11: Pathology of the biliary tract and pancreas

Question 1

What is cholelithasis?

Answer 1

Gallstones

Question 2

Where are gallstones most commonly found?

Answer 2

1. Gallbladder (because it’s static)

2. Biliary system (less common because the bile flows)

Question 3

How are symptomatic gallstones removed?

Answer 3

Cholecystectomy

Question 4

What are the three main components of bile?

Answer 4

Bilirubin

Bile salts

Cholesterol

Question 5

Where is bile stored and concentrated?

Answer 5

Gallbladder

Question 6

Which signal triggers the release of bile into the duodenum?

Answer 6

CCK

Question 7

Why do gallstones occur?

Answer 7

Imbalance of ratio between cholesterol and bile salts

i.e too much cholesterol

cholesterol crystalises to form solid stones.

Question 8

Who gets gallstones?

Answer 8

Female

Obese

Diabetics

Question 9

What is haemolytic anaemia?

Answer 9

Increased breakdown of red blood cells, more Hb to metabolise

⇒ increased unconjugated bilirubin which the liver can’t handle

Question 10

Apart from excess cholesterol, what other factor associated with haemolytic anaemia causes gallstones?

Answer 10

Increased bilirubin

Question 11

Name the two types of gallstone.

Answer 11

Cholesterol stones

Pigment (bilrubin) stones

Question 12

What do gallstones cause in the biliary lining?

Answer 12

Infection

Inflammation

Question 13

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

Question 14

What is cholecystitis?

What is it usually associated with?

Answer 14

Inflammation of the gallbladder

Gallstones, usually

Question 15

What causes acute cholecystitis?

Answer 15

Gallstones blocking outflow of bile

Question 16

In acute cholecystitis, the gallbladder is initally sterile but soon becomes ___.

Answer 16

infected

Question 17

What are some complications of acute cholecystitis?

Answer 17

Empyema

Rupture

Peritonitis

Question 18

If gallstones remain after a bout of acute cholecystitis, what can occur?

Answer 18

Chronic cholecystitis

Question 19

What happens to the muscle coat of the gallbladder in chronic cholecystitis?

Answer 19

Thickened

Question 20

What type of cancer rarely occurs in the gallbladder?

Answer 20

Adenocarcinomas

Question 21

Adenocarcinoma of the gallbladder is associated with ___.

Where can it directly spread?

Answer 21

gallstones

Liver

Question 22

What is cancer of the bile ducts called?

Answer 22

Cholangiocarcinoma

Question 23

What diseases are associated with cholangiocarcinoma?

Answer 23

Primary sclerosing cholangitis

(which itself is associated with UC)

Question 24

What are cholangiocarcinomas also called?

Answer 24

Klatskin tumours

Question 25

The **pancreas** is intimately associated with other organs. Name these associations according to each part of the pancreas.

Answer 25

**Head** - duodenum, stomach, liver **Neck** - bile ducts, stomach, IVC and abdominal aorta **Body** - stomach, splenic artery/vein **Tail** - spleen, left adrenal gland

Question 26

In terms of the GI tract, the **pancreas** is heavily involved in ___ of food.

Answer 26

**digestion**

Question 27

In terms of the endocrine system, removing the pancreas will render a patient \_\_\_.

Answer 27

**diabetic**

Question 28

What is **pancreatitis**?

Answer 28

**Inflammation of the pancreas**

Question 29

What is the main symptom of **acute pancreatitis**?

Answer 29

**Sudden onset severe abdominal pain**

Question 30

Patients with **acute pancreatitis** is associated with elevated serum \_\_\_.

Answer 30

**amylase**

Question 31

What is a biliary cause of acute pancreatitis?

Answer 31

**Gallstones block sphincters / damage sphincters** causing reflux of pancreatic enzymes / bile, causing inflammation

Question 32

Why are **autodigestive lipases** so damaging to the pancreas?

Answer 32

**Pancreas is surrounded by fat**

Question 33

What, associated with lipase secretion, is seen under the microscope in acute pancreatitis?

Answer 33

**Fat necrosis**

Question 34

What, associated with protease secretion, is seen under the microscope in acute pancreatitis?

Answer 34

**Tissue destruction** **Haemorrhage**

Question 35

In acute pancreatitis: **lipases** digest the ___ around the pancreas **proteases** digest the pancreas's ___ \_\_\_, resulting in \_\_\_.

Answer 35

**fat** **blood vessels , haemorrhage**

Question 36

What are the complications of acute pancreatitis if untreated?

Answer 36

**Shock** due to blood loss ⇒ **Death** **Pseudocysts ⇒** **Abscesses** Deranged metabolites (hypocalcaemia, hyperglycaemia)

Question 37

What causes **chronic pancreatitis**?

Answer 37

**Same things, really:** alcohol gallstones **CF**

Question 38

What is a **genetic disease** which causes **chronic pancreatitis**?

Answer 38

**Cystic fibrosis**

Question 39

What process occurs in **chronic pancreatitis**? What is the result of this?

Answer 39

**Chronic inflammation** **Fibrosis**

Question 40

What type of malignant tumour is most commonly found in the pancreas?

Answer 40

**Adenocarcinoma**

Question 41

Adenocarcinoma of the pancreas has a (**good / poor**) prognosis.

Answer 41

**poor**

Question 42

Why is the prognosis of pancreatic cancer so poor?

Answer 42

**Pancreas** is intimately related with lots of other organs - you can't resect it, especially in older patients

Question 43

What is a complication of **tumours in the head of the pancreas**?

Answer 43

**Bile duct obstruction**

Question 44

Which organ can be invaded by tumours in the **tail** of the pancreas?

Answer 44

**Spleen** **Adrenal gland** **Stomach**