PATOLOGIE HEPATICA

Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
AFECTIUNI HEPATICE
Inflamatia ( HEPATITE):
- infiltrat inflamator ac./cr. – portal/parenchim
- granuloame: corpi straini, microorganisme, droguri
- abcese
Degenerare:
- balonizarea hepatocitelor – grasimi/ hidropica
- acumulare intracitoplasmatica: pigment bilar, Fe, Cu, particulare
virale
Moarte celulara:
- necroza de coagulare – ischemie
- apoptoza: toxica, virala, imunologica
- focala / zonala/submasiva/ masiva
Fibroza:
- in inflamatii/toxice
- noduli de regenerare hepatocitara
- ciroza
 INSUFICIENTA HEPATICA
- 80-90% din functie hepatica pierduta- mortalitate 70-95%
CLINIC:

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M.

Reisner

Pocket Companion to Robbins and Cotran – Pathologic Basis of

Disease – International Edition 7th- Mitchell Kumar, Abbas Fausto
INSUFICIENTA HEPATICA
Necroza hepatica masiva
- Hepatita virala fulminanta
- Droguri hepato-toxice: ex.acetaminofen, halotan, intoxicatia cu
ciuperci

Boala hepatica cronica

- hepatitele cronice (+ b. metabolice) - ciroza

Disfunctii hepatice – fara necroza:

- toxicitate la tetraciclina
- steatoza acuta in sarcina
- disfunctii mitocondriale HIV
INSUFICIENTA HEPATICA
CLINIC:
ENCEFALOPATIA HEPATICA:
- afectarea SNC reversibila – afectarea hepatocelulara –
Sunt Sanghin – metaboliti in SNC ( amoniac)
- Mi: cerebral, edem -reactie astrocitara
- afectarea constientei: ex. tulburari comportamentale – confuzie-
coma
- modificari EEG : rigiditate, hiperreflexie, convulsii
- asterixis – tremor maini
SINDROMUL HEPATO-RENAL:
- fara patologie renala intrinseca
- oligurie
- restabilirea functiei hepatice depinde de restabilirea insuficientei
hepatice
 Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin,
Howard M. Reisner

CIROZA
Top 10 – cauza de deces
– insuficienta hepatica
- hipertensiune portala
- carcinom hepatocelular

Trei caracteristici:
1. Fibroza - septuri delicate / cicatrici
2. Noduli – regenerare hepatocitara
inconjurata de fibroza
3. Distortionarea arhitecturii
parenchimului hepatic
– micronodulara: c. alcoolica
- macronodulara: hepatite

Pocket Companion to Robbins and Cotran – Pathologic Basis of

Disease – International Edition 7th- Mitchell Kumar, Abbas Fausto
CIROZA
1.CIROZA BILIARA
- Secundara
- Colestatica
- Colangitica

2. PRIMITIVA 
F/B=6 /1
20-40-70 ani
Prurit, icter, xantoame, xantelasme
Hepatospenomegalie
90% din cazuri Atc. Antimitocondriali
ASOCIERI : S.Sjögren, sclerodermie, tiroidita
CIROZA BILIARA

MA: ficat nodular, verde

MI:
- Distructia ductelor interlobulare, granuloame: l,p,eo

- Proliferare ductuala, hepatita periportala

- Cicatrici, bridging necrosis, fibroza septala

- Ciroza
COLANGITA SCLEROZANTA PRIMARA

Idiopatica
B/F=2/1
30-50 ani

ASOCIERI : colita ulcerativa (70% din cazuri)

fibroza retroperitoneala

MI:
- Fibroza concentrica in jurul ductelor biliare mari
- Obliterare - disparitie

Dg.: = colangiografie retrograda endoscopica

- diagnostica in peste 80% din cazuri demonstrand stricturi
si dilatari pe caile biliare
Complicatii: colangio carcinom
Pathology made ridiculously simple –Aiman Zaher, M.D.
HIPERTENSIUNEA PORTALA
- Cresterea rezistentei fluxului sanguin portal
Cauze:

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

SINDROMUL BUDD-CHIARI:
- 50% idiopatic
- Policitemia vera
- Sarcina/postpartum
- Contraceptive orale
- Hepatocarcinom
BOALA VENO-OCLUZIVA:
- Alcaloizi de Senecio si Crotalaria
- Iradiere, anticanceroase, hipervitaminoza A
- Rejetul de transplant
Clinic:
- ascita
- sunturi portosistemice:
jonctiunea cardioesofagiana
(varice esofagiene)
rect ( hemoroizi)
retroperitoneu
ligament falciform
si ombilic (cap de meduza)

- splenomegalie congestiva -
hipersplenism
- encefalopatie hepatica

Essentials of Rubin’s Pathology – Edition5 – Editors

Emanuel Rubin, Howard M. Reisner
ICTERUL
ICTERUL:
- pigmentarea galbena a pielii si sclerelor (retentie bilirubina sistemica =
hiperbilirubinemie conjugata/neconjugata)

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

COLESTAZA
COLESTAZA:
- retentie sistemica de bilirubina – colesterol – datorata eliminarii
biliare inadecvate
- consecinta disfunctiei hepatobiliare ( colestaza intrahepatica)
- obstructia biliara ( colestaza extrahepatica)
- colestaza intrahepatica familiala – grup heterogen de boli autozomal
recesive
CLINIC:
- icter
- prurit
- xantoame

Fostafaza alcalina serica crescuta = enzima in epiteliu ductal biliar

si hepatocitar
COLESTAZA
Morfologie:
- acumulare de bila intrahepatica/dilatatie canaliculi biliari/degenerare
hepatocitara
- infiltrat cu PMN
- necroza parenchimatoasa focala = infarct biliar
- tardiv: fibroza portala – ciroza

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

HEPATITE
ETIOLOGIE:
= factori fizici: iradiere

= factori chimici: intoxicatii cu

ciuperci, alcool

= factori biologici: bacteriene,

virotice, micotice, parazitare

= factori imunologici: b.autoimune,

rejetul de transplant

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

 HEPATITE

Pocket Companion to Robbins and Cotran – Pathologic Basis of Disease – International Edition 7th- Mitchell Kumar,
Abbas Fausto
HEPATITELE ACUTE VIROTICE:

Morfologie:
Ma: - hepatomegalie usoara +- culoare verzuie
Mi: - necroza hepatocitara localizata / lobul – apoptoza =
corpi acidofili Council-Men
- balonizare hepatocitara
- limfocite + macrofage cu detritusuri hepatocitare
- arhitectura lobulara distorsionata
- necroza portalcentral ( bridging necrosis)
- cel. Kupffer hipertrofiate / hipertrofie
- regenerare hepatocelulara
- rari colestaza
Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner
HEPATITE CRONICE:
HEPATITA CRONICA VIROTICA:
- cu virus B: la copil (90%), la adult (5-10%)
- cu virus C: peste 50%
MA: ficat granular
MI:
GRADARE:
- hepatita lobulara – nu evolueaza spre ciroza

- hepatita de interfata
(piece-meal necrosis): evolueaza spre ciroza

- fibroza periportala
HEPATITE CRONICE:
Evolutie - ciroza

STADIALIZARE:
- Stadiul I: fibroza portala
- Stadiul II: fibroza stelata
- Stadiul III: fibroza in poduri
- Stadiul IV: ciroza

MARKERI HISTO:
- Virus B: citoplasme ground-glass, nuclei nisiposi
- Virus C: distrofie grasa+foliculi limfoizi in spatiul port+leziuni
de canal biliar
HEPATITE CRONICE:

Hepatita cronica virala tip B

“piece-meal necrosis”

hepatocite “ground glass”

 BOALA HEPATICA ALCOOLICA:

Indusa toxic

Pocket Companion to Robbins and Cotran – Pathologic Basis of Disease – International Edition 7th- Mitchell Kumar,
Abbas Fausto
BOALA HEPATICA ALCOOLICA:
 Sub actiunea alcoolului:

- STEATOZA: macro-, microveziculara

- HEPATITA CRONICA ALCOOLICA

- Corpi Mallory (hialin alcoolic)
- Infiltrate PMN (in jurul corpilor Mallory)
- Fibroza: pericentrolobulara, pericelulara

- CIROZA ALCOOLICA
Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner
HEMOCROMATOZA:
Def.: acumulare de Fe in cel. parenchimatoase – ficat ,pancreas, inima,
glande endocrine, piele, sinovie

H.primar:
- B. Autozomal recesiva = defect de absorbtie a Fe

H. secundar:
- B. asociate cu Fe in exces,
ex: transfuzii repetitive, eritropoeza ineficienta (Talasemia),
ingestie de Fe, B. hepatica cronica
HEMOCROMATOZA:
Clinic: - Hepatomegalie
- Dureri abdominale
- Pigmentare tegumentara
- Diabet zaharat
= diabet bronzat
- Disfunctie cardiaca
- Artrita
- Hipogonadism

Complicatii:
- Ciroza / Carcinom
hepatocelular

Tratament:
- Flebotomie
BOALA WILSON:
B. Autozomal recesiva = acumulare Cu in ficat, creier, ochi =
degenerescenta hepatolenticulara

Morfologie:
- steatoza hepatica – hepatita cronica/ ciroza / necroza hepatica
masiva
- cereabral: afectarea ganglionilor bazali ( simptome parkinsoniene)
- ochi: Inelul Kayser- Fleischer = depozit de Cu- membrana Descemt-
limbus corneal
 TUMORI HEPATICE
Hemagioamele + chiste biliare non-neoplazice
= leziuni benigne frecvente
HIPERPLAZIA NODULARA = noduli benigni solitari/multiplii in absenta
cirozei
- adult tanar – tumora neincapsulata, cicatrice stelata fibroasa
- transformare difuza nodulara fara fibroza
TUMORI HEPATICE
ADENOM:
F.FAVORIZANTI:
- Contraceptive orale
- Androgeni
- Glicogenoza I, diabet zaharat familial
MA:
- nodul unic/multiplu
- bine delimitat/incapsulat
- galben

MI:
- structura trabeculara
- fara spatii porte, vene centrolobulare

EVOLUTIE:
- rupere-hemoperitoneu
- hepatocarcinom in adenom
Adenom hepatic
Tumori maligne
1. Metastaze

2. Carcinom hepatocelular

3. Hepatoblastom

4. Angiosarcom + Arsenic +Thorotrast + Vinyl Chloride

Metastaza colon
Leiomiosarcom
Coriocarcinom
Melanom malign
Tumori maligne
Carcinom hepatocelular
F.FAV:
Africa si Asia de sud-est, Japonia, Europa de Est
Sexul: B/F=4-8/1
Varsta:
- 50-60 ani
Virus hepatitic B (hepatita cronica, ciroza): 70-75%
AIDS
Virus hepatitic C (ciroza): 10-15%
Aflatoxina (Aspergillus): Mozambic, China
Carcinom hepatocelular

Alcoolul: in Vest (50-70%)

Diabetul zaharat

Tulburari innascute de metabolism:

- Tirozinemie
- Glicogenoze (I)
- Porfirie
- Deficit de alfa-1-antitripsina
- Hemocromatoza

Steroizi gonadici sintetici

Obstructia membranoasa a venei cave inferioare

Iradiere
Carcinom hepatocelular

MA:
Nodular (masiv); multinodular; difuz
Pe ficat normal; pe ficat cirotic
Moale (exceptie-forma fibrolamelara)
alb±galbui (necroza)±rosu (hemoragii)±verde (bila)
extindere in: vena porta, v.suprahepatice, caile biliare
(extra-intrahepatice), a.hepatica
MI:
Trabecular
Pseudoglandular
Compact
Fibrolamelar
Aspectul reticulinei
Incluzii: corpi Mallory, corpusculi globulari acidofili,
ground glass
 Carcinom hepatocelular

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

Carcinom hepatocelular

Colorat bilar
Carcinom de ciroza

Aspect trabecular
aspect tubular

aspect trabecular
Carcinom fibrolamelar
Carcinom hepatocelular

PROGNOSTIC:
Sever
Favorabil:
- Tumori mici 2-3 cm
- Pedunculate
- Forma fibrolamelara
HEPATOBLASTOMUL
- copil (0,2-5% din toate tum.maligne)
Asocieri:
- Hemihipertrofia – sd. Beckwith-Widemann
- Absenta congenitala a venei porte
- Adenomatoza familiala a colonului

Sexul: B/F=2/1
Varsta: majoritatea in primii doi ani
HEPATOBLASTOMUL
MA:
Nodul: 5-25 cm
Bine delimitat
Arii de necroza, degenerescenta chistica, hemoragii

MI:
Varianta epiteliala: hepatocite embrionare, fetale, adulte
Varianta mixta: componenta epiteliala+osteoid+ mezenchim primitiv
Varianta teratoida: +melanina, cartilaj, muschi

PG: sever
COLANGIOCARCINOM
F.FAV:
Varsta: 60 de ani
Sexul: B=F
Infestatii (Asia de sud-est): clonorchiaza, opistorchiaza

Litiaza intrahepatica
Anomalii de dezvoltare ale cailor biliare
B.Caroli, Fibroza hepatica congenitala, Chistul de coledoc,
ficatul chistic, complexele Meyenburg

Colita ulcerativa, colangita sclerozanta primara

Contraceptive orale, steroizi androgeni anabolizanti

Fara ciroza
 COLANGIOCARCINOM
MA:
Nodul unic (hilar): multinodular
Alb, dur

MI: adenocarcinom

PG: prost -6 luni

 PATOLOGIA PANCREATICA

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

 PATOLOGIA PANCREATICA

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

DEZVOLTARE EMBRIOLOGICA MALFORMATII
AGENEZIE
Totala
Partiala: a portiunii ventrale
(pancreas scurt±polisplenie) sau dorsale

PANCREAS DIVISUM: 5%
Doua corpuri pancreatice (cu canale proprii, sau nu): favorizeaza
dezvoltarea pancreatitei cronice si a cc. Pancreatic

DUPLICATIE DUODENALA - CHIST/FISTULA in capul pancreasului

PANCREAS INELAR

PANCREAS ECTOPIC: 2% din necropsii

Stomac, duoden, jejun, diverticul Meckel

ECTOPIE DE TESUT SPLENIC: in coada pancreasului

ANOMALII MINORE: de ducte, acini, epitelii, formare de chiste,

BOLI GENETICE PANCREATICE
FIBROZA CHISTICA A PANCREASULUI (BOALA FIBROCHISTICA,
MUCOVISCIDOZA)
- Cea mai frecventa boala genetica la rasa alba: 1/2000-
1/3000 de nasteri vii
- B=F
- Gena (CFTR regulator transmembranal al FC) se gaseste pe
bratul lung al cromozomului 7 (s-au descris peste 120 de
mutatii): codeaza proteine implicate in transportul
transmembranal al CI si altor anioni

- Leziuni pancreatice:
- copil: pancreas granular
- adult: fibroza+chiste
- Insuficienta de secretie exocrina: steatoree, malnutritie
(85% din cazuri)
 BOALA FIBROCHISTICA, MUCOVISCIDOZA

LEZIUNI ALE APARATULUI RESPIRATOR

- Polipi nazali
- Bronsita catarala mucopurulenta (Stafilococ aureus,
Pseudomonas aeruginosa)
- Emfizem (uneori interstitial)+colaps alveolar
- Bronhopneumonii in repetitie
- Abcese bronhocentrice
BOALA FIBROCHISTICA, MUCOVISCIDOZA

LEZIUNI ALE APARATULUI DIGESTIV

- Ileus meconial peritonita meconiala calcificari

peritoneale, scrotale
- Dilatari glandulare - duoden, jejun
- Malabsorbtie facies de papusa
- Colonopatie fibrozanta
- Ficatul: normal, distrofie grasa, colestaza, ciroza biliara
focala
BOALA FIBROCHISTICA, MUCOVISCIDOZA

ALTE LEZIUNI

- Sterilitate: la barbat

- ELIMINARE MASIVA DE CLORURI IN SUDOARE!!!

- Testul sudoratiei
 PANCREATITE
PANCREATITA ACUTA:
- B. inflamatorie – tipic:
Dureri abdominale
Enzime pancreatice crescute
(amilaze /lipaze)
- Forme:
1. Ac. interstitiala
2. Ac. hemoragica
- 80% - Cholelitiaza / Alcoolism

Pocket Companion to Robbins and Cotran – Pathologic Basis of Disease – International Edition 7th- Mitchell Kumar,
Abbas Fausto
PANCREATITE

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

PANCREATITA INTERSITITIALA
(Edematoasa)

- pancreatita usoara
- secundara
- autonoma: la debutul formei necrotico-hemoragice

Ma.: Tumefiat, ferm, congestionat

MI:

- Edem, congestie, infirltrate PMN in interstitiu

- Poate exista putina necroza grasa peripancreatica
- Dar nu a acinilor glandulari, sau a stromei
PANCREATITA ACUTA NECROTICO-HEMORAGICA
(Pancreatita necrotizanta)

Forma severa

Ma. : multifocal /parcelar

- Arii de necroza grasa(citosteatonecroza): peripancreatic,
epiploic, mezenteric, retroperitoneal, subcutanat.
- Arii de necroza de lichefiere (enzimatica) a acinilor
glandulari: completa
- Hemoragii: prin necroza vasculara
Mi:
- necroze, hemoragii
- infiltrate cu PMN / necroza
Pancreatita acuta hemoragica

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner

PANCREATITA ACUTA

Complicatii :

- Vindecare 4 saptamini
– pseudochiste pancreatice
- 1-30 cm
- extrapancreatice - splina, stomacul, colonul
- continut enzimatic
- rupere: peritonita chimica
- compresie: duodenul, caile biliare
- erodare vase: hemoragii fatale,
diafragmul cu extindere:
in pleura, in mediastin

- Suprainfectie: abcese, septicemie

PANCREATITA ACUTA

EVOLUTIE:
- 1/3 - moarte

- 1/3 -se vindeca

- ± recaderi

- pancreatita cronica
PANCREATITA CRONICA

FACTORI FAVORIZANTI:
Pancreas divisum→cc
Pancreatita familiala→cc
Pancreatita recurenta
Pancreatita alcoolica
MA:
Organ mic, dur (scleroza
si atrofie)

Mi: Fibroza (perilobulara,

intralobulara-disecanta)
Infiltrate limfoidale:
variabile
Sistemul ductal-
dilatat±calculi
In ductele mici – secretie
coagulata

EV.:
Malabsorbtie
Essentials of Rubin’s Pathology – Edition5 –
Diabet zaharat
Editors Emanuel Rubin, Howard M. Reisner
CANCERUL PANCREATIC

F.FAV:
- fumatul (2-5 ori)
- dieta:
- cu grasimi (la gastrectomizati 2-5 ori)
- compusi nitrozamina
- compusi chimici
- varsta: 60-80 de ani, 10% din tineri
- sex: B
- rasa neagra
- pancreas divisum, pancreatita familiala,
diabetul zaharat
Pocket Companion to Robbins and Cotran – Pathologic Basis of Disease – International Edition 7th- Mitchell Kumar, Abbas Fausto

Pathology made ridiculously simple –Aiman Zaher, M.D.

CANCERUL PANCREATIC
MA:
- localizare: cap-60%, corp-15-20%; coada-5%, neclasabil-20%
- marime: variabila
- consistenta: dura, compacta
- tumori chistice:
-pana la 20 cm

MI:
- 90% de origine ductala
- 10% la nivelul acinilor

PG:
- supravietuirea la 5 ani = 3,7%
CANCERUL PANCREATIC
TUMORI INSULARE

Rare:sub1/100000 pe an
60-85% sunt functionale
Denumite in functie de hormonul principal:
insulinom, gastrinom, vipom, glucagonom
MA:
Nodulare, unice/multiple (adenomatoza), bine delimitate
Culoare variata: cenusii, galbui, roz, brune , 1-5 cm
Sub 0,5 –microadenom
Metastaze: ggl., ficat, rar extrahepatic
TUMORI INSULARE
MI:
Solide, trabeculare, glandulare
Pleiomorfismul lipseste, mitozele sunt neobisnuite
Depunerea de amiloid indica insulinomul
Structura glandulara+corpi psamomatosi
in somatostatinomul regiunii ampulare

CRITERII DE MALIGNITATE:
Histologia- nu
Angioinvazia, infiltrarea (macro) organelor vecine,
metastazele (pot apare dupa ani de zile)
INSULINOMUL

Cea mai frecventa

tumora secretoare
30-60 de ani, B=F
mai mic de 2 cm
90% benigne
10% contin amiloid

CLINIC: hipoglicemie
hiperinsulinemica

Essentials of Rubin’s Pathology – Edition5 –

Editors Emanuel Rubin, Howard M. Reisner
GASTRINOMUL

A doua tumora neuroendocrina ca frecventa

60% sunt maligne
S.Zollinger-Ellison (75% sporadic, 25% MEN tip 1)

In forma sporadica:
50-70% in capul pancreasului, restul: duoden, stomac,
jejun, cai biliare, ficat, rinichi, mezenter,
ggl.,peripancreatici,periduodenali

In pancreas: nodul solitar, >2 cm (in duoden<1 cm)

Hiperplazie de celule parietale (gastrice)

VIPOMUL

Produce polipeptid vasoactiv intestinal

Diaree apoasa, hipoposetamie, aclorhidrie-S.Verner-Morrison
F>B
Mai poate fi produs de:
feocromacitom, carcinoide intestinale, ganglioneurome si
ganglioneuroblastome (la copil)
80% sunt maligne
Nodul tumoral solitar, mare
GLUCAGONOMUL
40-60 de ani
F>B
Tumora mare, in sau atasata in pancreas

Eritem necrotizant migrator,

minima intoleranta la glucoza,

anemie, slabire in greutate,

depresie,

tromboze profunde
SOMATOSTATINOMUL
- mare, localizat in capul pancreatic (alteori in D2)
- malign
- diabet,
- colelitiaza,
- steatoree,
- hipoclorhidrie,
- anemie,
- slabire,
- diaree,
- dureri abdominale
Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner
NEOPLAZIA ENDOCRINA MULTIPLA
SINDROAME MEN
Def. predispozitia genetica de a dezvolta hiperplazii/tumori in doua
sau mai multe organe endocrine, sincron sau metacron

MEN tip 1 (sindrom Wermer):

1. adenom pituitar
2. hiperplazie paratiroidiana/adenom
3. tumori insulare pancreatice
Mutatia gena supresoara cromozom 11Q13 (proteina menina)

MEN tip 2:
AD-celulele C (tiroida), medulosuprarenala, paratiroide± tumori
neurogene, habitus marfanoid

MEN tip 2 A (sindrom SIPPLE)

- tiroida: hiperplazie nodulara/difuza multifocala de celule C, sau
carcinoma medular de tiroida >90%
- medulosuprarenala: hiperplazie/feocromocitom - 85-90%
- paratiroide: hiperplazie nodulara de celule principale-60%
NEOPLAZIA ENDOCRINA MULTIPLA
SINDROAME MEN
MEN tip 2 B ( sindromul neurinoamelor mucoase)

- AD, 10q11.2 (pe o zona mai larga)

- Tiroida: ca in MEN 2A >90%
- Medulosuprarenala: ca in MEN 2A – 85-90%
- Paratiroide: rar
- Habitus marfanoid: 100%
- Neuroame mucoase: 100%
- Ganglioneuromatoza intestinala: 40-50%
 COLECISTUL
VEZICA BILIARA

Histology a text and atlas with Corralated Cell and molecular Biology , Seventh Edition– Wojciech Pawlina
 COLECISTUL – VEZICA BILIARA

LITIAZA BILIARA
- precipitarea sarurilor de calciu+ matrice celule necrozate+ colonii
bacteriene = calculi

- 4 tipuri:
- colesterolici
- pigmentari
- calcici
- mixti
- F.fav.: 5 F ( “Five F’s)
- “female, fat, forthy, fertile, fair”

Pathology made ridiculously simple –Aiman Zaher, M.D.

Essentials of Rubin’s Pathology – Edition5 – Editors Emanuel Rubin, Howard M. Reisner
COLECISTUL – VEZICA BILIARA
Complicatii:
- obstructie – colecistita acuta
- migrare +- pancreatita acuta +- ileus biliar
- fistule bilio-biliare
bilio-intestinale
- degenerare neoplazica – c. scuamos - ADK
COLECISTUL – VEZICA BILIARA
COLECISTITA ACUTA:
Clinic:
-Colica biliara
- Triada Charcot = febra+ icter
+ dureri in hipocondru drept
- Asociere colangita ascendenta
= Pentada Reynolds
- dureri in hipocondru drept
- febra
- icter
- soc toxicoseptic
- depresie SNC

Pathology made ridiculously simple –Aiman Zaher, M.D.

 COLECISTUL – VEZICA BILIARA
COLECISTITA :
Mi: - acuta:
- catarala
- flegmonoasa
- gangrenoasa
- cronica:
- atrofica
- hipertrofica
- mixta
COLECISTOZE:
- colesteroloza colecistica:
- “ Vezicula fraga” =
Ma intramucosal + colesterol
- diverticuloza intramurala =
sinusurile Rokitansky-Aschoff
= cavitati +bila+microcalculi