L16- GIT Pathology VIII (gallbladder) Flashcards Preview

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Flashcards in L16- GIT Pathology VIII (gallbladder) Deck (17):
1

describe the types of cholelithiasis and their frequency distribution

Cholesterol stones: cholesterol monohydrate (80%)

Pigment stones: bilirubin calcium salts (20%)

2

list the risks for cholethiasis (by type)

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

Pigment stones: chronic hemolysis, biliary infection

3

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

4

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

5

list the complications of cholelithiasis

-empyema (pus in pleural cavity)
-perforation
-fistulas
-cholangitis
-pancreatitis
-gallstone ileus
-inc risk of gallbladder carcinoma

6

define and list the types of cholecystitis

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

7

briefly describe the types of acute cholecystitis

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

Acute Acalculous cholecystitis:
-result of ischemia (maybe)

8

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

9

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

10

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)

11

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)

12

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

13

describe histology of gall bladder carcinoma

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

14

list the diseases of the Hepato-biliary tree

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

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

15

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)

16

Choledocholithiasis:
-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

17

Cholangitis:
-(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