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Gasteroenterology2 > Gallbladder Diseases > Flashcards

Gallbladder Diseases Flashcards

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1
Q

What four conditions contribute to the formation of cholesterol gallstones

A

Super saturation of bio with cholesterol
hypomotility of the gallbladder
Accelerated cholesterol crystal nucleation
Hyper secretion of mucus in the gallbladder

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2
Q

Describe the process of cholesterol crystal nucleation

A

if cholesterol concentrations exceed the solubilizing capacity of super saturation, free cholesterol disperses and form solid and monohydrate crystals

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3
Q

describe the process of hyper secretion of mucus in the gallbladder

A

traps Nucleated crystals in the gallbladder; Eventually these aggregates get big enough to form a stone

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4
Q

Describe the pathogenesis Of Strawberry Gallbladder

A

AKA cholesterolosis
Cholesterol stones diffuse into the mucosal layer Leading to accumulation of cholesterol esters and foamy macrophages in the lamina propria
this gives the mucosal surface a strawberry like characteristic

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5
Q

Choleithiasis Are usually of what pigment

A

black to Brown

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6
Q

list the components of Gallstones

A

heterogenous mixures of Insoluble calcium salts, unconjugated bilirubin, and inorganic calcium salts

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7
Q

patients with these diseases are at increased risk for developing gallstones

A

Chronic hemolytic anemia, E coli biliary infections, Ascaris lumbricoides (liver fluke)

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8
Q

Describe the pathogenesis of acute cholesystitis

A

disruption & irritation of the protective glycoprotein mucus layer
Typically caused by stone obstruction
Prospect Landon’s release within the wall of a distended gallbladder contribute to the mucosal inflammation and cause gallbladder dismotality

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9
Q

Wood enzyme is elevated and acute cholesystitis

A

Alkaline phosphatase

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10
Q

Describe the gross Features of acute cholecystitis

A

Bright red Discoloration
if gangrenous type: Green black necrotic perforations

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11
Q

Infection by wood microbes Would you expect to find in cases of cholesystitis

A

Clostridia and coliforms May cause a cue emphasimitous cholecystitis

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12
Q

What’s secondary complications can arise from acute cholecystitis

A

Perforation, Biliary-enteric Fistula, obstructive Cholastasis, pancreatitis, diffuse peritonitis, cholangitis

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13
Q

Acute a calculus cholecystitis Is associated with what Medical conditions

A

post operation
trauma (severe)
burns
Immunosuppression
Diabetes mellitus
sepsis with hypotension
postpartum states

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14
Q

what is the pathogenesis of acute a calculus cholecystitis

A

ischemic mechanism: occulusion of cystic artery and inflammation of the GB wall
accumulation of cholesterol

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15
Q

Acute a calculus cholecystitis is usually asymptomatic. What causes it to become symptomatic

A

gangrene necrosis and perforation

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16
Q

90% of chronic cholecystitis cases are associated with what gallbladder disease

A

cololithiasis

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17
Q

what pathogens are commoly assoc. w/ Chronic cholecystitis

A

E coli; enterococci

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18
Q

What are gross characteristics of chronic cholecystitis

A

Dense fibrous adhesions may be visible and a very thick gallbladder wall

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19
Q

what are the histological features of chronic cholesystitis

A

Subsorosul fibrosis, Mucosal hyperplasia And fusion CAN FORM rOKIT oANSKY-aSCHOFF SINUSES
In more severe cases:
Dystrophic calcification within The wall; porcelain gallbladder

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20
Q

What is the definition of choledocholithiasis?

A

presence of stones within the bile ducts of the biliary tree

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21
Q

choledocholithiasis Is associated with what

A

bacterial infections of the bile ducts

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22
Q

What is ascending cholangitis

A

Infection of intra hepatic bile ducts: usually enteric gram negative bacteria: E. coli, Klebsiella, Bacteroides or Enterobacter

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23
Q

What would you expect to see microscopically for choledocholithiasis

A

acute inflammation of the biliary ducts with neutrophilic infiltration in the women

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24
Q

What are the most common benign tumors in the gallbladder

A

adenomas; inflammatory polyps; adenomyosis

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25
What are the histological features of Adenomyosis
Hyperplasia of muscularis and hyperplasia of intraural glands most common loctatoin: GB fundus
26
Gallbladder carcinoma is associated with what North American epidemiological factors
indigenous and Hispanic populations; twice as common in females
27
Where is gallbwater carcinoma found and what cancer is it
usually found in fundus GB carcinomas are actually adenocarcinomas gallstones present in 95% of cases
28
Describe the histological features of infiltrating gallbladder carcinoma Subtype
diffuse thickening of gallbladder wall
29
describe the histological features of the exophytic subtype of gall water carcinoma
Lesions grow into the lumen in a cauliflower like fashion
30
gallbladder carcinoma is associated with what mutations
gain of function mutations of the EGF receptor including HER2, RAS loss-of-function mutations in TP53
31
What are the gross features of gallbladder adenocarcinoma
Normal Gallbladder: hollow organ for a malignant GB, The Oregon cavity is going to be filled with a giant white mass
32
List biliary disease nomenclature
"Chol": Bile "Cholecyst": gallbladder "Cholangi": Bile duct "Choledoco": common bile duct
33
Anemia is associated with what kind of gallstones
bill of Reuben Stones
34
what are the clinical manifestations of cholithiasis
Intermittent In the right upper quadrant Subsequent to a fatty food meal
35
What is Boas' sign
right upper quadrant pain that radiates to the shoulder
36
what is the best way to diagnose cholithiasis
ultrasound of the right upper quadrant
37
what substance can be used for the management of cholithiasis If surgery is contraindicated
Urso deoxycolic acid
38
What is the pathology of cholecystitis
Obstruction and inflammation of the cystic duct
39
What are the clinical manifestations of cholesystitis
persistent RUQ w/ fever & leukocytosis + Murphy sign: inspiratory arrest on palpation + Bsoas sign
40
What is the pathological mechanism of referred shoulder pain in gallbladder diseases
Referred pain diaphragmatic irritation via phrenic nerve
41
How is colissa styles diagnosed with Radiography
cholescintigraphy: contrasting agent: hepatic iminodiacetic acid (HIDA) If cystic duct is obstructed, contrast will not fill the gallbladder
42
Untreated long term cholecystitis can cause what complications to arise
gangerene & clostridia infection (emphysematous cholecystitis)
43
What antibiotic is used for the treatment Of Clostridia
ampicillin subactum
44
what are a risk factors for emphasimitis cholecystitis
diabetes mellitus, vascular compromise, immunosuppression
45
What is the definition of a calculus cholecystitis
Inflammation of the gallbladder and the absence of a gallstone
46
what patient populations are high risk for a calculus cholecystitis
burn victims trauma pts. pt. on parenteral nutrition sepsis AIDS pts. (w/ active CMV infection)
47
What is the most common cause of choledocholithiasis
obstruction of the common bile duct by a gallstone
48
What kind of stones Are associated with primary obstruction of the CBD
Stones that form directly inside the CBD; brown pigment
49
what kind of stones are associated with secondary obstruction of the cbd
Stones that originate from the gallbladder and travel to the common bile duct
50
What abnormal lab findings would you expect to find for cases of suspected choledocholithiasis
hyperbolo rubenemia, elevated serum levels of ALP and GGT
51
Gallstone obstruction in the pancreatic duct Would cause elevated serum levels of what enzyme
Pancreatic lip base
52
What is ascending colingitis
let ascending infection of the ductal system from gut flora
53
What pathogens are implicated for suspected ascending cola anginous
E coli, klebsiella, enterobacter, enterococci
54
What are the clinical manifestations of ascending colanginess
Charcot's triad & Reynold's pentad
55
What are the components of Reynolds Pintad
Hypertension and confusion
56
what abnormal lab findings would be found for ascending cola anginas
leukocytosis elevated ALP, AST, & ALT
57
cholangits is usually secondary to what
choledocholithiasis
58
What is the definition of a gallstone ileus
enerocholecystic fistula Causing secondary small bowel obstruction
59
Where are small bowel obstructions associated with gallstones usually located
ileocecal valve
60
What can be seen radiographically in a gallstone ileus
a gallstone outside of the gallbladder pneumobilia
61
What is the definition of biliary dyskinesia
Failure of the gallbladder to fully contract and eject bile; heart failure equivalent of the gallbladder
62
What comorbidities are associated with biliary dyskinesia
PUD and ischemic heart disease
63
Gallbladder cancer is commonly associated with what
Chronic cholesystitis
64
What is the mechanism of autoimmune biliary diseases
T cell mediated autoimmunity attack on intra hepatic bile ducts Granulomatous inflammation leading to cholestasis
65
What are the clinical manifestations of autoimmune biliri disease
the most common in middle aged women Intense pruritus dermal hyperpigmentation & xanthelasma
66
What drugs can be used for management of autoimmune biliary diseases
ursodeoxycolic acid (first-line) tacrolimus for immunosupression
67
What is the pathogenesis of primary sclerosis cholangitis
Inflammation, fibrosis, and narrowing of intra and extra hepatic bile ducts
68
What antibody is elevated for autoimmune biliary disease
antimitochondrial (anti-AMA)
69
PSC Is highly associated with what GI disease
Ulcerative colitis & Inflammatory Bowel Disease
70
Psc is associated with an increased risk for what
colangio Adino carcinoma
71
What lab findings are indicative of PSC
Elevated serum levels of: ALP p-ANCA hyper-IgM HLA B8 HLA DR3 AMA always negative
72
PBC is associated with increased risk for what malignancy
hepatocellular carcinoma
73
Compare and contrast the clinical manifestations of PBC and PSC
PBC: Primarily affects middle aged women that present with symptoms of pruritus, hyperlipidemia, jaundice, & xanthelasmas PSC: UC predisposition and hepatomegaly
74
What is calangio carcinoma
Cancer of the bioduct epithelium
75
What are risk factors for colangio carcinoma
Psc, cystic liver disease, clonorchis, HCV, gallstone disease
76
What is a specific clinical manifestation of colangio carcinoma
Clay pale colored stools and dark urine

Gasteroenterology2 (4 decks)

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