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Flashcards in Path Biliary Deck (23):
1

Gallbladder origin

endodermal, ventral medial outgrowth of the foregut

2

Regulatory hormones of the gallbladder

Cholecystokinin and somatostatin

3

Cholelithiasis

presence of calculi (gallstones) in the gallbladder or biliary tree

4

Cholesterol stones

Occur more frequently in women. Can be caused by excess cholesterol synthesis or decreased production/recycling of bile salts (lecithin). Predisposing factors: estrogen, advanced age, obesity, family hx, high cholesterol diet, diabetes, primary biliary cirrhosis

5

Bilirubin stones

measure < 1 cm, composed of calcium bilirubinate, calcium salts, mucin. Occur in elderly, malnourished, sickle cell, cirrhosis, and thalassemia. Due to high concentrations of UNCONJUGATED bilirubin in bile = insoluble/precipitates.

6

Mixed (brown pigment) stones

Mix of cholesterol and bilirubin. Found in intra and extra hepatic ducts rather than the gallbladder

7

Cholecystitis

Inflammation of the gallbladder - almost always associated with gallstones. Acute cholecystitis - fibrinous exudates. Detergent bile salts damage mucosa. bacterial infection with clostridia or coliform bacteria = gangrenous cholecystitis which can lead to perforation. Chronic cholecystitis = thickened wall due to fibrosis and Rokitansky-Aschoff sinuses.

8

Rokitansky-Aschoff Sinuses

Histological change seen in the wall of the gallbladder indicative of CHRONIC CHOLECYSTITIS. Penetration of the mucosa into the muscular layer of the gallbladder

9

Cholesterolosis

accumulation of cholesterol filled macrophages in the lamina propria of the gallbladder. Common finding at autopsy. Mucosa appears speckled with yellow flecks. When extreme, condition is called a "strawberry gallbladder". No associated with hypercholesterolemia

10

Benign tumors of the gallbladder

Papillomas and mucous gland adenomas. If smooth muscle proliferates = adenomyoma.

11

Malignant tumors of the gallbladder

Adenocarcinoma

12

Adenocarcinoma of the gallbladder is associated with?

Chronic cholecystitis and cholelithiasis

13

Choledocholithiasis

Presence of calculi within the biliary tree

14

Choledocholithiasis can lead to?

pancreatitis, cholangitis, hepatic abscess, secondary biliary cirrhosis, acute calculous cholecystitis

15

Ascending Cholangitis

Inflammation and infection of the hepatic ducts and common bile duct. Usually secondary to partial or complete of a septic biliary tree by calculi

16

Signs and symptoms of ascending cholangitis:

mild epigastric to severe RUQ pain, N/V, peritoneal irritation, RIGHT SHOULDER/SCAPULAR PAIN, palpable gallbladder. Jaundice may be intermittent or mild

17

Most common etiologic agents of ascending cholangitis?

E. coli, Enterobacter spp, Klebsiella spp., Proteus spp., enterococci, non-hemolytic streptococci, and Bacteroides or clostridium

18

Biliary atresia

Obliteration of the lumen of part or all of the hepatic biliary tree within the first 3 months of life. Initially necrosis and inflammation of the ductal epithelium. Eventually leads to fibrosis with obliteration of the lumen and resolution of inflammation. Untreated patients progress to cirrhosis

19

Treatment of biliary atresia?

"Kasia procedure" or portoenterostomy, but most require liver tx

20

Choledochal cysts

uncommon dilations of the common bile duct. Usually occur in patient <10 years of age. Symptoms: jaundice and recurrent biliary colic.

21

Klatskin tumors

angiocarcinoma arising at the junction of the left and right hepatic ducts in the hepatic hilum

22

Predisposing genetics for pancreatic adenocarcinoma

KRAS, CDKN2A, p53.

23

Trousseau's syndrome

Migratory thrombophlebitis, suggestive of occult pancreatic adenocarcinoma