Gallbladder Path II Flashcards
acute cholecystitis
common
-majority from gallstones
dehydration - AIDS infection - cryptosporidium > CMV
disease model of blockage
acute obstruction
stone impaction - increased pressure behind obstruction and ischemia
bacterial infection - invasive of mucosa - can penetrate and perforate
gangrenous necrosis - compression of wall vessels
sonographic murphys sign
gallstones
ultrasound gallstones
see shadows
HIDA scan
nuclear study
- IV dye to liver
- to biliary tree
- fills gallbladder normally
- then seen in small bowel
if obstruction
-no dye to gallbladder
acute or chronic cholecystitis with stone formation
ERCP
endoscopic retrograde cholangiopancreatography
risks - pancreatitis
scope inserted to small bowel - tip of scope - instrument that has light, needle with catheter (to biliary tree) - to inject dye
can also examine pancreatic duct
identify stones, tumors, carolis disease, PSC
can grab and remove stones
and also needle and core biopsies
red mucosa of gallbladder
with inflammation
-this hurts
if white - no inflammation
hydrops of gallbladder
obstruction of cystic duct with no inflammation - but creates thick mucous
inspissation
inspissation
mucous more viscous by extracting water
acute/ascending cholangitis
stasis/obstruction of biliary tract
secondary bacterial infection - e. coli, klebs, entero
move up biliary tree into liver bile duct system - can lead to liver abscesses
charcots triad
fever
jaundice
abdominal pain
with ascending cholangitis
reynolds pentad
fever, jaundice, abdominal pain, hypotension, mental status change
with ascending cholangitis - increased mortality
tx ascending cholangitis
drainage with ERCP
remove obstruction
chronic cholecystitis
majority associated
repeated bouts of acute inflammation
rokitansky aschff sinus
stiff, thick walls with variable inflammation of gallbladder
chronic cholecystitis
surface mucosa pulled down into wall of gallbaldder
glands surrounded by inflammatory cells
