L16- GIT Pathology VIII (gallbladder) Flashcards

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1
Q

describe the types of cholelithiasis and their frequency distribution

A

Cholesterol stones: cholesterol monohydrate (80%)

Pigment stones: bilirubin calcium salts (20%)

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2
Q

list the risks for cholethiasis (by type)

A

Cholesterol stones: inc age, females, oral contraceptives, obesity, rapid weight loss

Pigment stones: chronic hemolysis, biliary infection

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3
Q

describe cholelithiasis mechanism for cholesterol stones

A

1) supersaturation of bile with cholesterol
2) hypomotility of gallbladder
3) accelerated cholesterol crystal nucleation
4) hypersecretion of mucus in the gall bladder

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4
Q

Cholelithiasis clinical presentation:

  • (1) predominant symptom, then (2) is most common after (1)
  • (3) is present in certain complications
A

1- asymptomatic (70-80%)

2- coliky-like pain, especially after a fatty meal

3- Murphy’s sign if cholecystitis is present

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5
Q

list the complications of cholelithiasis

A
  • empyema (pus in pleural cavity)
  • perforation
  • fistulas
  • cholangitis
  • pancreatitis
  • gallstone ileus
  • inc risk of gallbladder carcinoma
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6
Q

define and list the types of cholecystitis

A
  • inflammation of the gallbladder

- acute, chronic, acute superimposed on chronic

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7
Q

briefly describe the types of acute cholecystitis

A

Acute Calculous cholecystitis:

  • 90% cases
  • primary complication of *gallbladder

Acute Acalculous cholecystitis:
-result of ischemia (maybe)

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8
Q

describe acute cholecystitis pathogenesis (hint- very long)

A

1) chemical irritation / inflammation resulting from obstruction
2) mucosal phospholipase converts lecithin –> lysolecithin
3) damage to glycoprotein layer of mucosa
4) further release of PGs from mucosa
5) all (1-4) => mucosal / mural inflammation
6) gall bladder dysmotility, inc intraluminal pressure
7) superimposed bacterial contamination

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9
Q

Acute Cholecystitis clinical features:

  • (1) is the main symptom with (2) as associated symptoms
  • (3) is present upon examination
  • (4) may be indicated / a possible complication
A

1- R hypocondrium or epigastrium pain
2- fever, n/v
3- Murphy’s sign
4- surgical emergency

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10
Q

Chronic Cholecystitis:

  • results from (1)
  • usually associated with (2), although role is unclear
  • (3) is a common finding in 1/3 of patients
  • (4) is a rare complication
A

1- sequel of repeated acute cholecystitis

2- cholelithiasis

3- positive microorganism culture from bile

4- extensive dystrophic calcification (porcelain gall bladder: bluish discoloration, brittle consistency, associated with cancer)

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11
Q

describe histology of chronic cholecystitis

A
  • mucosa infiltrated by inflammatory cells
  • abnormal multiple folds
  • fibrosis surrounding cirrhosis

-out-pouching of mucosa thru wall containing bile = Rokitansky-Ashcoff sinuses (herniation of mucosa outside of gallbladder)

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12
Q

Gall Bladder carcinoma:

  • (1) common age, gender
  • (2) is present in most patients, and (3) are other risk factors
  • (4) is the most common form
  • (5) is common at time of diagnosis
A

1- 60s y/o, females (slightly)

2- gallstones (60-90%)
3- pyogenic / parasitic infections of biliary tract //// carcinogenic derivatives of bile may have a role

4- adenocarcinoma (exophytic)
5- invasion/spread to liver

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13
Q

describe histology of gall bladder carcinoma

A

(usually exophytic carcinoma)

  • disorganized malignant glands
  • interspersed dense fibrosis
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14
Q

list the diseases of the Hepato-biliary tree

A

(either Intra- or Extra- hepatic)

  • **bile duct stones (choledocholithiasis)
  • **cholangitis
  • biliary tract cysts
  • biliary atresia
  • bile duct carcinomas (cholangiocarcinoma)
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15
Q

Biliary Tree diseases, general pathophysiology:

  • (1) is the most important cause, usually due to (2) and or (3)
  • altered anatomy causes (4) which can lead to (5)
  • (6) may result from inflammatory damage after biliary tree disease
A

1- obstruction / impaired bile flow
2- gall stones
3- neoplastic masses

4- impaired bile flow
5- cysts (choledochal cyst)
6- scarring (recurrent cholangitis)

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16
Q

Choledocholithiasis:

  • occurs in some patients with (1)
  • defined as (2), mostly occurring at (3)
  • (4) describe Mirizzi syndrome
A

1- gallstones (15%)
2- stone blocking any part of bile duct
3- common bile duct

4- gallstone in cystic duct compresses common hepatic duct => obstructive jaundice

17
Q

Cholangitis:

  • (1) definition
  • (2) are the most common causes
  • recurrent form is common in (3) population
A

1- infection of biliary tree following biliary obstruction

2- E. coli, S. faecalis, Enterbacter

3- (recurrent pyogenic cholangitis / oriental cholangiohepatitis) Asia / Pacific rim countries due to Chinese liver fluke parasite