Path Biliary Tract Mig

Question 1

Caroli disease path

Answer 1

multiple cystic dilation of the intrahepatic biliary tree

Question 2

Choledochal cysts path

Answer 2

congenital dilations of the common bile duct in children before age 10. 20% in adults.

Question 3

Biliary atresia path

Answer 3

• congenital biliary disorder characterized by absence or severe deficiency of the biliary tree.

Question 4

Biliary Atresia Type

Answer 4

• Type I: the common duct is obliterated while the proximal duct is patent.
• Type II: atresia of the hepatic duct.
• Type IIa:the cystic and common bile ducts are patent.
• Type IIb: the cystic ,common bile and hepatic ducts are obliterated.
• Type III: the most common type of biliary atresia. Type III refers to atresia of the right and left hepatic ducts at the level of the porta hepatis.

Question 5

Primary Sclerosing Cholangitis (PSC)

• Path
• LabDx

Answer 5

• Path: autoimmune segmental fibrosis and inflammation of the intra and extrahepatic bile ducts.
• LabDx: Increased serum alkaline phosphatase + GGT; p-ANCA; anticardiolipin antibodies
• ** no specific Abs; diagnose but ERCP

Question 6

Pathogenesis of Cholelithiasis of Cholesterol Stone

Answer 6

1. bile is supersaturated with cholesterol
2. gallbladder hypomotility promotes nucleation
3. cholesterol nucleation is accelerated
4. mucus hypersecretion (acts like glue) traps crystals in the gallbladder permitting aggregation into stones and stone growth.

Question 7

Pathological change in Gallbladder Cholesterolosis

Answer 7

Strawberry Gallbladder - bright red coating

Question 8

Pigment Gallstone Et

Answer 8

• Cirrhosis
• Infections
• Hereditary blood Dx (SCD_

Question 9

Pigment Gallstone Types

Answer 9

Black: Oxidized Polymers of calcium salts of unconjugated Bilirubin; Radio-opaque

Brown Pigment: Pure calcium salts of conjugated bilirubin; Radio-lucent

Question 10

Chronic Cholecystitis

• EPI
• Morph:
• Histo:

Answer 10

• EPI: women after age 40.
• Morph: the gallbladder wall is thickened, 2-3 times normal; the lumen contains green –yellow mucoid bile and stones.
• Histo: Invasion of TLC, Eos, PCs into lamina propria; hypertrophy of muscularis; fibrosis, elastosis, + neural hyperplasia; accentuation of Rokitansky-Aschoff sinuses

Question 11

Hydrops of the Gallbladder

Answer 11

Marked dilatation of the gallbladder due to chronic obstruction of the cystic duct resulting in accumulation of mucus.

Question 12

Gallbladder Polyps

Answer 12

• Inflammatory polyp are sessile
• Adenomatous polyps are rate + A/S PJS or Cholelithiasis;
• Few progress to carcinoma

Question 13

Charcot’s Triad

Answer 13

fever/chills, jaundice, RUQ abdominal pain

Question 14

Carcinoma of the Ampulla of Vater

• A/S
• Genetics
• S/S:

Answer 14

• A/S: familial adenomatous polyposis and ulcerative colitis
• G: K-RAS
• S/S: Anemia, jaundice, loss of appetite, back pain, fever, and acute pancreatitis.