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43 Cards in this Set
- Front
- Back
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where does bile enter duodenum? |
ampulla of Vater |
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congenital abn of GB |
absent, double, bilobed, aberrant location (w/in liver), folded fundus (mass-like lesion in lumen) |
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3 main processes of GB |
cholecystitis, cholelithiasis, tumors |
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Cholelithiasis - general |
most silent; common in Native Americans; F>M, obesity/rapid weight loss; cholesterol & pigment stones |
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pigment stone |
caused by infection & hemolysis |
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cholesterol stone formation |
cholesterolosis (buildup of cholesterol) |
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cholesterolosis - gross |
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cholesterolois - histology |
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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 |
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complications of acute cholecystitis |
perforation (bile peritonitis), gall stone ileus, secondary infections (Salmonella), gangrene |
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gall stone ileus |
GB adheres to intestine -> fistula forms -> stone drains into intestine -> reaction -> blockage -> peristalsis stops -> proximal bowel dilates |
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histology of acute cholecystitis |
neutrophils in all layers |
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acute cholecystitis w/ stones - gross |
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chronic cholecystitis general |
90% a/w stones, others due to repeated acute acalculous; RUQ pain, some acute onset |
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chronic cholecystitis types |
porcelain (calcium), hydrops (mucus) |
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chronic cholecystitis |
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biliary tumors |
rare; signs similar to chronic cholecystitis; 5ys 1% (high stage); a/w stones (US), parasites (liver flukes, schisto) |
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MC type biliary tumor |
adenocarcinoma (>95%), others SCC, carcinoids |
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adenocarcinoma of gall bladder |
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carcinoma of extrahepatic bile ducts |
rare, M>F, cause progressive jaundice (obstruct duct); hard to dx & rx |
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carcinoma of bile duct |
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choledocholithiasis |
stones in bile duct; obstructive symptoms, can cause infections; uncommon |
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ascending cholangitis |
bacterial inf. a/w stones; enteric gram negative bacteria (E. coli) |
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biliary atresia |
cause neonatal cholestasis -> MCC death from liver disease in kids; extrahepatic biliary tree completely obstructed |
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most acute pancreatitis related to... |
gallbladder disease (obstruction), alcoholism |
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less common causes of acute pancreatitis |
parasitic obstruction, arterial obstruction (acute ischemia), idiopathic, drugs (thiozide, azothioprine, sulfas, furosemide), trauma |
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pancreatitis pathogenesis |
release of enzymes -> tissue destruction -> fat necrosis -> fibrosis -> secondary infections; fluid & electrolyte shifts |
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clinical presentation of pancreatitis |
abd. pain, high amylase/lipase, DIC, shock, ARDS, 5% mortality |
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pancreatitis - gross |
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acute pancreatitis |
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chronic pancreatitis |
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clue for chronic pancreatitis on xray? |
numerous calcifications, stones |
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tumors of pancreas |
adenocarcinoma, cysts, pseudocysts, neoplastic cysts |
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serous cystadenomas |
benign, women, older |
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mucinous cystic neoplasms |
benign, borderline or malignant; women; remove completely |
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intraductal papillary mucinous neoplasms |
can be borderline or malignant; men; head, ductal involvement; more likely precursor to cancer |
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solid-pseudopapillary tumor |
young women, large solid & cystic areas; bizarre & uncommon |
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microcystic low grade borderline tumor of pancreas |
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Adenocarcinoma of pancreas presentation |
Trousseau's syndrome (migratory thrombophlebitis), obstructive jaundice, painful (neural involvement) |
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adenocarcinoma of pancreas head |
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pancreatic adenoCA - histology |
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Ampulla adenoCA - most from bile duct, some from duodenal mucosa; symptomatic EARLY |
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Islet cell tumors |
small neuroendocrine neoplasms; Zollinger-Ellison syndrome (gastrinoma), insulinoma, MEN syndromes |
