Path Test 3: Gallbladder and Exocrine Pancreas

  1. Cholelithiasis risk factors
    Fat, Forty, Female Fertile
  2. People w/ these 2 disease are more likely to have black pigmented gallstone
    Sickle Cell disease, thalassemia
  3. 1)  Cholesterol gallstones
    2)  Black pigment gallstones
    • 1)  Supersaturation of bile w/ cholesterol
    • 2)  Increased biliary unconjugated bilirubin
  4. Complications of cholelithiasis
    • Biliary colic (recurrent bouts of RUQ pain)
    • Acute Cholecystitis (pain > 6 hrs)
    • Gallstone ileus:  Gallstones erode through gallbaldder wall into small intestin and cause obstruction (near ileocecal valve)
    • Primary carcinoma of the gallbladder (virtually always arises in the setting of cholelithiasis.
    • *Serious complications related to asymptomatic cholelithiasis are rare, therapy is initiated when symptoms occur.
  5. Acute Calculous Cholecystitis vs. Acute acalculus cholecystitis
    • Both= morphologically thick edematous gallbladder wall that shows fibobrlast proliferation and hemorrhage.
    • Acute Calculous Cholecystitis (gallstone present):  3/4 of these cases resolve in a few days, no surgical intervention is required.
    • Acute acalculous (no gallstones) cholecystitis patients are usually ALREADY severely ill, bad prognosis
  6. Acalculous cholcystitis results from?
    Can result in?
    • vascular compromise
    • gangrenous cholecystitis, perforation w/ bile peritonitis
    • Worse prognosise than calculous cholecystitis, poor surgical candidates
    • 10-15% mortality rate
  7. Empyema of gallbladder.  When is this seen?
    Gallbladder  is filled with pus.  Seen in acute cholecystitis
  8. In Chronic Cholecystitis patients generally complain of
    • Recurrent RUQ/ epigastric pain
    • Nause
    • Fatty food intolerance
  9. What is Rokitansky-Aschoff Sinus? When is this seen?
    Protrusion of gallbladder mucosa into muscularis.  Often seen in Chronic cholecystitis.
  10. Tips of mucosal villi are filled w/ lipid-laden macropahges giving a grossly yellow speckled appearance to the mucosal surface.
    Strawberry gallbladder (related to hypersecretion of cholesterol by the liver)
  11. Strawberry Gallbladder:  Tips of mucosal villi are filled w/ _________ giving a grossly yellow speckled appearance to the mucosal surface.
    lipid-laden macrophages, related to hypersecreiton of cholesterol by the liver
  12. Porcelain gallbladder
    Extensive dystrophic calcification (radiographically visible) in the gallbladder wall (chronic cholecystitis).  Associated w/ a greatly increased risk for development of gallbladder carcinoma.  Indication fo prophylactic cholecystectomy.
  13. Indication for prophylactic cholecystectomy because it is associated with greatly increased risk of gastric carcinoma.
    Porcelain gallbladder
  14. Most common underlying cause of biliary obstruction
    Choledocholithiasis (presence of gallstone in bile duct)
  15. Acute cholangitis
    • Infection of hte bile ducts associated w/ biliary tract obstruction.
    • Charcot's triad (fever w/ chills, jaundice, RUQ pain)
  16. Destruction of extrahepatic bile ducts following birth
    Biliary atresia

    Neonates appear healthy at birth, but develop alcoholic stools and jaundice in week 2 or 3
  17. Biliary Atresia tx?
    • Kasai procedure:  Connecs porta hepatis bile duct remnants w/ bowel lumen. 
    • Liver transplant is the only possible tx for many biliary atresia pts.
  18. Congenital dilatations of the COMMON bile duct and cause of childhood jaundice, RUQ mass, and abdominal pain.
    Choledochal cysts
  19. Most gallbladder malignancies are
  20. Are gallbladder and bile duct tumors resectable at time of discovery?
  21. Which is rarer gall bladder or bile duct carcinoma?
    Bile duct
  22. Bile duct carcinoma pt. presentation
    Painless jaundice, hepatomegaly and distended palpable gallbladder (Courvoisier's sign)
  23. Tumors that arise at the bifurcation of the hepatic duct
  24. Etiologic factors of acute pancreatitis (7)
    Alcoholism, gallstones, hyperlipoproteinemia, hypercalcemia, trauma, shock, genetic alterations
  25. Acute pancreatitis presentation
    Moderate to severe steady abdominal or epigastric pain which may radiate to upper back.  Elevated serum amylase and lipase are usual.
  26. There is a great range in severity and prognosis of
    Acute pancreatitis
  27. Leads to more widespread fat necrosis.
    Release of pancreatic enzymes (they complex w/ sodium salts in the process of saponification --> calcium soaps.)  Acute pancreatitis
  28. How do you establish a diagnosis of acute pancreatitis?
    CT scan shows enlarged pancreas
  29. 2 Bad prognostic indicators in acute pancreatitis
    • Hypocalcemia
    • Falling hematocrit
  30. Chronic pancreatitis results in loss of?  Most commonly seen in
    • Acinar tissue first, but then islet tissue
    • Middle-aged alcoholic
  31. Acute Pancreatitis Sequelae
    • Shock
    • ARDS (DAD)
    • Pseudocyst formation
    • acute renal failure
    • DIC
  32. Chronic Pancreatitis Sequelae
    • Pseudocyst formation
    • Malabsorption
    • Diabetes mellitus
  33. Fluid-filled cyst-like spaces lined by granulation tissue, fibrin and fibrous tissue that form following pancreatitis or acute pancreatic injury
    Pancreatic pseudocyst (True cysts have an epithelial lining)
  34. Pancreatic Pseudocysts vs. othe pancreatic tumors
    • Cystic neoplasma = multicystic; Pseudocysts= unicystic
    • Pancreatic carcinomas= solid; pseudocysts= fluid-filled
  35. Pancreatic carcinoma is the ____ most common cause of cancer death in the US.
  36. Definite risk factor of pancreatic carcinoma
  37. Pancreatic carcinoma patient presentation
    Weight loss, abdominal discomfort
  38. Carcinomas arising in the head of the pancreas may present with
    obstructive jaundice
  39. In most cases of ______, metastases are present at the time of diagnosis.  What percentage of these pts. have resectable tumors at the time of diagnosis?
    • pancreatic carcinoma
    • 20% (most in head)
  40. Most common type of primary pancreatic malignancy
  41. Usually a moderatly to poorly differentiated ductal-type adenocarcinoma producing a firm mass due to stromal fibrosis
    Pancreatic adenocarcinoma
Card Set
Path Test 3: Gallbladder and Exocrine Pancreas
Gallbladder and Exocrine Pancreas