11: Pathology of the biliary tract and pancreas Flashcards
What is cholelithasis?
Gallstones
Where are gallstones most commonly found?
1. Gallbladder (because it’s static)
2. Biliary system (less common because the bile flows)
How are symptomatic gallstones removed?
Cholecystectomy
What are the three main components of bile?
Bilirubin
Bile salts
Cholesterol
Where is bile stored and concentrated?
Gallbladder
Which signal triggers the release of bile into the duodenum?
CCK
Why do gallstones occur?
Imbalance of ratio between cholesterol and bile salts
i.e too much cholesterol
cholesterol crystalises to form solid stones.
Who gets gallstones?
Female
Obese
Diabetics
What is haemolytic anaemia?
Increased breakdown of red blood cells, more Hb to metabolise
⇒ increased unconjugated bilirubin which the liver can’t handle
Apart from excess cholesterol, what other factor associated with haemolytic anaemia causes gallstones?
Increased bilirubin
Name the two types of gallstone.
Cholesterol stones
Pigment (bilrubin) stones
What do gallstones cause in the biliary lining?
Infection
Inflammation
chronic cholecystitis is constant waves of inflammation
mucocoele - buildup of mucus
empyema - buildup of pus
ascending cholangitis - gallstone blocks bile duct leading to ascending cholangitis (infection)
gallstone ileus - eroding action of gallstone forms fistula between duodenum and gall bladder, then travels to terminal ileum and blocks ileocaecal valve
pancreatitis - gallstone blocks sphincter of oddi, pancreatitis, autodigestion of pancreas by its own enzymes
What is cholecystitis?
What is it usually associated with?
Inflammation of the gallbladder
Gallstones, usually
What causes acute cholecystitis?
Gallstones blocking outflow of bile
In acute cholecystitis, the gallbladder is initally sterile but soon becomes ___.
infected
What are some complications of acute cholecystitis?
Empyema
Rupture
Peritonitis
If gallstones remain after a bout of acute cholecystitis, what can occur?
Chronic cholecystitis
What happens to the muscle coat of the gallbladder in chronic cholecystitis?
Thickened
What type of cancer rarely occurs in the gallbladder?
Adenocarcinomas
Adenocarcinoma of the gallbladder is associated with ___.
Where can it directly spread?
gallstones
Liver
What is cancer of the bile ducts called?
Cholangiocarcinoma
What diseases are associated with cholangiocarcinoma?
Primary sclerosing cholangitis
(which itself is associated with UC)
What are cholangiocarcinomas also called?
Klatskin tumours
The pancreas is intimately associated with other organs.
Name these associations according to each part of the pancreas.
Head - duodenum, stomach, liver
Neck - bile ducts, stomach, IVC and abdominal aorta
Body - stomach, splenic artery/vein
Tail - spleen, left adrenal gland
In terms of the GI tract, the pancreas is heavily involved in ___ of food.
digestion
In terms of the endocrine system, removing the pancreas will render a patient ___.
diabetic
What is pancreatitis?
Inflammation of the pancreas
What is the main symptom of acute pancreatitis?
Sudden onset severe abdominal pain
Patients with acute pancreatitis is associated with elevated serum ___.
amylase
What is a biliary cause of acute pancreatitis?
Gallstones block sphincters / damage sphincters causing reflux of pancreatic enzymes / bile, causing inflammation
Why are autodigestive lipases so damaging to the pancreas?
Pancreas is surrounded by fat
What, associated with lipase secretion, is seen under the microscope in acute pancreatitis?
Fat necrosis
What, associated with protease secretion, is seen under the microscope in acute pancreatitis?
Tissue destruction
Haemorrhage
In acute pancreatitis:
lipases digest the ___ around the pancreas
proteases digest the pancreas’s ___ ___, resulting in ___.
fat
blood vessels , haemorrhage
What are the complications of acute pancreatitis if untreated?
Shock due to blood loss ⇒ Death
Pseudocysts ⇒ Abscesses
Deranged metabolites (hypocalcaemia, hyperglycaemia)
What causes chronic pancreatitis?
Same things, really:
alcohol
gallstones
CF
What is a genetic disease which causes chronic pancreatitis?
Cystic fibrosis
What process occurs in chronic pancreatitis?
What is the result of this?
Chronic inflammation
Fibrosis
What type of malignant tumour is most commonly found in the pancreas?
Adenocarcinoma
Adenocarcinoma of the pancreas has a (good / poor) prognosis.
poor
Why is the prognosis of pancreatic cancer so poor?
Pancreas is intimately related with lots of other organs - you can’t resect it, especially in older patients
What is a complication of tumours in the head of the pancreas?
Bile duct obstruction
Which organ can be invaded by tumours in the tail of the pancreas?
Spleen
Adrenal gland
Stomach
