Path Biliary

Question 1

Gallbladder origin

Answer 1

endodermal, ventral medial outgrowth of the foregut

Question 2

Regulatory hormones of the gallbladder

Answer 2

Cholecystokinin and somatostatin

Question 3

Cholelithiasis

Answer 3

presence of calculi (gallstones) in the gallbladder or biliary tree

Question 4

Cholesterol stones

Answer 4

Occur more frequently in women. Can be caused by excess cholesterol synthesis or decreased production/recycling of bile salts (lecithin). Predisposing factors: estrogen, advanced age, obesity, family hx, high cholesterol diet, diabetes, primary biliary cirrhosis

Question 5

Bilirubin stones

Answer 5

measure < 1 cm, composed of calcium bilirubinate, calcium salts, mucin. Occur in elderly, malnourished, sickle cell, cirrhosis, and thalassemia. Due to high concentrations of UNCONJUGATED bilirubin in bile = insoluble/precipitates.

Question 6

Mixed (brown pigment) stones

Answer 6

Mix of cholesterol and bilirubin. Found in intra and extra hepatic ducts rather than the gallbladder

Question 7

Cholecystitis

Answer 7

Inflammation of the gallbladder - almost always associated with gallstones. Acute cholecystitis - fibrinous exudates. Detergent bile salts damage mucosa. bacterial infection with clostridia or coliform bacteria = gangrenous cholecystitis which can lead to perforation. Chronic cholecystitis = thickened wall due to fibrosis and Rokitansky-Aschoff sinuses.

Question 8

Rokitansky-Aschoff Sinuses

Answer 8

Histological change seen in the wall of the gallbladder indicative of CHRONIC CHOLECYSTITIS. Penetration of the mucosa into the muscular layer of the gallbladder

Question 9

Cholesterolosis

Answer 9

accumulation of cholesterol filled macrophages in the lamina propria of the gallbladder. Common finding at autopsy. Mucosa appears speckled with yellow flecks. When extreme, condition is called a “strawberry gallbladder”. No associated with hypercholesterolemia

Question 10

Benign tumors of the gallbladder

Answer 10

Papillomas and mucous gland adenomas. If smooth muscle proliferates = adenomyoma.

Question 11

Malignant tumors of the gallbladder

Answer 11

Adenocarcinoma

Question 12

Adenocarcinoma of the gallbladder is associated with?

Answer 12

Chronic cholecystitis and cholelithiasis

Question 13

Choledocholithiasis

Answer 13

Presence of calculi within the biliary tree

Question 14

Choledocholithiasis can lead to?

Answer 14

pancreatitis, cholangitis, hepatic abscess, secondary biliary cirrhosis, acute calculous cholecystitis

Question 15

Ascending Cholangitis

Answer 15

Inflammation and infection of the hepatic ducts and common bile duct. Usually secondary to partial or complete of a septic biliary tree by calculi

Question 16

Signs and symptoms of ascending cholangitis:

Answer 16

mild epigastric to severe RUQ pain, N/V, peritoneal irritation, RIGHT SHOULDER/SCAPULAR PAIN, palpable gallbladder. Jaundice may be intermittent or mild

Question 17

Most common etiologic agents of ascending cholangitis?

Answer 17

E. coli, Enterobacter spp, Klebsiella spp., Proteus spp., enterococci, non-hemolytic streptococci, and Bacteroides or clostridium

Question 18

Biliary atresia

Answer 18

Obliteration of the lumen of part or all of the hepatic biliary tree within the first 3 months of life. Initially necrosis and inflammation of the ductal epithelium. Eventually leads to fibrosis with obliteration of the lumen and resolution of inflammation. Untreated patients progress to cirrhosis

Question 19

Treatment of biliary atresia?

Answer 19

“Kasia procedure” or portoenterostomy, but most require liver tx

Question 20

Choledochal cysts

Answer 20

uncommon dilations of the common bile duct. Usually occur in patient <10 years of age. Symptoms: jaundice and recurrent biliary colic.

Question 21

Klatskin tumors

Answer 21

angiocarcinoma arising at the junction of the left and right hepatic ducts in the hepatic hilum

Question 22

Predisposing genetics for pancreatic adenocarcinoma

Answer 22

KRAS, CDKN2A, p53.

Question 23

Trousseau’s syndrome

Answer 23

Migratory thrombophlebitis, suggestive of occult pancreatic adenocarcinoma