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FALL 2024: Pathology > Hepatobilliary System > Flashcards

Hepatobilliary System Flashcards

1
Q

acalculous cholecystitis

A

Only about 5% of acute cholecystitis cases have an absence of gallstones, and this is known as acalculous cholecystitis

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2
Q

anastomosis

A

Surgical procedure that joins 2 tubular structures, such as blood vessels or loops of intestine, together with

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3
Q

ascites

A

the accumulation of fluid within the peritoneal cavity

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4
Q

bile

A

Yellow-green fluid produced by the liver that helps break down fats and helps with digestion

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5
Q

bilirubin

A

the orange or yellowish pigment in bile

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6
Q

cholecystokinin

A

A hormone secreted by the duodenum in response to ingestion of fats that helps with digestion and appetite

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7
Q

circumscribed

A

Confined to a limited area

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8
Q

dyspnea

A

Shortness of breath

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9
Q

hepatocytes

A

The major parenchymal cells in the liver

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10
Q

hepatomegaly

A

Enlargement of the liver as might be seen with viral hepatitis

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11
Q

hyperalimentation

A

the administration of nutrients directly into a patient’s bloodstream or through a feeding tube

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12
Q

insidious onset

A

any disease that comes on slowly and does not have obvious symptoms at first

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13
Q

paracentesis

A

a procedure performed in patients with ascites, during which a needle is inserted into the peritoneal cavity to obtain ascitic fluid

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14
Q

parenteral

A

outside of the digestive tract, i.e., parenteral routes include intravenous, intramuscular, subcutaneous, intraosseous, epidural, and intradermal

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15
Q

pericholecystic inflammation (fat stranding)

A

Inflammation of the gallbladder

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16
Q

porcelain gallbladder

A

Results from chronic cholecystitis where the chronically inflamed gallbladder wall gradually calcifies. Approximately 30% of people with porcelain gall­bladders develop carcinoma and are thus referred for prophylactic cholecystectomy.

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17
Q

pneumobilia

A

Gas visualized in the biliary tree

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18
Q

portal (venous) hypertension

A

A condition where the pressure in the portal venous system (a major vein that leads to the liver) is higher than normal

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19
Q

pseudocapsule

A

A compressed layer of cells surrounding an adenoma

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20
Q

What is the difference between a cyst and a pseudocyst?

A

A true cyst is a localized fluid collection that is contained within an epithelial lined capsule. In contrast, a pseudocyst is a fluid collection that is surrounded by a non-epithelialized wall made up of fibrous and granulation tissue, hence the name “pseudo” cyst.

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21
Q

What is the difference between focal and diffuse disease or lesions?

A

Focal means confined to one place and diffuse means spread throughout. For example, focal lesions of the liver can be solitary or multiple but are confined to the liver.

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22
Q

What is fat-stranding?

A

Fat stranding is a sign that is seen on CT. It describes the change in attenuation of fat around an inflamed structure (like the gallbladder with cholecystitis) and is a very helpful indicator for intra-abdominal pathology.

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23
Q

Endoscopic retrograde cholangiopancreatogram (ERCP)

A

•A means of visualizing the biliary system and main pancreatic duct. ERCP combines fluoroscopy and endoscopy techniques for concomitant diagnosis and treatment of the biliary system. A fiberoptic endoscope is passed through the mouth and GI tract to the duodenal C-loop to visualize the hepatopancreatic ampulla (ampulla of Vater). A thin catheter is then directed into the orifice of the CBD and/or pancreatic duct, followed by a retrograde injection of iodinated contrast medium
•Indications: used to visualize nondilated ducts, distal obstructions, bleeding disorders, and the pancreatic duct

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24
Q

Laparoscopic cholecystectomy

A

Minimally invasive closed surgical procedure. This technique allows a less traumatic entry, excision, and removal of the gallbladder, resulting in shortened hospitalization and reduced costs. Radiographers are commonly called to the operating environment to image injections of contrast medium into the exposed biliary duct (operative cholangiography) to determine whether all stones have been removed.

25
Q

Magnetic resonance cholangiopancreatography (MRCP)

A

•An imaging procedure that uses MRI to visualize the gallbladder, biliary system, and pancreas. MRCP is noninvasive and does not require the use of a contrast agent. Fat-suppressed T2-weighted sequences result in hyperintensity of bile and are used to suppress the tissues around the biliary system, allowing the gallbladder and bile ducts to appear bright and enabling visualization of stones or other obstructions.
•Indications: screening tool for ductal stone disease, choledochal cysts, and intrahepatic ductal anomalies

26
Q

Open cholecystectomy

A

Surgical removal of the gallbladder by making a single large incision in the abdomen

27
Q

Operative cholangiography

A

Performed during surgery at the time of a cholecystectomy to detect biliary calculi and the need for CBD exploration. A needle is placed directly into the cystic duct or CBD by the surgeon, and a small volume (6 mL) of iodinated contrast material is injected, followed by radiography. A second injection of 5 mL is made, followed by radiography a second time. A more modern imaging method for operative cholangiography is to use intraoperative fluoroscopy produced by a portable fluoroscopic C-arm unit to obtain real-time visualization during the injection of contrast.

28
Q

Paracentesis

A

Procedure the removes fluid from the abdomen using a needle or catheter. A diagnostic paracentesis involves removal of 50 to 100 mL of peritoneal fluid for analysis. Therapeutic paracentesis involves draining larger amounts of peritoneal fluid, or even the placement of an intraperitoneal drainage catheter for continued drainage. Individuals with ascites generally complain of nonspecific abdominal pain and dyspnea.

29
Q

Percutaneous transhepatic cholangiography (PTC)

A

•Puncture and injection of contrast through abd wall (transhepatic) into biliary tree.
•Evaluation of proximal hepatic ducts & CBD obstructions from calculi or neoplasms

30
Q

Radiofrequency ablation (RFA)

A

An effective local therapy that uses heat-generating electrodes to provoke necrosis of a tumor and its adjacent margins. RFA is generally used for people with early-stage tumors who are not surgical candidates

31
Q

T-tube cholangiography

A

A fluoroscopic study used after a cholecystectomy to demonstrate patency of the CBD and to check for residual calculi. A T-shaped tube is inserted surgically into the CBD during the cholecystectomy. Iodinated contrast medium is injected to verify removal of all calculi and to evaluate for any other abnormalities of the biliary tree. The contrast should flow retrograde, filling the right and left hepatic ducts and smaller branches, and it should also flow antegrade into the CBD and eventually the duodenum

32
Q

Transjugular intrahepatic portosystemic shunt (TIPSS)

A

Used to divert the pressure of portal hypertension and to treat acute variceal hemorrhage, which does not respond to endoscopic therapy. The TIPSS procedure is commonly performed in the vascular interventional area of a radiology department. A catheter is placed in the right internal jugular vein and pushed through the right atrium into the IVC. The needle end of the catheter is inserted into the closest portal vein in the liver, commonly the right portal vein. A fistula is created between the portal and hepatic veins trough use of angioplasty via a balloon-expandable metallic stent (Fig. 6.34). The tract is enlarged such that a shunt can be placed to reroute the flow of portal blood through the liver and into the IVC.

33
Q

Whipple’s procedure(pancreaticoduodenectomy)

A

•A complex surgical operation to remove tumors in the pancreas, duodenum, gallbladder, and bile duct. It consists of a partial pancreatectomy, duodenectomy, and cholecystectomy, and may or may not (pylorus-sparing) include a distal gastrectomy. Jejunal anastomoses are created with the CBD (choledochojejunostomy) and remaining pancreatic duct (pancreaticojejunostomy), as well as the stomach (gastrojejunostomy) if there was a partial gastrectomy.

34
Q

What is the modality of choice for imaging the gallbladder? The liver?

A

•Gallbladder: sonography
•Liver: CT

35
Q

Alcohol-Induced Liver Disease

A

•Alcohol is a known toxin, which, when metabolized by the liver, causes cellular damage. Alcohol abuse has long been associated with liver disease. Alcohol cannot be stored in the human body, and therefore, the liver must convert it, through oxidation, to alcohol dehydrogenase, acetaldehyde, and acetate, all of which reduce cellular function. This leads to interference with carbohydrate and lipid metabolism.
•Modalities: CT or sonography, but CT is currently the examination of choice

36
Q

Fatty Liver Disease (hepatic steatosis)

A

•Generally classified as alcohol fatty liver disease or nonalcoholic fatty liver disease (NAFLD). Factors other than alcohol abuse may lead to fatty infiltrates within the liver. These include, but are not limited to: obesity, total parenteral nutrition (TPN), small bowel bypass surgery, diabetes mellitus, steroid use, chemotherapy, pregnancy, hyperlipidemia, glycogen storage disease, lipid storage disease, hepatitis, HIV infection, and ulcerative colitis.
•Modalities: CT, Ultrasound, MRI

37
Q

Cirrhosis

A

•A chronic liver condition resulting from hepatocyte injury through which the liver parenchyma and architecture are destroyed, fibrous tissue is laid down, and regenerative nodules are formed as the liver attempts to repair hepatocytic damage. In its early stages, it is usually asymptomatic, as it may take months or even years before damage becomes apparent. Cirrhosis affects the entire liver and is considered an end-stage condition resulting from liver damage caused by chronic alcohol abuse, drugs, autoimmune disorders, metabolic and genetic diseases, chronic hepatitis, cardiac problems, and chronic biliary tract obstruction
•Modalities: Endoscopy but may be seen with an esophagram or by CT examination

38
Q

Viral Hepatitis

A

•Most frequently caused by a viral infection, but it can also be caused by congenital disorders, autoimmune systemic lupus erythematosus, pregnancy, use of various medications, alcohol or drug abuse, non­alcoholic steatohepatitis, and ischemic hepatitis. At least six types of viral agents that cause acute inflammation of the liver have been identified. This inflammation interferes with the liver’s ability to excrete bilirubin, the orange or yellowish pigment in bile.

39
Q

Cholelithiasis

A

•Gallstones
•Modalities: Sonography

40
Q

Cholecystitis

A

•Inflammation of the gallbladder. It may be acute or chronic, and is common in individuals with chronically symptomatic cholelithiasis
•Modalities: Sonography

41
Q

Pancreatitis

A

•Inflammation of the pancreatic tissue is known as pancreatitis. It is one of the most complex and clinically challenging disorders of the abdomen and is classified as acute or chronic, according to clinical, morphologic, and histologic criteria
•Modalities: CT and MRI

42
Q

Jaundice, Medical vs Surgical

A

•A yellowish discoloration of the skin and whites of the eyes, is not a disease itself but rather a sign of disease. The accumulation of excess bile pigments (i.e., bilirubin) in the body tissues “stains” the skin and eyes this yellowish color.
•Medical (nonobstructive) jaundice occurs because of hemolytic disease, in which too many red blood cells (RBCs) are destroyed or because of liver damage from cirrhosis or hepatitis. The most common appearance of medical jaundice is transient in the first few days after birth, when more bile pigments are released than can be handled. A liver that is damaged from disease simply cannot excrete the bilirubin in a normal fashion, and it enters the bloodstream.
•Surgical (obstructive) jaundice occurs when the biliary system is obstructed and prevents bile from entering the duodenum. A common cause of this obstruction is blockage of the CBD caused by stones or masses. The longer the obstruction persists, the more likely it is that complications (e.g., liver injury, infection, bleeding) will arise

43
Q

Is Ascites classified as an additive or subtractive condition?

A

Additive

44
Q

How does liver disease lead to esophageal varices?

A

Slowing or blocking blood flow to the liver which increases pressure in the portal vein and forces blood into smaller veins in the esophagus

45
Q

Hepatitis A

A

•Route of transmission: It is excreted in the GI tract in fecal matter and is spread by contact with an infected individual, normally through ingestion of contaminated food or water. It is the most common form of hepatitis and is highly contagious.
•Vaccine? Yes but it usually goes away on its own. The incubation period of the disease is relatively short (30 days) and its course is usually mild.

46
Q

Hepatitis B

A

•Route of transmission: parenterally through infected serum or blood products. Its incubation period is much longer (60–180 days) and its effects are more severe than those of HAV
•Vaccine? Yes

47
Q

Hepatitis C

A

•Route of transmission: parenterally transmitted RNA virus. Type C accounts for 80% of the cases of hepatitis that develop after blood transfusions
•Vaccine? No

48
Q

Hepatitis D

A

•Route of transmission: caused by an RNA virus and occurs only concurrently with acute or chronic HBV. It cannot occur alone.
•Vaccine? No but getting the hepatitis B vaccine also protects you from hepatitis D

49
Q

Hepatitis E

A

•Route of transmission: also an RNA viral agent. It is most commonly responsible for outbreaks of waterborne epidemic acute hepatitis in developing countries
•Vaccine? No

50
Q

Hepatitis G

A

•Route of transmission: may be transmitted via blood products and may cause chronic hepatitis. Recently isolated.
•Vaccine? No

51
Q

Hepatocellular Adenoma

A

•A benign tumor of the liver and is also known as a hepatic adenoma. Most tumors are asymptomatic, but the incidence of this disease has increased over the past few years. Hepatocellular adenomas occur most often in females using oral contraceptives, which play a role in the development of these benign lesions. They are also associated with steroid use.
•Modalities: CT, Sonography, MRI

52
Q

Hemangioma

A

•The second most common benign tumor of the liver after the hepatic cyst. It is a benign neoplasm composed of newly formed blood vessels, and these neoplasms may form in other places within the body. For instance, a port wine stain on the face (a superficial purplish red birthmark) is an example of a hemangioma elsewhere in the body. Hemangiomas are generally well-circumscribed and can be solitary or multiple tumors. They may range in size from microscopic to 20 cm
•Modalities: NM, CT, and MRI(most specific test)

53
Q

Hepatocellular Carcinoma (HCC)

A

•The most common primary malignant neoplasm of the liver. A strong association between cirrhosis and HCC exists, with chronic HBV or HCV and alcoholism associated with each. Thus, the incidence of this neoplasm is on the rise because of an increase in chronic HBV and HCV infections in the United States. Noncirrhotic causes include toxins, genetic defects, obesity, type II diabetes mellitus, and chronic steatohepatitis
•Modalities: Sonography is used for screening, CT and MRI reveal the extent of the tumor

54
Q

Metastatic Liver Disease

A

•Lesions are much more common than primary carcinoma because of the liver’s role in filtering blood. The liver is a common site for metastasis from almost all primary sites, but the most common are colon, pancreas, stomach, lung, and breast (Fig. 6.54). Primary cancers located in the abdomen, especially those drained by the portal venous system, often metastasize to the liver (Fig. 6.55). Hepatic metastases are generally not hypervascular and they are often multiple, and are difficult to detect and characterize on imaging if they measure less than 5 mm in size
•Malignant
•Modalities: CT and MRI

55
Q

Carcinoma Of The Gallbladder

A

•Occurs infrequently, but most are malignant. Most primary carcinomas of the gallbladder, approximately 85%, are adenocarcinomas, with the remaining 15% being anaplastic or squamous cell cancers. Carcinoma of the gallbladder is more common in females and older adults, with gallstones present in about 75% of all cases
•Modalities: CT and Sonography

56
Q

Cholangiocarcinoma

A

•A malignancy of the bile ducts. Greater than 90% of cholangiocarcinomas are ductal adenocarcinomas and the rest are squamous cell tumors. The etiology is unknown but increased risk is reported in those with chronic cholangitis, chronic liver disease (especially cirrhosis), chronic parasitic infections, ulcerative colitis, and chronic cholecystitis
•Modalities: ERCP usually the choice, CT and MRI with MRCP

57
Q

Pancreatic Cancer

A

•Usually rapidly fatal and is the fifth most common cause of cancer-related death in the United States. Its diagnosis is difficult because of the location of the pancreas and the lack of symptoms before extensive local spread. In most cases, the tumor is well advanced before the diagnosis is made.
•Modalities: CT and Sonography

58
Q

A fluid collection in the pancreas with a defined fibrous capsule that typically develops 4 to 6 weeks after the onset of acute pancreatitis

A

Pancreatic pseudocyst

59
Q

______________________ are benign, rarely symptomatic and usually an incidental find during cross-sectional imaging studies of the liver

A

Simple hepatic cysts

FALL 2024: Pathology (10 decks)

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