Gallbladder and Esophagus Pathology Flashcards
Where are cholesterol gallstones most prevalent?
- Most prevalent in US and western Europe
- Also higher rates in Native Americans
Where are pigment gallstones most prevalent?
- Non-western populations
What is the main cause of pigment gallstones?
- Bacterial infections or parasitic infestations of the biliary tree
Where are pigment gallstones found?
- Sterile gallbladder
Where are brown gallstones found?
- Infected large bile ducts
Who are gallstones most often seen in?
- Females
- Fair skinned
- Fat
- Forty
- Fertile
- Family history
What is the major symptom of gallstones?
- Pain, often initiated after a fatty meal, localized to the RUQ or epigastrium (may radiate to right shoulder)
What are some severe complications of gallstones?
- Empyema
- Perforation
- Fistula
- Inflammation of the biliary tree
- Obstructive cholestasis
- Pancreatitis
What size of stones are the most dangerous and why?
- Smaller stones are more dangerous because they are able to move and obstruct the cystic or common ducts
What are gallstones associated with?
- Increased risk of gallbladder carcinoma
What is one of the main causes of acute cholecystitis?
- Obstruction of the neck of the gallbladder or the cystic duct by a stone
What are the most common symptoms of acute cholecystitis?
- Mild fever
- Anorexia
- Tachycardia
- Sweating
- Nausea
- Vomiting
What does hyperbilirubinemia suggest in acute cholecystitis?
- Obstruction of the common bile duct
What may cause chronic cholecystitis?
- A sequel to repeated bouts of mild to severe acute cholecystitis, but in many instances it develops in the apparent absence of antecedent attacks
What are the clinical features of chronic cholecystitis?
- Recurrent attacks of either steady epigastric or RUQ pain
- Will have nausea, vomiting, and intolerance for fatty foods
What complications are seen in both acute and chronic cholecystitis making diagnosis important?
- Bacterial superinfection with cholangitis or sepsis
- Gallbladder perforation with local abscess formation
- Gallbladder rupture with diffuse peritonitis
- BIliary enteric fistula
- Aggravation of preexisting medical illness, with cardiac, pulmonary, renal, or liver decompensation
- Porcelain gallbladder
What geographical distribution is seen with adenocarcinoma?
- Highest rates in US, UK, Canada, and Australia
Which group has the highest risk of adenocarcinoma?
- Caucasians
- 7x more likely in men
What are the risk factors for adenocarcinoma?
- Barrett esophagus
- Tobacco
- Radiation
- H. pylori
How does adenocarcinoma initially appear?
- As flat or raised patches in otherwise intact mucosa
Where is adenocarcinoma of the esophagus usually seen?
- Distal third of esophagus
What are the clinical features of adenocarcinoma?
- Usually discovered in evaluation of GERD or surveillance of Barrett esophagus
- Most commonly present with pain or difficulty in swallowing, progressive weight loss, hematemesis, chest pain, or vomiting
What is the geographical distribution of SCC?
- Iran
- Central China
- Hong Kong
What group has the highest risk of SCC?
- > 45
- Males 4:1
- African Americans are 8x more likely
What are some risk factors for SCC of the esophagus?
- Alcohol and tobacco
- Poverty
- Caustic esophageal injury
- Achalasia
- Tylosis
- Radiation
- Plummer-Vinson syndrome
- Diets that are deficient in fruits or vegetables
- Frequent consumption of hot beverages
Where is SCC of the esophagus usually seen?
- Upper 2/3 of the esophagus
How does someone with SCC present?
- Dysphagia
- Odynophagia
- Obstruction
- Patients will progressively change their diet from solids to liquids as the tumor grows
What are the symptoms of SCC of the esophagus?
- Dysphagia
- Odynophagia
- Obstruction
- Patients will alter diet to eat more liquids than solids due to tumor size
