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?
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.