Flashcards in Path Gallstones and Biliary diseases - mechanical cholestasis Deck (22):
EtOH risk factor for cholethiasis?
Stone types (composition, causes)
infectious - Calcium salts and deconjugated bilirubin , cytoeskeleton of bacteria, previous surgery, duodenal diverticula
Pure calcium bilirubinate, calcium copper, mucin glycoprotein. hemolysis.
Cholesterol Ca salts of bilirubin (most common, not seen by xray)
enzyme & location for bile acid formation?
7alphahydroxylase in hepatocytes is RLS
deficiency -> cholesterol^, stones
increased estrogen risk
GI absorption of bile acids/salts
low absorption in jejunum – active and passive absorption in ileum
3 causes of cholesterol bile stones
supersaturation of cholesterol - pathalogic or physiologic?
physiologic until stone formation. micelles.
delay in gallbladder emptying result?
4 risk factors for gall stone formation
Defective acidification of gallbladder bile
> pH higher precipitation of calcium salts
Gallbladder stasis can produce increase of mucin and interfere with mechanical emptying
Decreased response to CCK
3 risks for brown gall stones
Bacterial infection (duodenum normally sterile - surg & diverticula are risks)
Decreasing biliary secretory IgA
High activity of B-glucuronidase
describe biliary tree
RHD, LHD --> HD
HD & CD --> CBD --> PD --> sphincter of odi, ampulla of Vader
acute cholecystitis symptoms
abd pain, fever
choledocholithiasis w/cholangitis symptoms
abd pain, fever, jaundice
biliary pancreatitis symptoms
abdominal pain, increased amylase
% of pts w/cholecystectomy w/coledocholithiasis
emphysematous cholecystitis association
Tx of gallstones
sphincterotomy, removal w/balloon
2 types of cholestasis & causes
intrahepatic: PBC, drugs, malignancy, etc
extrahepatic: stones, obstruction (surg, primary sclerosing cholangitis, infection, chronic pancreatitis, transplantation stricture)