Path 6 Biliary Tract Flashcards
CCK role
Gallbladder contraction
Cholelithiasis
Gall stones
-Cholesterol, Bilirubin, Calcium salts
Cholelithiasis risk factors (4)
- Chronic hemolysis (increased bilirubin)
- Crohns (bile salt malabsorption)
- Biliary tract infection
- Cirrhosis
3 stone locations
Cholelithiasis (cystic)
Hepatolithiasis (hepatic)
Choledocholithiasis (common)
Biliary Colic
- Gall obstruction
- Spasmodic RUQ pain
- Tx with cholecystectomy
Cholesterolosis
- Strawberry gallbladder
- Lipid-containing macrophages in lamina propria
Polypoid cholesterolosis
Foamy macrophages forming polypoid excresences
Acute cholecystitis clinical
- RUQ rigidity, pain to right shoulder
- Increased WBC
- Increased serum Alkaline Phosphatase
Chronic cholecystitis clinical
- Fatty food intolerance
- Nausea, vague RUQ pain
- Cancer risk
Differentiate acute from chronic
- Always enlarged
- Fibrinous serosa
- Neutrophils v. eosinophils
- Turbid v. normal bile
Chronic cholecystitis histology
- Rokitansky-Aschoff sinuses
- Mucosal outpouchings
Porcelain gallbladder
- Chronic inflammation -> calcium
- Carcinoma risk
Gene for choledocholithiasis
-MDR3 gene (impaired biliary phospholipid secretion)
Charcot’s triad
Cholangitis
- Intermittent abdominal pain
- Spiking fever with chills
- Jaundice
Perinatal biliary atresia
- Normal biliary tree destroyed at birth
- Jaundice in 2 weeks
Fetal biliary atresia
- Immediate jaundice
- Associated with other congenital malformations
Biliary atresia histology
- Bile duct proliferation
- Portal fibrosis
- Bile plugs in ducts
Biliary atresia type I, II, III
I - common bile duct
II - hepatic bile duct
III - all ducts (above porta hepatis)
Biliary atresia presentation
Normal at first, problems (cirrhosis) in a few weeks
Biliary atresia Tx
- Kasai procedure for type I, II
- Liver transplantation for rest
Choledochal cyst
Congenital dilatation of bile duct
Gallbladder carcinoma risk, type
- Cholelithiasis
- Usually adenomacarcinoma
Cholangiocarcinoma
Carcinoma lining bile ducts
