L16- GIT Pathology VIII (gallbladder) Flashcards Preview

DERS (GIT) > L16- GIT Pathology VIII (gallbladder) > Flashcards

Flashcards in L16- GIT Pathology VIII (gallbladder) Deck (17):

describe the types of cholelithiasis and their frequency distribution

Cholesterol stones: cholesterol monohydrate (80%)

Pigment stones: bilirubin calcium salts (20%)


list the risks for cholethiasis (by type)

Cholesterol stones: inc age, females, oral contraceptives, obesity, rapid weight loss

Pigment stones: chronic hemolysis, biliary infection


describe cholelithiasis mechanism for cholesterol stones

1) supersaturation of bile with cholesterol
2) hypomotility of gallbladder
3) accelerated cholesterol crystal nucleation
4) hypersecretion of mucus in the gall bladder


Cholelithiasis clinical presentation:
-(1) predominant symptom, then (2) is most common after (1)
-(3) is present in certain complications

1- asymptomatic (70-80%)

2- coliky-like pain, especially after a fatty meal

3- Murphy's sign if cholecystitis is present


list the complications of cholelithiasis

-empyema (pus in pleural cavity)
-gallstone ileus
-inc risk of gallbladder carcinoma


define and list the types of cholecystitis

-inflammation of the gallbladder
-acute, chronic, acute superimposed on chronic


briefly describe the types of acute cholecystitis

Acute Calculous cholecystitis:
-90% cases
-primary complication of *gallbladder

Acute Acalculous cholecystitis:
-result of ischemia (maybe)


describe acute cholecystitis pathogenesis (hint- very long)

1) chemical irritation / inflammation resulting from obstruction
2) mucosal phospholipase converts lecithin --> lysolecithin
3) damage to glycoprotein layer of mucosa
4) further release of PGs from mucosa
5) all (1-4) => mucosal / mural inflammation
6) gall bladder dysmotility, inc intraluminal pressure
7) superimposed bacterial contamination


Acute Cholecystitis clinical features:
-(1) is the main symptom with (2) as associated symptoms
-(3) is present upon examination
-(4) may be indicated / a possible complication

1- R hypocondrium or epigastrium pain
2- fever, n/v
3- Murphy's sign
4- surgical emergency


Chronic Cholecystitis:
-results from (1)
-usually associated with (2), although role is unclear
-(3) is a common finding in 1/3 of patients
-(4) is a rare complication

1- sequel of repeated acute cholecystitis

2- cholelithiasis

3- positive microorganism culture from bile

4- extensive dystrophic calcification (porcelain gall bladder: bluish discoloration, brittle consistency, associated with cancer)


describe histology of chronic cholecystitis

-mucosa infiltrated by inflammatory cells
-abnormal multiple folds
-fibrosis surrounding cirrhosis

-out-pouching of mucosa thru wall containing bile = Rokitansky-Ashcoff sinuses (herniation of mucosa outside of gallbladder)


Gall Bladder carcinoma:
-(1) common age, gender
-(2) is present in most patients, and (3) are other risk factors
-(4) is the most common form
-(5) is common at time of diagnosis

1- 60s y/o, females (slightly)

2- gallstones (60-90%)
3- pyogenic / parasitic infections of biliary tract //// carcinogenic derivatives of bile may have a role

4- adenocarcinoma (exophytic)
5- invasion/spread to liver


describe histology of gall bladder carcinoma

(usually exophytic carcinoma)
-disorganized malignant glands
-interspersed dense fibrosis


list the diseases of the Hepato-biliary tree

(either Intra- or Extra- hepatic)
-**bile duct stones (choledocholithiasis)

-biliary tract cysts
-biliary atresia
-bile duct carcinomas (cholangiocarcinoma)


Biliary Tree diseases, general pathophysiology:
-(1) is the most important cause, usually due to (2) and or (3)
-altered anatomy causes (4) which can lead to (5)
-(6) may result from inflammatory damage after biliary tree disease

1- obstruction / impaired bile flow
2- gall stones
3- neoplastic masses

4- impaired bile flow
5- cysts (choledochal cyst)
6- scarring (recurrent cholangitis)


-occurs in some patients with (1)
-defined as (2), mostly occurring at (3)
-(4) describe Mirizzi syndrome

1- gallstones (15%)
2- stone blocking any part of bile duct
3- common bile duct

4- gallstone in cystic duct compresses common hepatic duct => obstructive jaundice


-(1) definition
-(2) are the most common causes
-recurrent form is common in (3) population

1- infection of biliary tree following biliary obstruction

2- E. coli, S. faecalis, Enterbacter

3- (recurrent pyogenic cholangitis / oriental cholangiohepatitis) Asia / Pacific rim countries due to Chinese liver fluke parasite