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43 Cards in this Set

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where does bile enter duodenum?

ampulla of Vater

congenital abn of GB

absent, double, bilobed, aberrant location (w/in liver), folded fundus (mass-like lesion in lumen)

3 main processes of GB

cholecystitis, cholelithiasis, tumors

Cholelithiasis - general

most silent; common in Native Americans; F>M, obesity/rapid weight loss; cholesterol & pigment stones

pigment stone

caused by infection & hemolysis

cholesterol stone formation

cholesterolosis (buildup of cholesterol)

cholesterolosis - gross

cholesterolois - histology

acute cholecystitis

usually caused by impacted stone in neck or cystic duct; present w/ pain, hx of 'biliary disease'; acalculous seen in elderly/debilitated patients

complications of acute cholecystitis

perforation (bile peritonitis), gall stone ileus, secondary infections (Salmonella), gangrene

gall stone ileus

GB adheres to intestine -> fistula forms -> stone drains into intestine -> reaction -> blockage -> peristalsis stops -> proximal bowel dilates

histology of acute cholecystitis

neutrophils in all layers

acute cholecystitis w/ stones - gross

chronic cholecystitis general

90% a/w stones, others due to repeated acute acalculous; RUQ pain, some acute onset

chronic cholecystitis types

porcelain (calcium), hydrops (mucus)

chronic cholecystitis

biliary tumors

rare; signs similar to chronic cholecystitis; 5ys 1% (high stage); a/w stones (US), parasites (liver flukes, schisto)

MC type biliary tumor

adenocarcinoma (>95%), others SCC, carcinoids

adenocarcinoma of gall bladder

carcinoma of extrahepatic bile ducts

rare, M>F, cause progressive jaundice (obstruct duct); hard to dx & rx

carcinoma of bile duct

choledocholithiasis

stones in bile duct; obstructive symptoms, can cause infections; uncommon

ascending cholangitis

bacterial inf. a/w stones; enteric gram negative bacteria (E. coli)

biliary atresia

cause neonatal cholestasis -> MCC death from liver disease in kids; extrahepatic biliary tree completely obstructed

most acute pancreatitis related to...

gallbladder disease (obstruction), alcoholism

less common causes of acute pancreatitis

parasitic obstruction, arterial obstruction (acute ischemia), idiopathic, drugs (thiozide, azothioprine, sulfas, furosemide), trauma

pancreatitis pathogenesis

release of enzymes -> tissue destruction -> fat necrosis -> fibrosis -> secondary infections; fluid & electrolyte shifts

clinical presentation of pancreatitis

abd. pain, high amylase/lipase, DIC, shock, ARDS, 5% mortality

pancreatitis - gross

acute pancreatitis

chronic pancreatitis

clue for chronic pancreatitis on xray?

numerous calcifications, stones

tumors of pancreas

adenocarcinoma, cysts, pseudocysts, neoplastic cysts

serous cystadenomas

benign, women, older

mucinous cystic neoplasms

benign, borderline or malignant; women; remove completely

intraductal papillary mucinous neoplasms

can be borderline or malignant; men; head, ductal involvement; more likely precursor to cancer

solid-pseudopapillary tumor

young women, large solid & cystic areas; bizarre & uncommon

microcystic low grade borderline tumor of pancreas

Adenocarcinoma of pancreas presentation

Trousseau's syndrome (migratory thrombophlebitis), obstructive jaundice, painful (neural involvement)

adenocarcinoma of pancreas head

pancreatic adenoCA - histology



Ampulla adenoCA - most from bile duct, some from duodenal mucosa; symptomatic EARLY

Islet cell tumors

small neuroendocrine neoplasms; Zollinger-Ellison syndrome (gastrinoma), insulinoma, MEN syndromes