Documente Academic
Documente Profesional
Documente Cultură
biliare intra/extra
hepatice i a veziculei
biliare
Delia Ciobanu
Glande Luschka
Sinusuri Rokitansky-Aschoff
Anomaliile congenitale
Colesteroloza veziculei biliare
Colelitiaza
Colecistitele
Tumorile cilor/veziculei biliare
Anomalii congenitale
Vezicula biliar:
Anomalii de form i dimensiune:
Vezicula frigian - angularea fundusului veziculei biliare
Agenezia/hipoplazia veziculei biliare
Duplicarea/triplicarea veziculei biliare
Vezicula multiseptat 3-10 septuri tapetate de epiteliu
cilindric (n sticl de ceas/transversal)
Diverticulii/pseudodiverticuli ai veziculei biliare
Anomalii de localizare:
Vezicula inclus n parenchimul hepatic
Vezicula plonjant
Heterotopia cu mucoas gastric, pancreatic, hepatic,
tiroidian, SR
Anomalii congenitale
Vezicula phrygian
Heterotopia de mucoas
gastric
Anomalii congenitale
Ci biliare:
Atrezia cilor biliare intra i extrahepatice
Chisturile de canale biliare:
Chist de canal coledoc
Coledococelul
Maladia Caroli
Chisturile de ci biliare
Maladia Caroli
Colesteroloza veziculei
biliare
25% din cazurile de colecistectomie
Acumularea colesterolului esterificat n
macrofagele din lamina propria (celule xantice)
Macroscopic: vezicula frag
Microscopic:
Etiologie:
Colesteroloza veziculei
biliare
Colesteroloza veziculei
biliare
Colelitiaza
Cea mai frecvent patologie biliar
Asociat/nu cu hepatolitiaz/coledocolitiaz
Calculi:
Colesterol:
75-80%
Puri (90%)/micti (60-70% colesterol)
Unici
Rotund/ovalari, culoare galben, suprafa neted
Aspect radiar pe seciune
Factori favorizani: genetici/sarcini repetate/boli
ileale/obezitatea
Mecanismele formrii:
Colelitiaza
Calculi:
Pigmentari:
10-25%
Colesterol sub 25%
Bilirubinat de Ca negri/bruni
ntotdeauna multiplii
Negri suprafa lucioas, radiari pe seciune,
relativ duri, se formeaz n bila steril
Bruni - staz/infecii biliare; suprafa solzoas, care
se detaeaz n lambouri, duritate mic
Macanism: glucuronidazele bacteriene care
degradeaz bilirunina neconjugat
Colelitiaz
Colelitiaza
Colelitiaza - complicaii
Calculii exercit aciune iritativ asupra
mucoasei:
Inflamaie
Perforaie fistule
colecisto-duodenale
colecisto-colice
coledoco-duodenale
Hidrops vezicular
obliterarea coletului vezical/cistic
vezicula destins, perete gros/fibros, lumenul conine
un lichid transparent/mucoid
Colecistitele
Inflamaii ale colecistului acute/cronice
Colecistitele acute:
Etiologie:
90% calculoase
Ne-calculoase: infecii ascendente ci biliare Giardia/lamblia, malformaii ci
biliare
Macroscopic:
Microscopic:
Colecistita acut
Colecistita acut
Colecistita acut
Colecistita cronic
95% asociat cu colelitiaz
Macroscopic:
Form hipertrofic
Form atrofic
Microscopic:
Colecistit cronic
Colecistita cronic
Vezicula de porelan
Adenomatoi
Hiperplazici
Colesterolozici
Inflamator
Fibros
Adenomioza
Hemangiom/leiomiom/lipom/paragangliom/limfangiom
Tumori maligne:
Tumori secundare
Polip adenomatos
tubular/papilar
Adenomioza
Decada 6-7
F/B-3/1
Antecedente: colelitiaz (75%)/colecistit cronic (50%)
Macroscopic:
Microscopic:
Adenocarcinom (75-85%)
Evoluie:
Carcinomul de vezicul
biliar
Adenocarcinom
Bine difereniat
Moderat difereniat
Carcinom scuamocelular
PROGNOSTIC FEATURES
In as many as 50% of cases, gallbladder cancers are discovered
at pathologic analysis after simple cholecystectomy for
presumed gallstone disease.
Five-year survival is 50% for patients with T1 tumors.
Patients with T2 tumors have a 5-year survival rate of 29%,
which appears to be improved with more radical resection.
Patients with lymph node metastases (Stage IIIB or higher) or
locally advanced tumors (Stage IVA or higher) rarely experience
long-term survival.
The site-specific prognostic factors include histologic type,
histologic grade, and vascular invasion.
Papillary carcinomas have the most favorable prognosis.
Unfavorable histologic types include small cell carcinomas and
undifferentiated carcinomas.
Lymphatic and/or blood vessel invasion indicate a less favorable
outcome.
PROGNOSTIC FEATURES
Histologic grade also correlates with outcome.
Patients with T2T3 cancers discovered at pathologic analysis
are usually offered a second operation for radical resection of
residual tumor.
This may include nonanatomic resection of the gallbladder
bed (segments IVB and V of the liver) or more formal anatomic
resection such as a right hepatectomy.
Resection of the biliary tree is dependent on surgical decision
making at the time of the definitive procedure and may be
based on cystic duct margin status.
Staging classification should be reported for tumors removed
by either a single operation or a staged surgical procedure
(cholecystectomy followed by definitive resection).
In cases where the surgical procedure was staged, it should
be noted whether the cholecystectomy was performed
laparoscopically or via an open approach.
Factori prognostici
PROGNOSTIC FACTORS (SITE-SPECIFIC FACTORS)
(Recommended for Collection)
Required for staging None
Clinically significant
Tumor location
Specimen type
Extent of liver resection
Free peritoneal side vs. hepatic side for T2
Decada 6-7
Antecedente:
Macroscopic:
Vegetante/infiltrative
Microscopic:
Adenocarcinoame 90-95%
Adenoscuamos 6,5%
Scuamocelular
Carcinom ci biliare
Carcinom ci biliare
PROGNOSTIC FEATURES
Patients who undergo surgical resection for localized perihilar cholangiocarcinoma have a
median survival of approximately 3 years and a 5-year survival rate of 20% to 40%.
In carefully selected patients with primary sclerosing cholangitis and early-stage perihilar
cholangiocarcinoma, preliminary data report excellent results with neoadjuvant
chemoradiation and liver transplantation.
Complete resection with negative histologic margins is the major predictor of outcome,
and liver resection is essential to achieve negative margins. Factors adversely associated
with survival include high tumor grade, vascular invasion, lobar atrophy, and lymph node
metastasis.
Papillary morphology carries a more favorable prognosis than nodular or sclerosing
tumors.