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Salient Features:
• 63 year old female
• 4 months history of abdominal pain
• CC: Hematemesis
• PMHx: BPUD, PTB (4 months treatment)
o and HPN
• S/P TAHBSO (1983)
• S/P Hemorrhoidectomy (1998)
External Examination
Skin is jaundiced with minimal postmortem rigidity and posterior lividity.
Head is normocephalic.
Sclerae are icteric.
Chest is symmetrical.
Abdomen is globular with a midline infraumbilical scar measuring 5 cm in length.
Internal Examination
Thoracic Cavity
Marked pleural adhesions were noted at the right hemithorax.
Mediastinum is shifted to the left and markedly thickened with adherence to
the left lung.
No fluid pleural fluid noted.
Pericadial sac: 30 cc of clear, serous, straw-colored fluid.
Esophagus
Ruptured esophageal varices
Liver
Weighs: 2,232 grams (NV: 1,100 – 1,300 gms)
Measures: 22.5 x 13 x 3 cm.
Thickened fibrous capsule
Spleen
Weighs: 157 gms (NV: 80 -125 grams)
10 x 9 x 3 cm.
Capsule is dull and thickened.
CSS: solid and dark red parenchyma
CONGESTION
Kidneys
RIGHT: 242 grams
LEFT: 267 grams
Capsules are easily stripped off revealing fine granularities on the cortical surface.
CSS:
indistinct corticomedullary junctions
unremarkable pelvico-calyceal stuctures
*** ACUTE TUBULAR NECROSIS
Intestines
Haemorrhages and necrosis
Gallbladder Carcinoma
Uncommon but aggressive type of malignancy
Incidence: slightly more in females (3-4:1)
most frequent in 7th decade
Usually diagnosed late or in advance state.
Location:
• Fundus (60 %)
• Body (30 %)
• Neck (10 %)
Growth patterns:
• Infiltrating – more common, appears as poorly defined area of diffuse
thickening and induration of the gallbladder wall
• Exophytic – cauliflower-like mass within the lumen; invades the underlying
wall, luminal portion may be necrotic, hemmorhagic, and ulcerated
S/Sx: indolent, chronic abdominal pain, anorexia,weight loss; jaundice, nausea and
vomiting
PE: palpable mass
hepatomegaly
jaundice - malignant obstruction of the biliary tree rather than hepatic
metastasis .
Spread: directly to the liver and adjacent structures (biliary tree)
Stage V 0%
Gallbladder Adenocarcinoma
Portal Hypertension
( ascites, jaundice,
esophageal varices)
Gallbladder Adenocarcinoma Ruptured esophageal varices
with involvement of (hematemesis and melena)
liver parenchyma and porta
hepatis
Massive Bleeding
Predisposes to DIC
Hemorrhagic Shock
Multi-Organ
Failure
DEATH
( other pathological diseases... )
Portal hypertension
- Increased resistance to portal flow
a. Prehepatic
- Obstructive thrombosis and narrowing of portal vein, massive
splenomegaly
b. Intrahepatic
- Cirrhosis dominant intrahepatic cause acct for most cases of portal
hpn
- Schistosomiasis
- Massive fatty change
- Diffuse fibrosing granulomatous disease ( sarcoidosis and military Tb)
c. Posthepatic
- Severe right sided heart failure , constrictive preicarditis and hepatic
vein outflow obstruction
Pathophysio:
- Increased resistance to portal flow at the level of sinusoids and compression of the
terminal hepatic veins by perivenular scarring and expansile parenchymal nodules
Hemorrhagic shock
- Hypovolemic shock
- Loss of blood or plasma volume
- Cardiovascular collapse
- Gives rise to systemic hypoperfusion caused by reduction either in cardiac output or
in effective circulating blood volume
- End results are hypotension, flowed by impaired tissue perfusion and cellular hypoxia
Ayan.. haha! Tpos na. Galing to sa book, ppts, harrison’s and post notes ntin last year s
patho... natuwa tuloy ako mgbasa ng mga greetings ntin last year... sana helpful po ung
4 n CPC tranx.. hi hello sa mga ka OFW lunch ko knina... Starfish! Lucky! Wico! And the
cook.. Joana! sa susunod daw smin n venue... c Peter barber.. ( Grrr.. Ahhh!), wala ka
naman sa nicasia. Ang lamig s tagaytay! WAAAHHHH! Pero okei lng, natpos ko naman ang
last tranx ng CPC ditto... Hahaha! hi wix kahit d mo to mbabasa, busy ka kasi mg aral dyn
sa harap ko!
GO Superfriends! <yeye, keln maglalaban si histioxytosis X at si walking zombie sign?>
Studdy Buddies! 1 week na naman tyong may bangagan session! luto uli kyo ng food!
Karen... 8.5 pla ah!