Gallstones and Biliary Disease AND ALCOHOLIC LIVER DISEASE Flashcards
What disease presents with this appearance in the intestines?
• Key characteristics
Lipid Accumulation
• Abetalipoproteinemia
Vacuolization of fat in enterocytes is characteristic of Fat Accumulation in enterocytes
What is likely the problem with this gallbladder?
Acute Cholecystitis
What is seen here?
• what pathogens are most typically the cultprit?
Ascending Cholangitis
•Often occurs as a result of:E. coli, Klebsiella, Enterococci, Clostridium, and Bacteroides.
What is shown here?
Gallbladder Empyema
**Shown below is a gallbladder with a stone obstructing the neck
What complication of cholelithiasis is shown here?
Gangrenous Cholecystitis - obstruction allows species like clostrium and coliforms like to set up shop in the gallbladder
**You may see air in the gallbladder as a result**
What is shown here?
• key features?
Often you can see sub serosal fibrosis and microscopically you can see scattered lymphocytes, plasma cells, and Macrophages
What feature is KEY to knowning that someone has had chronic cholecystitis?
mucosa dives into wall of the gallbladder, big sign of chronic cholecystitis. These are called Rokitansky-Aschoff sinuses (shown below)
Other Features:
You can have acute on chronic with neutrophils and scattered lymphocytes
Cholesterol can build in subepithelium of the gallbladder
What happens when a Rokitansky-Aschoff sinus ruptures?
This is a Xanthogranulomatous Cholecystitis
A thickened, fibrotic gallbladder wall with a centrally located xanthogranulomatous cholecystitis lesion (arrows) containing chronic inflammatory cells, bile pigment, and foamy pigment-laden macrophages.
What liver/biliary pathology is likely present if the liver has this appearance?
Green Pigment build up in hepatocytes is indicative of Cholestatis (can be intrahepatic or extrahepatic)
Shown here is the geographic pattern associated with Primary Sclerosing Cholangitis.
Large duct inflammation - acute, neutrophilic infiltration of the epithelium superimposed on a chronic inflammation
Smaller ducts, have little inflammation and show a striking circumferential “onion skin” fibrosis around an atrophic duct lumen, with eventual obliteration.
What disease is this person at a high risk of aquiring?
Shown here is PSC putting the patient at high risk of Cholangiosarcoma
Associations you should make are
Ulcerative Cholitis => Primary Sclerosing Cholangitis => Cholangiosarcoma
What changes do you expect to see in a liver with steatosis vs. a normal liver?
What changes do you see in Hepatitis from EtOH vs. a normal
Compare the features seen in a liver with alcoholic hepatitis to one with cirrhosis.
What mark of alcoholism is seen here?
Fatty Change (steatosis)
Where do almost all changes in fatty liver take place?
Zone 3 that drains to the hepatic vein
What is the pathogensis of fatty liver?
What is seen here?
• Key Features?
What is the earliest pattern of fibrosis on alcoholic liver disease?
• what causes this?
Perivenular Fibrosis => earliest pattern of fibrosis in alcholic liver disease
• Activation of STELLATE cells and hepatic fibroblasts leads to the fibrosis
What feature of alcoholic fatty liver disease is seen here?
• is this reversible?
Cirrhosis is seen here and it is reversible
What is seen here?
