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Cholelithiasis risk factors
Fat, Forty, Female Fertile
People w/ these 2 disease are more likely to have black pigmented gallstone
Sickle Cell disease, thalassemia
1) Cholesterol gallstones
2) Black pigment gallstones
- 1) Supersaturation of bile w/ cholesterol
- 2) Increased biliary unconjugated bilirubin
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.
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
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
Empyema of gallbladder. When is this seen?
Gallbladder is filled with pus. Seen in acute cholecystitis
In Chronic Cholecystitis patients generally complain of
- Recurrent RUQ/ epigastric pain
- Fatty food intolerance
What is Rokitansky-Aschoff Sinus? When is this seen?
Protrusion of gallbladder mucosa into muscularis. Often seen in Chronic cholecystitis.
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)
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
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.
Indication for prophylactic cholecystectomy because it is associated with greatly increased risk of gastric carcinoma.
Most common underlying cause of biliary obstruction
Choledocholithiasis (presence of gallstone in bile duct)
- Infection of hte bile ducts associated w/ biliary tract obstruction.
- Charcot's triad (fever w/ chills, jaundice, RUQ pain)
Destruction of extrahepatic bile ducts following birth
Neonates appear healthy at birth, but develop alcoholic stools and jaundice in week 2 or 3
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.
Congenital dilatations of the COMMON bile duct and cause of childhood jaundice, RUQ mass, and abdominal pain.
Most gallbladder malignancies are
Are gallbladder and bile duct tumors resectable at time of discovery?
Which is rarer gall bladder or bile duct carcinoma?
Bile duct carcinoma pt. presentation
Painless jaundice, hepatomegaly and distended palpable gallbladder (Courvoisier's sign)
Tumors that arise at the bifurcation of the hepatic duct
Etiologic factors of acute pancreatitis (7)
Alcoholism, gallstones, hyperlipoproteinemia, hypercalcemia, trauma, shock, genetic alterations
Acute pancreatitis presentation
Moderate to severe steady abdominal or epigastric pain which may radiate to upper back. Elevated serum amylase and lipase are usual.
There is a great range in severity and prognosis of
Leads to more widespread fat necrosis.
Release of pancreatic enzymes (they complex w/ sodium salts in the process of saponification --> calcium soaps.) Acute pancreatitis
How do you establish a diagnosis of acute pancreatitis?
CT scan shows enlarged pancreas
2 Bad prognostic indicators in acute pancreatitis
- Falling hematocrit
Chronic pancreatitis results in loss of? Most commonly seen in
- Acinar tissue first, but then islet tissue
- Middle-aged alcoholic
Acute Pancreatitis Sequelae
- ARDS (DAD)
- Pseudocyst formation
- acute renal failure
Chronic Pancreatitis Sequelae
- Pseudocyst formation
- Diabetes mellitus
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)
Pancreatic Pseudocysts vs. othe pancreatic tumors
- Cystic neoplasma = multicystic; Pseudocysts= unicystic
- Pancreatic carcinomas= solid; pseudocysts= fluid-filled
Pancreatic carcinoma is the ____ most common cause of cancer death in the US.
Definite risk factor of pancreatic carcinoma
Pancreatic carcinoma patient presentation
Weight loss, abdominal discomfort
Carcinomas arising in the head of the pancreas may present with
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)
Most common type of primary pancreatic malignancy
Usually a moderatly to poorly differentiated ductal-type adenocarcinoma producing a firm mass due to stromal fibrosis