion - cholesterol crystals form stones
7
Q
Pigment stone formation
A
Calcium salts of unconjugated bilirubin form
Hemolysis increases unconjugated bilirubin
8
Q
Cholesterol stones main location
A
In gall bladder
9
Q
Pure Cholesterol stones gross morphology
A
Pale yellow Round to oval Fine Hard external surface Solitary in general
10
Q
Cholesterol stones histology morphology
A
Soapy to touch with low specific gravity
Glistening appearance with radiating crystalline palisades
No laminations
11
Q
Pigment stone type
A
Black
Brown
12
Q
Black pigment stone
A
Sterile bile gall bladder forming stone
13
Q
Brown pigment stone
A
Infected bile in intra or extra hepatic bile ducts forming stones
14
Q
6Fs of risk factors for cholesterol gallstones
A
Female Forty Fertile (multiparous) Fat Flatulent Familial
15
Q
How do you know that a cholesterol stone was combined
A
Laminated cortex
black grey core with cholesterol
16
Q
How do you know that a stone is mixed
A
If wholly laminated
17
Q
When cholesterol forms majority of stone is it radiolucent or radio opaque
A
Radiolucent
At low cholesterol level it is radioopaque
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
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
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)
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
22
Q
Can gallstone lead to cancer
A
Yes
23
Q
Cholecystitis definition
A
Inflammation of the gallbladder
24
Q
Cholecystitis types
A
Acute calculous
acute acalculous
chronic cholecystitis
25
Acute calculous cholecystitis
90% Acute inflammation by obstruction of gallbladder neck or cystic duct by stone
26
Most common reason for cholecystectomy
Acute calculus cholecystitis
27
Acute calculous cholecystitis incidence
40+ years
| mostly females
28
Acute calculus cholecystitis Clinical presentation
Progressive spasmodic right upper quadrant abdominal pain or epigastric pain
```
Mild fever
anorexia
tachycardia
Vomiting
tender right upper abdomen
```
29
When do you have jaundice in a cute calculus cholecystitis
When additional Obstruction of common bile duct, Leucytosis increased serum ALP
30
acute calculous cholecystitis
| pathogenesis
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
```
31
acute calculous cholecystitis
| gross morphology
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)
32
acute calculous cholecystitis
| complications
Cholangitis ->septicemia
perforation with abscess formation
gallbladder rupture-> diffuse peritonitis
biliary enteric fistula
33
acute calculous cholecystitis
| prognosis
Good
| Mortality less than 1%
34
Treatment of acute calculous cholecystitis
Surgical
35
Acute acalculous cholecystitis
5-13% of acute cholecystitis
| No stone in gall bladder
36
Acute acalculous cholecystitis Predisposing condition
```
Post op after major non-biliary surgery
severe trauma
severe burns
multi system organ failure
septicemia
prolonged intravenous hyperalimentation
postpartum
```
37
How do you differentiate Acute acalculous cholecystitis from Acute calculous cholecystitis
More insidious
| Marked by primary disease
38
Acute acalculous cholecystitis pathogenesis
Ischemic damage to gall bladder
39
Causes of Acute acalculous cholecystitis
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
Mortality Acute acalculous cholecystitis
10%
| 50% in critically ill
41
Morphology of Acute acalculous cholecystitis
Same as Acute calculous cholecystitis but no stones
42
Acute acalculous cholecystitis complications
High incidence of perforation and gangrene
43
What bacteria can cause acute emphysematous cholecystitis
Clostridia
44
When can you have chronic cholecystitis
Sequel to mild to severe acute cholecystitis
De novo
90% associated with gallstones
45
Organisms associated with chronic cholecystitis
E. coli
| Enterococci
46
Symptoms of chronic cholecystitis
Same as In acute
47
Gross morphology of chronic cholecystitis
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
Micro morphology of chronic cholecystitis
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
What happens if numerous calcification in chronic cholecystitis
Porcelain gallbladder which is associated with increased incidence of carcinoma
50
What is a hydrops
Gallbladder filled with clear fluids
| shows atrophy , inflamed mucosa, and obstructed cystic duct
51
Choledocholithiasis and ascending cholangitis
Stones in biliary tree
52
Most common form of stones in Africa
Pigment
53
Clinical presentation Choledocholithiasis and ascending cholangitis
Asymptomatic
| Obstruction pain
54
Disease associated with Choledocholithiasis and ascending cholangitis
```
Pancreatitis
Cholangitis
Hepatic abscess
Secondary biliary cirrhosis
Acute calculus cholecystitis
```
55
CHolangitis definition
Infection of bile ducts
56
Cholangitis causes
```
Lesion obstructing blood flow
Choledocholithiasis
Catheterization
Tumors
Acute pancreatitis
Strictures
Fungi, bacteria, virus, parasites
```
57
Cholangitis clinical presentation
Fever
Chills
Abdominal pain
Jaundice
58
Cholangitis micro morphology
Acute inflammation of the wall of bile ducts
Neutrophils in lumen
May be suppurative
Hepatic abscess if infection get there
59
Why is cholangitis difficult to diagnose
Symptoms mostly from infection and not from cholestasis
60
Biliary atresia incidence
1:10,000 births
| 1/3 of infants presenting with jaundice
61
The most important cause of death from liver disease in children
Biliary atresia
62
Most common cause for liver transplant
Biliary atresia
63
What disease progresses rapidly to secondary biliary cirrhosis
Biliary atresia
64
Biliary atresia pathogenesis
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
Biliary atresia cause
Unknown
66
Factors included in biliary atresia
Viral infection (reovirus, CMV, rubella)
Genetic
Anomalous embryonic development
Polysplenism
CDV defects
Malrotation of bowel
Bowel atresia
67
Morphology of biliary atresia
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
Type 1 biliary atresia
Limited to common bile duct
69
Type 2 biliary disease
Limited to hepatic bile ducts
70
Type 3 biliary atresia
90% cases
Obstruction of bile ducts at or above the porta hepatis
71
Which type of biliary atresia is correctible and which one is not
Type 1 and 2 surgically correctable
Type 3 non correctible
72
Clinical presentation of biliary atresia
Neonatal cholestasis
Normal birth weight and postnatal gain weight
Normal stool at first, later acholic
73
Bio chem of biliary atresia
High bilirubin
Transaminase
High alkaline phosphatase
74
Biliary atresia prognosis
Death within 2 years if no correction
Transplant
75
Choledochal cysts
Congenital dilatation of common bile ducts
76
Presentation of Choledochal cysts
Jaundice
Recurrent abdominal pain
Carolis disease in adulthood
77
Choledochal cyst morph
Segmental or cylindrical dilatation of CBD
Choledochocoeles - Cystic lesiosn that can protrude into lumen of duodenum
78
Complication of choledochal cysts
```
Stone formation
Stenosis
Stricture
Pancreatitis
Obstructive bile complications in liver
Bile duct carcinoma
```
79
Benign epithelial tumor of gall bladder
Adenomas - tubular, papillary, tubulopapillary
80
Gall bladder adenomas morphology
Sessile
Pedunculated
Less than 1cm in diameter
81
Carcinoma of gall bladder prognosis
Bad because of late discovery
| Less than 1% survival over 5years
82
Gall bladder carcinoma morphology
Infiltrating or fungating
Infiltrating in fundus and neck of gall bladder
83
Histology of gall bladder carcinoma
Adenoca 90%
Squamous cell ca 5%
Carcinoid 1%
84
Gall bladder ca presentation
Insidious onset of jaundice
Abdominal pain
Anorexia
Vomiting
