Pathology - biliary tree Flashcards
pruritus jaundice dark urine light coloured stools hepatosplenomegaly
biliary tract disease
presentation of biliary tract disease lab style please
cholestatic pattern of LFTs:
- increased conjugated bilirubin
- increased cholesterol
- increased ALP
what is the pathos of secondary biliary cirrhosis
extrahepatic biliary obstruction – increases pressure in intrahepatic ducts – injury fibrosis and bile stasis
who gest secondary biliary cirrhosis
patietsn with known OBSTRUCTIVE lesiosn ie gallstones, biliary strictures, pancreatic carcinoma
what are the complications of secondary biliary cirrhosis
asecndong cholangitis
how to differentiatl secondary from primary biliarly cirrhosis vai blood work
no increased IgM in secondary; yes in primary
what is the pathology of primary biliary cirrhosis
an autoimmune reaction – lymphocytic infiltrate and granulomas – desctruction of intralobular bile ducts
typical patient with primary biliary cirrhosis
women in 40-50s with another autoimmuencondigion CREST, sjuogren, RA, celiacl dsiease
typical co presentined pathos with primary biliary cirrhosis
rheumatoid arthritis
sjogren
CREST
celiac disease
anti mitochondrial abs and increased IgM
primary biliary cirrhosis
what can be increased risk by primary biliary cirrhosis
HCC
labs of primary biliarly sclerosis please
increased cholesterol increased conjugated bilirubin increased ALP increased GGT increased igM positive anti-mitochondrial antibodies
describe the pathos of primary sclerosign cholangitis
unkno cause of concentric onion skin bild duct fibrosis - alternating strictures and dilation fo BEADING of intra and extrahepatic bild ducts on ERCP, or magnetic resonance cholangiopancreatography
typical patient with primary sclerosing cholangitis
young man with UC
pbilterative fibrosis of intrahepatic and extrahepatic bile ducts
primary sclerosing cholangitis
cirroses due to granulomatous desctruction of bile ducts and portal triad
primary biliary cirrhosis
labs in primary sclerosing cholangitis
increased cholesterol increased conjugated bilirubin increased ALP increased GGT increased IgM MPO-ANCA/p-ANCA positive
what is associated with MPO-ANCA/p-ANCA positiviti
primary sclerosing cholangitis/UC
microscopic angitis
chrug strauss (granulomatous polyangiits with eosinophilia or something like that. good try brain)
what are consequences of primary sclerosing cholangitis
secondary biliary cirrhosis (ascending cholangitis)
cholangiocarcinoma
biliary tract disease with increased risk of a) cholangiocarcinoma and b) hepatocellular carcinoma
cholangiocarcinoma - primary sclerosing cholangitis
hepatocellular carcinoma - primary biliary cirrhosis
what causes cholangiocarcinoma
primary sclerosing cholangitis
clonorchis sinuses
thorium dioxide
choledochal cyst
obstructive jaundice
palpable gallbladder Courvorsier sign
hepatmegaly
cholangiocarcinoma
what can cause gallbladder stones?
increased cholesterol
increased bilirubin
decreased bile salts
gall bladder stasis
which type of stones are radiolucent?
cholesterol if no calcium
brown pigmented
which type of stones are radiopaque
cholesterol if calcium
black pigmented
causes of cholesterol stones please
chron disease fat female fertile - pregos native American old clofibrate estropgen therapy multiparity rapid weight loss
RF and name the stone: fat
cholesterol
RF and name the stone: multiparity
cholesterol
RF and name the stone: native american
cholesterol
RF and name the stone: rapid weight loss
cholesterol
RF and name the stone: estrogen therapy
cholesterol
RF and name the stone: clofibrate use
cholesterol
RF and name the stone: chron disease
cholesterol
RF and name the stone: SCD
black pigment
RF and name the stone: asian
brown pigment
RF and name the stone: hereditary spherocytosis
black pigment
RF and name the stone: alcoholic cirrhosis
black/brown pigment
RF and name the stone: total parenteral nutrition
black/brown pigment
charcots triad
jaundice
fever
RUQ
jaundice
fever
RUQ
cholelithiasis
what complicatiosn come from cholelithiasis
cholecystits
cholangitis
acute pancreatitis
bile stasis
what is biliary colic
cholelithiasis can cause biolary colic = neurohormonal activation of gall bladder contractions via CCK after a fatty meal ( stimulated by protein and fatty acids) forcitn a stone into the cystic dcut
can be painless in diabetics ** watch out
what is gallstone ileus
fistula between gallbladder and small intestine - air in biliary tree and passage of gallstone into the intestinal tract - usually at ileocecal valve
diseases associated with air where they aren’t suppseo to be
duodenal PUD anterior perforation - under diaphragm
diverticulitis - pneumaturia
necrotizing enterocolitis - air in portal vein, pneumatosis intestinalis, free air in abdomen
gallstone ileus - in biliary tree
how to dx gallstones
u/c (cholesterol and black pigmented are ragiopague and some cholesterol and brom are radiolucent)
what is cholecystits
acute or chornic inflammation of the gallbaldder
what causes cholecystits
gallstones blockgin the cystic duct
pathogenesis of cholecystitis
stone into cystic duct – biliary colic - impacts in cystic uct with bacterial proliferation - bacteria invade wall - perforation
diffuse mid epigastric colicky pain - RUQ constant pain dull achey - positive murphys sign
cholecystits
who is most likely to get cholecystitis
females in 5th to 6th decade in North America
fever stage dependent pain localization PMn above 12 000 bilirubin above 4 palpable GB jaundice vomiting increased/not increased amylase
obstruction at cbd
cholecystis
with out without acute pancreatitis
what tis a porcelain gallbladder
dystrophic calcification fo the gall bladder
must be removed – gallbladder carcinoma – very poor prognosis <2 % 5 year survival
what causes porcelain gallbladder
chronic cholecystitis
who presents with porcelain gallbladder
elderly women
what is acute pancreatitsi
autodigestion of the panrease by pancreatic enzymes
GET SMASHED
gallstones ethanol trauma scorpion bite mumps autoimmune disease steroids hypercalcemia, hyperTAGemia ercp drugs: sulfa drugs, NRTIs, protease inhibitors
epigastric abdominal pain radiating to back anorexia nausea increased amylase increased lipase hypocalcemia
acute pancreatitsi
what causes acute pancreatitis
hypertriglyceridemia, hypercalcemia, scorpions, sulfa drugs, NRTIs, protease inhibitos, gallsontes, alcohol, truma, steroids, mumps, autoimmune diseases, ercp
drugs that can cause acute pancreatitis
NRTIs, protease inhibitors sulfas
what are complications of acute pancreatitis
pseudocyst DIC ARDS difuse fat necrosis - hypocalcemia (collects in pancreatic soap deposits) hemorrhage infection multi organ system failure
what causes ARDS in acute pancreatitis
phospholipases degrade surfactant
what casues hypovolemia in acute pancreatitis
pancreatic fluid build up - increased third space fluid
what causes hypoxemia in acute pancreatitis
phospholipase degrade surfactant - ARDS
what is ARDS?
acute onset of respiratory failure with bilateral lung opacities with no heart failure. can be cacused by trauma, sepsis shock, gastric aspiration uremia, acute pancreatitis, AF embolism
diffuse alveolar damage - increased alveolar capillary permeability and protein rish leakage into alveoli and noncardiogenic pulmonary edema with normal PCWP.
intraalveolar hyaline membranes - initial damge due to relase from PMNs that are toxic to alveolar wall - activates coagulation cascades and ROS
what can cause ARDS
trauma sepsis shock gastric aspiration uremia acute pancreatitis AF embolism
what is a pseudocyst
abdominal mass of pancreatic enzymes that is surrounded by granulation tissue not epithelium.
what is most common cause of acute pancreatits in children
seatbelt trauma
what viruses can cause acute pancreatitsi due to damge to alveolar celsl
CMV
mumps
coxsackie viruses
what causes hemorrhage in acute pancreatitsi
elastases going to town on bvs
what is chronic pancreatits
chornic inflammation, atrophy and calcification fo the pancreas
what are the major causes of chronic pancreatitis?
OH
idiopathy
CF
what is major cause of chronic pancreatitis in developing countries
malnutrition
steathorrhoea
vitamin ADEK, folate B12 deficiencies
diabetes mellitus
chornic pancreatitis
dxtic tools for chronic pancreatitis please
amylase and lipase may or may not be elevated
asses with secretin stimulation test
and bentromidefert test - ability of pancreatic chymotrypsin fto cleave orally administered wahterver to PAH and then assesses levels in urine.
what is the prognosis of pancreatic adenocarcinoma
average survival is one year after diagnosis
histoathos of pancreatic adenocarcinoma
of the exocrine pancrease
very aggressive tumoru arising from pancreatic ducts - disorganized glandular structure with cellular infiltration
what is common when pancreatic adenocarcinoma presents
mets already :(
tumour marker of pancreatic adenocarcinoma please
CA 19-9 and sometimes CEA, can also look at genes KRAS, p16 and p53
what genes are associated with pancreatic adenocarcinoma
KRAS
p16
p53
risk factors for pancreatic adenocarcinoma please
MOST COMMON - SMOKING chronic pancreatits for more than 30 years diabetes > 50 years old jweish and African america
nationality most likely to get pancreatic adenocarcinoma
jewish
African americans
abdominal pain radiating to back weight loss light stools jaundice palpable gallbladder redness and tenderness on palpation of extremities
pancreatic adenocarcinoma
weight loss - malabsoprtion and anorexia
obstructive jaundice - at head = light stools, jaundice and palpable gallbladder
redness and tenderness on palpation of extremities - migratory thrombophlebitis
what is trousseaus syndrome
migratory thrombophlebitis - redness and tenderness on
migratory thrombophlebitis - redness and tenderness on palpation of extremities
pancreatic adenocarcinoma
acanthosis nigricans
gastric adeocarcinoma
dermatitis herpetiformis
celiac
seborrhoeic keratosis
gastric adenocarcinoma
list the associated pathology:
a) acanthosis nigricans
b) dermatitis herpetiformis
c) seborrhoeic keratosis
d) migratory thrombophlebitis
a) acnathosis nigricans - gastric adenocarcinoma
b) dermatitis nigricans - celiac disease
c) seborrhoeic keratosis - gastric adenocarcinoma
d) migratory thrombophlebitis - pancreatic adenocarcinoma
how to treat pancreatic carcinoma
whipple - take out head and neck leave tail
chemo
radiation
epigastric pain weight loss jaundice light coloured stools palpable gallbladder red and tenderness on palpation fo extremities vichows node sister mary joseph
pancreatic adenocarcinoma
remember virchows: gastric adenocarcinoma, squamous (weird…. maybe my brain si wrong and is adeon that does this) esophageal, cervical, pancreatic do this but GASTRIC is MOST COMMON
