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Pathology > Gallbladder And Biliary Tree > Flashcards

Gallbladder And Biliary Tree Flashcards

1
Q

Cholesterol stone formation is enhanced by

A

Hypomobility of gallbladder promoting nucleation
Mucus hypersecretion with trapping of crystals
Cholesterol exceeding solubilizing capacity of bile and crystalization

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2
Q

Precipitation of insoluble calcium in unconjugated bilirubinate salts

A

Pigment stone

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3
Q

Exclusive in the gallbladder
Pale yellow inc proportion of calcium carbonate, phosphates and bilirubin
gray white to black discoloration
ovoid firm radiolucent but 20% with calcium carbonate making them radiopaque

A

Cholesterol stone

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4
Q 
Arise anywhere in biliary tree 
Black and brown 
Black in sterile gallbladder
Brown in infected
Calcium salt of inconjigated bilirubin 
Small fragile numerous  with greasy and soaplike consistency from FA 
Radiopaque black, brown radiolucent
A

Pigment stone

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5
Q

red blotchy violaceous color with subserosal hemorrhage of GB
serosa covered by fibrinopurulent exudate
90% of cases stones are present often obstructing neck of bladder or cystic duct
Lumen is filled with cloudy turbid bile containing fibrin, blood and pus

A

Acute cholecystitis

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6
Q

Pus in gallbladder

Thick edematous hyperemic

A

empyema

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7
Q

Green black necrotic organ of gallbladder

A

Gangrenous cholecystitis

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8
Q

Acute inflamm of gallbladder with stones by obstruction of neck or cystic duct
Due to chemical irritation and inflammation
Occur in the absence of bacterial infection

A

acute calculous cholecystitis

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9
Q

Most common major complication of gallstone and most common reason for emergency OR

Biliary pain >6 hours severe and steady

A

acute calculous cholecystitis

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10
Q

Cholecystitis develps bec of hydrolysis of lecithin to lysolecithin which is toxic to mucosa

Protective glycoprotein mucous layer is disrupted exposing epithelium to detergent action of

A

bile salt and prostaglandin

distention and inc intraluminal pressure compromise blood flow to mucosa

Occur in absence of bacteria

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11
Q

Predisposing injury to acute acalculus chole

A 
Major nonbiliary
Severe trauma
Severe burns
Sepsis 
Dehydration 
Gallbladder stasis
Sludging
Vasc compromise
Bacterial contamination
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12
Q

Predisposes px to chronic inflamm and stone formation

A

Supersaturation of bile

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13
Q

stones within biliary tree

sx develop because of

A

choledocholithiasis

biliary obstruction
cholangitis
hepatic abscess
chronic liver disease with secondary biliary cirrhosis
acute calculous chole
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14
Q

acute inflamm of wall of bile duct by bacterial infection of sterile lumen

A

cholangitis

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15
Q

Propensity of bacteria in biliary tree to infect intrahepatic biliary duct

Caused by E coli, Klebs, enteroccoci, clostridium, fasciola, schistosomiasis, clonorchis, opisthorchis or cryptosporidiosis

A

Ascending cholangitis

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16
Q

Complete obstruction of bile flow caused by destruction or absence of all or part of extrahepatic duct

Major cause of neonatal cholestasis
Most freq cause of death from liver disease in early childhood

A

Biliary atresia

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17
Q

Inflammation and fibrosing stricture of hepatic or common bile duct
Inflamm of major intrahepatic bile duct with progressive destruction of intrahepatic biliary tree
Florid features of biliary obstruction on liver biopsy ductular reaction, portal tract edema and fibrosis and parenchymal cholestasis
Periportal fibrosis and cirrhosis within 3-6 mos of birth

A

Biliary atresia

Dx biopsy
Tx liver transplant

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18
Q

Most freq malignant tumor of biliary tract

2-6x W in 7th decade

A

Gallbladder carcinoma

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19
Q

Most of the gallbladder cancers are

A

adenocarcinoma

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20
Q

Exhibit exophytic or infiltrating growth pattern
Infiltrating pattern is more common poorly defined area of diffuse thickening and induration of gallbladder
Scirrhous very firm irregular cauliflower-like masa invading underlying wall

A

Gallbladder cancer

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21
Q

Adenocarcinoma that arise from cholangiocyte lining intrahepatic and extrahepatic biliary duct

2/3 are extrahepatic at the hilum aka

A

Cholangiocarcinoma

Klatskin tumor

22
Q

Risk factors of cholangiocarcinoma

A

Primary sclerosing cholangitis
Fibropolycystic disease of biliary tree
Clonorchis sinensis
Opisthorchis viverrini

Cause chronic cholestasis and inflamm promoting somatic mutations

23
Q

Cholangiocarcinoma is associates with mutations in the ff genes

A

KRAS
BRAF
TP53

24
Q

Adenocarcinoma with well formed glands accom by abundant fibrous stroma desmoplasia with firm gritty consistency
Absent bile pigment and hyaline inclusion from tumor with prominent intracellular mucin

A

Cholangiocarcinoma

Intra- nonspecific like HCC

Extra- jaundice, acholic, nausea, vomiting

Inc ALP and aminotrans

Transplantation is contraindicated

25
Q

Cholangiocarcinoma spreads to the abdomen by

A

Invasion of peribiliary nerves

Greater propensity for spread than HCC

26
Q

Most common malignancy of liver

More common than primary hepatic neoplasia
Most common primary sources:
-colon, breast, lung and pancreas

A

Liver metastases

27
Q

90% are cholesterol stones
Contain more than 50% of crystalline cholesterol monohydrate
10% are pigment stones
Composed of bilirubin calcium salts

A

Cholelithiasis

28
Q

Supersaturation causes nucleation into solid cholesterol monohydrate crystals

A

Cholesterol stones

29
Q

Elevated levels of unconjugated bilirubin in bile such as hemolytic syndromes, severe ileal dysfunction and bacterial contamination

A

Pigment stones

30
Q

sterile gallbladder bile

Composition: oxidized calcium salts of unconjugated bilirubin

Radiopaquev

A

Black stones

31
Q

Infected intrahepatic or extrahepatic ducts
Composition: pure calcium salts of unconjugated bilirubin
Radiolucent

A

Brown stones

32
Q

Due to ischemia

Risk factors: sepsis, immunosupression, major trauma and burns, diabetes mellitus, infections

A

Acute Acalculous Cholecystitis

33
Q

GB exudate is virtually pure pus

A

Acute cholecystitis

Gallbladder empyema

34
Q

GB transformed into a green-black necrotic organ

A

Gangrenous cholecystitis

35
Q

Invasion of gas-forming organisms, notably clostridia and coliforms

A

Emphysematous cholecystitis

36
Q

Outpouchings or the mucosal epithelium through the GB wall

A

Rokitansky-Aschoff sinuses

37
Q

Extensive dystrophic calcification in GB wall

Increased incidence of associated cancer

A

Porcelain gallbladder

38
Q

Massively thickened GB wall

Chronic inflammatory with necrosis and hemorrhage

A

Xanthogranulomatous cholecystitis

39
Q

Atrophic, chronically obstructed gallbladder containing only clear secretions

A

Hydrops of the gallbladder

Chronic cholecystitis

40
Q

Most common malignancy of the extrahepatic biliary tract

Most important risk factor: gallstones

Most common sites of involvement: fundus and neck

A

Gallbladder adenocarcinoma

41
Q

Excessive accumulation of body iron, most of which is deposited in parenchymal organs such as the liver and pancreas

A

Hemochromatosis

42
Q

Homozygous recessive inherited disorder

A

Primary hemochromatosis

43
Q

Due to parenteral iron overload, transfusion, RBC anomalies, chronic liver disease

A

Acquired hemochromatosis (hemosiderosis)

44
Q

Hepatomegaly: HP micronodular cirrhosis
Diabetes mellitus
Bronze skin pigmentation

A

Hemochromatosis

45
Q

Liver, pancreas, myocardium, pituitary, adrenal, thyroid and parathyroid, joints, skin

Detected using Prussian blue stain

A

Deposition of hemosiderin

46
Q

Autosomal recessive disorder

Impaired copper excretion into bile

Failure to incorporate copper into ceruloplasmin

Accumulation of toxic levels of copper in many tissues and organs (liver, brain, eye)

A

Wilson disease

47
Q 
Hepatic changes
fatty change (steatosis)
acute hepatitis
chronic hepatitis
massive liver necrosis

Atrophy and cavitation of putamen and basal ganglia

A

Wilson’s disease

48
Q

Eye lesion of Wilson

Green to brown deposits of copper in Descemet’s membrane in the limbus of the cornea

A

Kayser-Fleischer rings

49
Q

Obstruction of two or more hepatic veins

Characterized by liver enlargement, pain and ascites

Associations include:
Polycythemia vera
Inherited disorders of coagulation
Paroxysmal nocturnal hemoglobinura

A

Budd-Chiari Syndrome

50
Q

Acute thrombosis of hepatic veins or hepatic portion of IVC
Liver is swollen and red-purple
Tense liver capsule
Severe centrilobular congestion and necrosis

A

Budd-Chiari Syndrome

51
Q

Inflammatory autoimmune disease mainly affecting the intrahepatic bile ducts

Laboratory studies:
elevated alkaline phosphatase and cholesterol
(+) for antimitochondrial antibodies

A

Primary biliary cirrhosis

52
Q

Portal tracts are infiltrated by lymphocytes, macrophages, plasma cells, and eosinophils

Florid duct lesions
Non caseating granulomatous reaction to a bile duct undergoing destruction

A

Pre-Cirrhotic Phase

Primary Biliary Cirrhosis

Pathology (24 decks)

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