General Pathology: Diseases of the Gallbladder and Biliary Ducts PDF

GENERAL PATHOLOGY Diseases of the gallbladder and the biliary ducts Dr. Antonio Barrasa  Intended learning objectives To introduce to the clinical presentation of the patient with diseases of the bile ducts and pancreas – Introduction to pathophysiology of c...

GENERAL PATHOLOGY Diseases of the gallbladder and the biliary ducts Dr. Antonio Barrasa  Intended learning objectives To introduce to the clinical presentation of the patient with diseases of the bile ducts and pancreas – Introduction to pathophysiology of cholelithiasis – Introduction to pathophysiology of cholecystitis – Introduction to pathophysiology of cholangitis – Introduction to the pathophysiology of pancreatitis – Introduction to pathophysiology bile duct tumors – Introduction to pathophysiology choledocal cysts Dr. Antonio Barrasa  Composition – >70% cholesterol y calcium – ≃ 20% bile salts – < 10% cholesterol Cause: Precipitation – High colesterol and lipids concentration in bile – Hemolisis in pigmentary – Galbladder motility Dr. Antonio Barrasa 12:08  Biliary colic Chronic cholecistitis Acute Cholecistitis – Murphy’s sign Bile duct obstruction – Choledocolithiasis – Mirizzi´s síndrome Cholangitis – Charcot’s triad Pancreatitis Gallstone ileus – Bouveret’s syndrome Dr. Antonio Barrasa 12:08  Clinical manifestations Ultrasound CAT scan ColangioMR ERCP EUS Dr. Antonio Barrasa 12:08  Acute Trypsin inhibitors – Cholelithiasis – Alcohol Intracellular trypsin activation Necrosis Severity scores Pseudocysts Inflammation Ramson Abscess APACHE I y II Ascytis Glasgow Haemorrhage Blathazar Perforation SIRSàMOF Dr. Antonio Barrasa 12:08  Chronic – Alcohol – Autoimmune diseases Pseudocyst – Recurrent Exocrine insufficiency – Tumoral Malapsorption – Cystic fibrosis Endocrine insufficiency Diabetes Obstructive jaundice Bowel obstruction Portal vein thrombosis Peptic ulcer PAIN Dr. Antonio Barrasa 12:08  Carcinoma of the gallbladder – Gallstones – ”Porcelain gallbladder” – Polips Cholangiocarcinoma – Intrahepatic – Extrahepatic Periampulary tumors – Pancreatic – Bile duct – Duodenum – Ampulla de Vater Pancreatic cancer – Intraductal Papilar Mucinous Neoplasm Dr. Antonio Barrasa 12:08  Todani classification Dr. Antonio Barrasa 12:08