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gallbladder pathology Flashcards

1
Q

cholecystitis etiology

A

stones in the GB can lead to acute cholecystitis. Characterized by retention of bile and secondary infection by E. coli/bacteroids. stones in cystic duct in 80% of cases

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2
Q

acute cholecystitis etiology

A

most often caused by cholelithiasis causing a blockage of the cystic duct

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3
Q

cholecystitis pathophysiology

A

GB walls become inflamed and extreme damage may occur leading to necrosis or rupture

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4
Q

when can acalculous cholecystitis occur?

A

With trauma to the area or in debilitated pts, inflamation and infection can occur in the absence of stones. 10-20 % of cholecystitis cases

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5
Q

acalculous cholecystitis risk factors

A

can result from obstructing tumors, inadequate blood supply, seen in pts with CAD, trauma, immunosuppression,anorexia nervosa (dt bile stasis)

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6
Q

s/sx of acute cholecystitis

A

pain is initially abrubt, colicky, and becomes constant and more severe in the RUG. Can have referred pain in scapula region.
Low grade fever, N/V, diarrhea

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7
Q

infectious agents of cholecystitis

A

E.coli, klebsiella, pseudomonas, B. fragilis, enterococcus

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8
Q

lab results for acute cholecystits

A

raised hepatocellular liver enzymes AST/ALT, high WBC count, Alk Phos very high

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9
Q

histology of acute cholecystitis

A

friable and ulcerated mucosa, edema, infiltration of neutrophils and monocytes

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10
Q

comapare and contrast bile stones

A

cholesterol stones-mostly cholesterol, most common, radiolucent
pigment stones-dark bile
mixed

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11
Q

composition of cholesterol stones

A

light yellow–dark green or brown, tiny central dark spot.
usu oval, several mm- 2-6 cm
may present as single stone (most common) or several
must be 80% cholesterol or more

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12
Q

gallstone risk factors

A

4 Fs: Fat, Female (dt estrogen), Forty+, Fertile
AND
-race (esp american indian women)
-genetics
-crohns (decreased reabsorption of bile salts)
-parenteral nutrition
-rapid weight loss

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13
Q

cholesterol stone formation

A

too much cholesterol, not enough bile salts in bile.
ALSO additional proteins present in bile and lowered gall bladder emptying ability
-estrogen does all of these things

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14
Q

components of mixed stones

A

20-80% cholesterol
calcium carobonate, bilirubin, bile pigments
may be visible on Xray

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15
Q

components of pigment stones

A

small, dark, made of bilirubin and calcium salts,
less than 20% bile
depending on Ca content, mb vivible on Xray
can be single, but not as commonly large single like cholesterol stones

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16
Q

what is cholesterolosis?

A

abnormal deposition of cholesterol/triglyceride laden macrophages in lamina propria of GB
bule, lifiting epithelium overlying them
-associated with chronic cholelithiasis

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17
Q

clinical significance of cholesterolosis

A

generally no sx, alone mb no clinical significance
no evidence that this condition on its own predisposes pts to cholelithiasis/cholecystitis (though it often shows up with these conditions)

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18
Q

strawberry gallballder

A

dt triglyceride laden macrophages (see cholesterolosis)

can be localized or extensive and diffuse. Diffuse and with mucosal involvement is known as “strawberry galbaldder”

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19
Q

chronic cholecystitis etiol

A

in 1/3 to 1/4 , bacteria can be cultured from fluid in the GB
-not always associated with acute cholecystitis attacks, but there mb a hx of acute attacks

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20
Q

chronic cholecystitis risk factors

A

same population as acute, usu associated with cholelithiasis

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21
Q

porcelain GB etiol

A

chronic cholecystitis present for long enough that GB wall hardens and calcifies. morphological variant of chronic choleystits. Predisposes to cancer, so removal recommended.
Laparosopic removal contraindicated.

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22
Q

Rokitansky-Aschoff sinuses

A

outpouchings of mucosa thru muscle of GB wall are characteristic, but not diagnostic (cholelithiasis, cystitis)

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23
Q

choledocolithiasis etiol

A

Gallstone that has moved into the common bile duct. Obstruction of bile at this point may lead to abdominal pain, jaundice

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24
Q

ascending cholangitis etiol

A

usu dt obstruction/stricutre in common bile duct, bacteria from duodenum grow in static bile and ascend biliary tree into liver. life threatening infection. Gallstones noted in 70-90% of cases

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25
obstruction of pancreatic duct by gallstone
a stone in the ampulla of Vater can lead to acute pancreatitis
26
ascending cholangitis complications
irreversible shock with multiple organ failure dt sepsis, before 1980, mortality rate was greater than 50%, but after it was 10-30% dt improved diagnostic /tx measures.
27
MRCP
magnetic resonance cholangiopancreatogrophy, visualizes pancreatic and billiary ducts
28
Ascending cholangitis histo
secondary sclerosis cholangitis secondary to ascending cholangitis shows onion-skin like periductal fibrosis (just like PSC)
29
Gallbladder carcinoma risk factors
strongly associated with gallstone dz. However, a pt with stones has a relatively low risk of adenocarcinoma. Usu Female, 70s. Porcelain GB is potentially a higher risk factors , but it is relatively rare
30
gall bladder carcinoma types
majority are well differetiated adenocarcinomas also -papillary form of adenocarcinoma -poorly differetiated adenocarcinoma -well differentiated with squamous metaplasia
31
risk factors for carcinoma of extraheptatic bile ducts
ulcerative colitis (+/- PSC) choledocal cysts parasites gallstones
32
intestinal type adenomcarcinoma of GB
we see goblet cell rich areas that should only be in bowel
33
pancreatic tissue types
exocrine (acini of pyramidal cells with ducts) and endocrine (islets of langerhans, making insulin, glucagon...)
34
Acute pancreatitis etiology
women more likely to have gallstone pancreatitis men more likely t have alcohol induced pancreatitis abscess formation is a possible complication mb due to ischemia, drug toxicity , infection
35
tx and outcomes of pancreatitis
mild: treated with IV fluids and pain meds severe: agressive IV fluids, antibiotics, tube feeding non-infected pseudocysts can resolve spontaneously mortality as high as 10-15%, in severe cases 30%
36
acute pancreatitis GROSS
loss of lobula surface, saponification dt enzymes, hemorrhage
37
pancreatitis s/sx
may be acute or chronic severe upper abdominal pain, radiating to back N/V worse with eating tender abdomen
38
pancreatic pseudocysts gross appearance
no epithelial component peri-pancreatic fluid colleciton with high conc of enzymes within a defined fibrous wall contain cholesterol clefts, blood, hemosiderin macrophages
39
pancreatic abscess etiol
collection of pus resulting from tissue necrosis, liquefaction and infection usu develop in existing pseudocysts also can be dt perforated gastric ulcers... alcoholism,etc
40
infected necrosis def:
refers to bacterial contamination of necrotic pancreas w/o abscess formation
41
solid pseudopapillary tumor micro histology
sheets of cells with uniform nuclei, eosinophilic or clear cytoplasms, PAS positive eosinophilic inclusions "pseudopapillary" bc of cystic areas btwn cancer cells rare tumor, always in women, mostly benign
42
pancreatic abscess organisms and mortality
enteric--E.coli, Klebsiella pneumoniae, Enterococcus feacalis, S. aureus, Pseudomonas
43
benign pancreatic tumors of exocrine pancreas
pseudopapillary tumor (some question in lecture) , serous cystadenoma, mucinous cystadenoma
44
malignant tumors of exocrine pancreas
pancreatic adenomcarcinoma, mucinous cystaednocarcinoma
45
mucinous cystic neoplasms
occur almost exclusively in women, tumors make mucin, supported by ovarian-like stroma. Can be benging or malignant depending on histo
46
mucinous cystadenoma
most common cystic tumor of pancreas, usu benign, but can transform, 80% female
47
Von Hippel-Landau syndrome
associated with serous cystadenoma genetic condition in which cysts develop in pancreas, kidneys, liver and hemangioblastomas found in other organs, as well as cafe au lait spots.
48
serous cystadenoma histology
small cysts lined by cilliated cuboidal epithelium
49
MALIGNANT pancreatic cancer
pancreatic adenocarcinoma, 90-95 % arises from exocrine , either ducts (99%) or acinar cells small minority arise from islet cells and are classified as neuroendocrine tumors really bad prognosis
50
pancreatic cancer etiol
4th most common cancer mortality cause worldwide
51
second most common type of exocrine cancer of the pancreas
mucinous | prognosis slightly better
52
congenital form of biliary atresia
common bile duct is blocked or absent
53
acquired biliary atresia
most often due to autoimmune disease. One of main causes of liver transplant rejection.
54
other names for acquired biliary atresia
extrahepatic ductopenia, progressive obliterative cholangiopathy
55
sx of biliary atresia in neonates
initially jaundice-->pruritus, clay colored stools, dark urine, swollen abdomen, malabsorption, cirrhosis/ portal HTN -->liver failure jaundice resistant to photo-therapy (no risk of Kernicterus bc bilirubin is conjugated)
56
tx for biliary atresia
surgical anastomosis, liver transplant
57
choledocal cysts
congenital cystic dilations of the bile duct, often have jnct btwn bile duct and pancreatic duct (empties into bile duct >1cm before ampulla of Vater)
58
presentation of choledocal cysts
dx usually during infancy/childhood infants can present with jaundice, clay colored stools children present with intermittent biliary obstruction, pancreatitis adults can have abdominal pain, jaundice, palpable RUQ mass
59
choledocolithiasis
stones in the ducts of biliary tract frequently obstruct-->can lead to infection (ascending cholangitis) can result in pancreatitis
60
2 main factors leading to cholesterol stones
1. amount of cholesterol secreted by liver cells relative to lecithin/bile salts. 2. degree of conc. and stasis in the GB
61
pancreatic pseudocyst etiol
sequelea of acute or chronic pancreatitis
62
pancreatic abscess development
often late complication of acute necrotizing pancreatitis, often 4 weeks or more after acute pancreatitis episode
63
serous cystadenoma
2nd most common cystic tumor of the pancreas honeycombed appearance dx based on CT almost always benign, rarely transform

path III (1 decks)

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