Gallbladder Diseases Flashcards
What four conditions contribute to the formation of cholesterol gallstones
Super saturation of bio with cholesterol
hypomotility of the gallbladder
Accelerated cholesterol crystal nucleation
Hyper secretion of mucus in the gallbladder
Describe the process of cholesterol crystal nucleation
if cholesterol concentrations exceed the solubilizing capacity of super saturation, free cholesterol disperses and form solid and monohydrate crystals
describe the process of hyper secretion of mucus in the gallbladder
traps Nucleated crystals in the gallbladder; Eventually these aggregates get big enough to form a stone
Describe the pathogenesis Of Strawberry Gallbladder
AKA cholesterolosis
Cholesterol stones diffuse into the mucosal layer Leading to accumulation of cholesterol esters and foamy macrophages in the lamina propria
this gives the mucosal surface a strawberry like characteristic
Choleithiasis Are usually of what pigment
black to Brown
list the components of Gallstones
heterogenous mixures of Insoluble calcium salts, unconjugated bilirubin, and inorganic calcium salts
patients with these diseases are at increased risk for developing gallstones
Chronic hemolytic anemia, E coli biliary infections, Ascaris lumbricoides (liver fluke)
Describe the pathogenesis of acute cholesystitis
disruption & irritation of the protective glycoprotein mucus layer
Typically caused by stone obstruction
Prospect Landon’s release within the wall of a distended gallbladder contribute to the mucosal inflammation and cause gallbladder dismotality
Wood enzyme is elevated and acute cholesystitis
Alkaline phosphatase
Describe the gross Features of acute cholecystitis
Bright red Discoloration
if gangrenous type: Green black necrotic perforations
Infection by wood microbes Would you expect to find in cases of cholesystitis
Clostridia and coliforms May cause a cue emphasimitous cholecystitis
What’s secondary complications can arise from acute cholecystitis
Perforation, Biliary-enteric Fistula, obstructive Cholastasis, pancreatitis, diffuse peritonitis, cholangitis
Acute a calculus cholecystitis Is associated with what Medical conditions
post operation
trauma (severe)
burns
Immunosuppression
Diabetes mellitus
sepsis with hypotension
postpartum states
what is the pathogenesis of acute a calculus cholecystitis
ischemic mechanism: occulusion of cystic artery and inflammation of the GB wall
accumulation of cholesterol
Acute a calculus cholecystitis is usually asymptomatic. What causes it to become symptomatic
gangrene necrosis and perforation
90% of chronic cholecystitis cases are associated with what gallbladder disease
cololithiasis
what pathogens are commoly assoc. w/ Chronic cholecystitis
E coli; enterococci
What are gross characteristics of chronic cholecystitis
Dense fibrous adhesions may be visible and a very thick gallbladder wall
what are the histological features of chronic cholesystitis
Subsorosul fibrosis, Mucosal hyperplasia And fusion CAN FORM rOKIT oANSKY-aSCHOFF SINUSES
In more severe cases:
Dystrophic calcification within The wall; porcelain gallbladder
What is the definition of choledocholithiasis?
presence of stones within the bile ducts of the biliary tree
choledocholithiasis Is associated with what
bacterial infections of the bile ducts
What is ascending cholangitis
Infection of intra hepatic bile ducts: usually enteric gram negative bacteria: E. coli, Klebsiella, Bacteroides or Enterobacter
What would you expect to see microscopically for choledocholithiasis
acute inflammation of the biliary ducts with neutrophilic infiltration in the women
What are the most common benign tumors in the gallbladder
adenomas; inflammatory polyps; adenomyosis
What are the histological features of Adenomyosis
Hyperplasia of muscularis and hyperplasia of intraural glands
most common loctatoin: GB fundus
Gallbladder carcinoma is associated with what North American epidemiological factors
indigenous and Hispanic populations; twice as common in females
Where is gallbwater carcinoma found and what cancer is it
usually found in fundus
GB carcinomas are actually adenocarcinomas
gallstones present in 95% of cases
Describe the histological features of infiltrating gallbladder carcinoma Subtype
diffuse thickening of gallbladder wall
describe the histological features of the exophytic subtype of gall water carcinoma
Lesions grow into the lumen in a cauliflower like fashion
gallbladder carcinoma is associated with what mutations
gain of function mutations of the EGF receptor including HER2, RAS
loss-of-function mutations in TP53
What are the gross features of gallbladder adenocarcinoma
Normal Gallbladder: hollow organ
for a malignant GB, The Oregon cavity is going to be filled with a giant white mass
List biliary disease nomenclature
“Chol”: Bile
“Cholecyst”: gallbladder
“Cholangi”: Bile duct
“Choledoco”: common bile duct
Anemia is associated with what kind of gallstones
bill of Reuben Stones
what are the clinical manifestations of cholithiasis
Intermittent In the right upper quadrant Subsequent to a fatty food meal
What is Boas’ sign
right upper quadrant pain that radiates to the shoulder
what is the best way to diagnose cholithiasis
ultrasound of the right upper quadrant
what substance can be used for the management of cholithiasis If surgery is contraindicated
Urso deoxycolic acid
What is the pathology of cholecystitis
Obstruction and inflammation of the cystic duct
What are the clinical manifestations of cholesystitis
persistent RUQ w/ fever & leukocytosis
+ Murphy sign: inspiratory arrest on palpation
+ Bsoas sign
What is the pathological mechanism of referred shoulder pain in gallbladder diseases
Referred pain diaphragmatic irritation via phrenic nerve
How is colissa styles diagnosed with Radiography
cholescintigraphy:
contrasting agent: hepatic iminodiacetic acid (HIDA)
If cystic duct is obstructed, contrast will not fill the gallbladder
Untreated long term cholecystitis can cause what complications to arise
gangerene & clostridia infection (emphysematous cholecystitis)
What antibiotic is used for the treatment Of Clostridia
ampicillin subactum
what are a risk factors for emphasimitis cholecystitis
diabetes mellitus, vascular compromise, immunosuppression
What is the definition of a calculus cholecystitis
Inflammation of the gallbladder and the absence of a gallstone
what patient populations are high risk for a calculus cholecystitis
burn victims
trauma pts.
pt. on parenteral nutrition
sepsis
AIDS pts. (w/ active CMV infection)
What is the most common cause of choledocholithiasis
obstruction of the common bile duct by a gallstone
What kind of stones Are associated with primary obstruction of the CBD
Stones that form directly inside the CBD; brown pigment
what kind of stones are associated with secondary obstruction of the cbd
Stones that originate from the gallbladder and travel to the common bile duct
What abnormal lab findings would you expect to find for cases of suspected choledocholithiasis
hyperbolo rubenemia, elevated serum levels of ALP and GGT
Gallstone obstruction in the pancreatic duct Would cause elevated serum levels of what enzyme
Pancreatic lip base
What is ascending colingitis
let ascending infection of the ductal system from gut flora
What pathogens are implicated for suspected ascending cola anginous
E coli, klebsiella, enterobacter, enterococci
What are the clinical manifestations of ascending colanginess
Charcot’s triad & Reynold’s pentad
What are the components of Reynolds Pintad
Hypertension and confusion
what abnormal lab findings would be found for ascending cola anginas
leukocytosis
elevated ALP, AST, & ALT
cholangits is usually secondary to what
choledocholithiasis
What is the definition of a gallstone ileus
enerocholecystic fistula Causing secondary small bowel obstruction
Where are small bowel obstructions associated with gallstones usually located
ileocecal valve
What can be seen radiographically in a gallstone ileus
a gallstone outside of the gallbladder
pneumobilia
What is the definition of biliary dyskinesia
Failure of the gallbladder to fully contract and eject bile; heart failure equivalent of the gallbladder
What comorbidities are associated with biliary dyskinesia
PUD and ischemic heart disease
Gallbladder cancer is commonly associated with what
Chronic cholesystitis
What is the mechanism of autoimmune biliary diseases
T cell mediated autoimmunity attack on intra hepatic bile ducts
Granulomatous inflammation leading to cholestasis
What are the clinical manifestations of autoimmune biliri disease
the most common in middle aged women
Intense pruritus
dermal hyperpigmentation & xanthelasma
What drugs can be used for management of autoimmune biliary diseases
ursodeoxycolic acid (first-line)
tacrolimus for immunosupression
What is the pathogenesis of primary sclerosis cholangitis
Inflammation, fibrosis, and narrowing of intra and extra hepatic bile ducts
What antibody is elevated for autoimmune biliary disease
antimitochondrial (anti-AMA)
PSC Is highly associated with what GI disease
Ulcerative colitis & Inflammatory Bowel Disease
Psc is associated with an increased risk for what
colangio Adino carcinoma
What lab findings are indicative of PSC
Elevated serum levels of:
ALP
p-ANCA
hyper-IgM
HLA B8
HLA DR3
AMA always negative
PBC is associated with increased risk for what malignancy
hepatocellular carcinoma
Compare and contrast the clinical manifestations of PBC and PSC
PBC: Primarily affects middle aged women that present with symptoms of pruritus, hyperlipidemia, jaundice, & xanthelasmas
PSC: UC predisposition and hepatomegaly
What is calangio carcinoma
Cancer of the bioduct epithelium
What are risk factors for colangio carcinoma
Psc, cystic liver disease, clonorchis, HCV, gallstone disease
What is a specific clinical manifestation of colangio carcinoma
Clay pale colored stools and dark urine
