Pathology: Gallbladder, Biliary Tract and Alcoholic Liver Disease Flashcards
(24 cards)
What are Cholelithiasis and what are the two types?
gallstones
- cholesterol stones - 80%
- pigment stones (bilirubin) - 20%
What are the risk factors for cholesterol stones and pigmented stones?
Cholesterol stones:
- age; 30% >80 yrs
- females; contraceptives
- obesity
Pigment stones:
- chronic hemolytic diseases
- GI disorders —> cystic fibrosis of the pancreas
what are the causes of cholesterol stones?
- hepatic hyper-secretion of cholesterol
- impaired gallbladder motility
- rapid phase transition of cholesterol
what are the causes of pigmented stones?
- hemolytic disorders
- infections
what are the clinical presentations and complications of Cholelithiasis?
- 70-80% asymptomatic
- abdominal pain in upper right quadrant
- nausea, vomiting
- jaundice
- increased risk of CARCINOMA (<0.5%)
What is Acute Calculous Cholecystitis and what are the clinical presentations?
inflammation of the gallbladder caused by gallstones
- pain in right hypochondrium or epigastrium
- fever, nausea, vomiting
- jaundice (rare)
What is Chronic Calculous Cholecystitis and what are rare complications?
recurrent acute cholecystitis —-> direct mucosal irritation from gallstones or intermittent mechanical obstruction of the cystic duct by stones
- Porcelain Gallbladder: associated with an increased risk of gallbladder cancer
What is Acute Pancreatitis and what are the main causes?
reversible pancreatic parenchymal injury associated with inflammation
- gallstone disease (leading cause)
- alcohol (2nd most common cause)
What are the clinical presentations for Acute Pancreatitis?
- Severe epigastric pain, nausea, vomiting
- Serum amylase or lipase levels elevated ≥3x the upper limit of normal
- Lipase is more specific for acute pancreatitis
- Hypocalcemia, high blood glucose
What is Chronic Pancreatitis?
- repeated mild/moderate inflammaton with atrophy of pancreatic parenchyma and replacement with fibrous tissue
- atrophy causes loss of function/insufficiency —-> diabetes, fat malabsorption, vitamin k deficiency
What can Chronic Pancreatitis lead to?
- Diabetes
- Fat Malabsorption in small bowel (intraluminal digestion phase anomaly) —> steatorrhea + decrease in Vit K
- Vit K deficiency leads to decreased in coagulation factors II-VII, IX and X —> bleeding mucosa (gums)
What causes Chronic Pancreatitis?
- prolonged alcohol abuse
- obstruction from masses or stones
- mutations
What are the oral cavity presentations of Chronic Panccreatitis?
- angular cheilitis
- glossitis
- stomatitis
- mucosal bleeding
What are the risk factors for Pancreatic Adenocarcinoma?
- smoking
- alcohol abuse
- hereditary syndromes
What is the main location for carcinomas of the pancreas and what can it cause?
- head 60-70%
- obstruction to bile flow –> jaundice and early diagnosis
What are the clinical features of Pancreatic Adenocarcinoma?
- back pain, weight loss, jaundice, DM
- Trousseau sign
- raised CA 19-9 levels (marker)
- local lymph node metastases
What is Macrovesicular Steatosis and where is it seen?
fatty liver change where a large single fat droplet accumulates in the hepatocyte
- liver disease
- chronic hepatitis C
- methotrexate use
What markers indicate Liver Cell Damage vs Biliary Duct Disease?
- ↑ AST/ALT → indicates hepatocyte injury
- ↑ ALP & GGT → suggests bile duct obstruction
- ↑ Prothrombin time ↓ Albumin → indicates impaired vascular changes and coagulation
what virus is the most important cause of Chronic Liver Disease?
Hepatitis C (80-85% higher rate than HBV)
What are the oral associated lesions of Hepatitis C?
- oral lichen planus; autoimmune condition causing white, lace-like patches on the mucosa and red, inflamed areas
What are the main drugs that cause liver damage?
- acetaminophen
- oral contraceptives
What is Cirrhosis?
Diffuse liver process with fibrosis and conversion of normal architecture into structurally abnormal nodules
- Micronodular < 3mm nodules
- Macronodular >3 mm nodules
What is Cirrhosis a usual feature of and what can it increase the risk of?
portal hypertension and liver failure
- increased risk of hepatocellular carcinoma
what are the oral cavity associated manifestations of Cirrhosis?
- bleeding gums
- bleeding afer dental procedures
