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path III > gallbladder pathology > Flashcards

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
Q

obstruction of pancreatic duct by gallstone

A

a stone in the ampulla of Vater can lead to acute pancreatitis

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26
Q

ascending cholangitis complications

A

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
Q

MRCP

A

magnetic resonance cholangiopancreatogrophy, visualizes pancreatic and billiary ducts

28
Q

Ascending cholangitis histo

A

secondary sclerosis cholangitis secondary to ascending cholangitis shows onion-skin like periductal fibrosis (just like PSC)

29
Q

Gallbladder carcinoma risk factors

A

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
Q

gall bladder carcinoma types

A

majority are well differetiated adenocarcinomas
also
-papillary form of adenocarcinoma
-poorly differetiated adenocarcinoma
-well differentiated with squamous metaplasia

31
Q

risk factors for carcinoma of extraheptatic bile ducts

A

ulcerative colitis (+/- PSC)
choledocal cysts
parasites
gallstones

32
Q

intestinal type adenomcarcinoma of GB

A

we see goblet cell rich areas that should only be in bowel

33
Q

pancreatic tissue types

A

exocrine (acini of pyramidal cells with ducts) and endocrine (islets of langerhans, making insulin, glucagon…)

34
Q

Acute pancreatitis etiology

A

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
Q

tx and outcomes of pancreatitis

A

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
Q

acute pancreatitis GROSS

A

loss of lobula surface, saponification dt enzymes, hemorrhage

37
Q

pancreatitis s/sx

A

may be acute or chronic
severe upper abdominal pain, radiating to back
N/V worse with eating
tender abdomen

38
Q

pancreatic pseudocysts gross appearance

A

no epithelial component
peri-pancreatic fluid colleciton with high conc of enzymes
within a defined fibrous wall
contain cholesterol clefts, blood, hemosiderin macrophages

39
Q

pancreatic abscess etiol

A

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
Q

infected necrosis def:

A

refers to bacterial contamination of necrotic pancreas w/o abscess formation

41
Q

solid pseudopapillary tumor micro histology

A

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
Q

pancreatic abscess organisms and mortality

A

enteric–E.coli, Klebsiella pneumoniae, Enterococcus feacalis, S. aureus, Pseudomonas

43
Q

benign pancreatic tumors of exocrine pancreas

A

pseudopapillary tumor (some question in lecture) , serous cystadenoma, mucinous cystadenoma

44
Q

malignant tumors of exocrine pancreas

A

pancreatic adenomcarcinoma, mucinous cystaednocarcinoma

45
Q

mucinous cystic neoplasms

A

occur almost exclusively in women, tumors make mucin, supported by ovarian-like stroma. Can be benging or malignant depending on histo

46
Q

mucinous cystadenoma

A

most common cystic tumor of pancreas, usu benign, but can transform, 80% female

47
Q

Von Hippel-Landau syndrome

A

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
Q

serous cystadenoma histology

A

small cysts lined by cilliated cuboidal epithelium

49
Q

MALIGNANT pancreatic cancer

A

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
Q

pancreatic cancer etiol

A

4th most common cancer mortality cause worldwide

51
Q

second most common type of exocrine cancer of the pancreas

A

mucinous

prognosis slightly better

52
Q

congenital form of biliary atresia

A

common bile duct is blocked or absent

53
Q

acquired biliary atresia

A

most often due to autoimmune disease. One of main causes of liver transplant rejection.

54
Q

other names for acquired biliary atresia

A

extrahepatic ductopenia, progressive obliterative cholangiopathy

55
Q

sx of biliary atresia in neonates

A

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
Q

tx for biliary atresia

A

surgical anastomosis, liver transplant

57
Q

choledocal cysts

A

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
Q

presentation of choledocal cysts

A

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
Q

choledocolithiasis

A

stones in the ducts of biliary tract
frequently obstruct–>can lead to infection (ascending cholangitis)
can result in pancreatitis

60
Q

2 main factors leading to cholesterol stones

A
  1. amount of cholesterol secreted by liver cells relative to lecithin/bile salts.
  2. degree of conc. and stasis in the GB
61
Q

pancreatic pseudocyst etiol

A

sequelea of acute or chronic pancreatitis

62
Q

pancreatic abscess development

A

often late complication of acute necrotizing pancreatitis, often 4 weeks or more after acute pancreatitis episode

63
Q

serous cystadenoma

A

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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