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Phase 2 GI and Surgery > 3. Biliary and Pancreatic Pathology > Flashcards

3. Biliary and Pancreatic Pathology Flashcards

1
Q

define the following:

  1. CHOLESTASIS
  2. CHOLELITHIASIS
  3. CHOLEDOCHOLITHIASIS
  4. CHOLECYSTITIS
  5. CHOLANGITIS
A
  1. impairment of bile formation and/or bile flow
  2. presence of gall stones in the gall bladder
  3. presence of gall stones in the common bile duct
  4. inflammation of the gall bladder
  5. Inflammation of the billiary tree
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2
Q

Describe the anatomy of the billiary tree

A

cystic duct drains gall bladder; common hepatic duct drains liver
cystic duct joins common hepatic duct - forms common bile duct
common bile duct joins with pancreatic duct at the ampulla

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3
Q
  1. What are gall stones a result of?
  2. How can gall stones cause billiary colic
  3. How can gall stones cause jaundice?
A
  1. bile super saturation
  2. stone migrates to the opening of the cystic duct and obstructs the neck of the gall bladder → increase in bladder wall tension
  3. obstruction results in a backflow of bilirubin into the bloodstream. Usually results from obstruction of COMMON BILE DUCT
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4
Q

describe the following types of gall stone and conditions in which they are associated:

  1. cholesterol
  2. pigment
  3. mixed
A
  1. composed purely of cholesterol; result of excess cholesterol production; associated with obesity
  2. composed purely of bile pigments; result of excess bile pigment production; associated with haemolytic anaemia
  3. composed of both cholesterol and bile pigments
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5
Q

Name the 6 risk factors for gall stone disease

A
  1. fat
  2. female (oestrogen increases billiary cholesterol secretion); HRT and oestrogen containing contraceptives also increase risk
  3. forty
  4. fertile (progesterone decreases gall bladder contractility)
  5. family history
  6. haemolytic anaemia
  7. malabsorption - Ileal resection; Crohn’s
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6
Q
  1. What is uncomplicated billiary colic

2. Describe the pain associated with uncomplicated billiary colic

A
  1. impaction of gallbladder neck by stone. No inflammatory response but contraction against the stone causes colicky pain
  2. sudden, dull, colicky pain. poorly localised and visceral. precipitated by fatty foods. associated nausea and vomiting. Examination unremarkable
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7
Q
  1. What is acute cholecystitis?
  2. Describe the pain associated with acute cholecystitis
  3. Examination findings
A
  1. CYSTIC DUCT OBSTRUCTION → gall bladder inflammation
  2. colicky pain. pain often well localised to RUQ. May be persistent and constant due ti inflammatory process
  3. Positive murphy’s sign - press on costal margin and ask patient to take deep breath. Will elicit pain
    patient may be jaundiced.
    associated signs of inflammation
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8
Q
  1. What is ascending cholangitis?
  2. What is this condition characterised by?
  3. what is this condition regarded as?
A
  1. infection of the billiary tree
    COMMON BILE DUCT OBSTRUCTION → bile stasis
    stagnant bile becomes infected with bacteria - bacteria spreads up ductal system causing inflammation. can cause bacteremia and sepsis
  2. CHARCOT’S TRIAD - RUQ pain; jaundice, fever
  3. medical emergency
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9
Q

What investigations are useful in the diagnosis of gall stone pathology? (7)

A
  1. urinalysis - exclude pregnancy, renal or tubo-ovarian pathology
  2. Inflammatory markers - raised in cholecystitis and cholangitis
  3. LFTs - biliary colic and acute cholecystitis are likely to show raised ALP
  4. amylase - pancreatitis
  5. trans-abdominal ultrasound - visualise the presence of gall stones, assess gall bladder thickness and any bile duct dilatation
  6. MRCP
  7. ERCP
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10
Q

Why is pancreatitis a complication of gall bladder disease?

A

gall stones can become impacted in the ampulla, which impairs drainage of pancreatic duct

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11
Q

Name the 4 types of cholangitis

A
  1. Acute ascending cholangitis
  2. primary sclerosing cholangitis
  3. secondary scleroising cholangitis
  4. recurrent pyogenic cholangitis
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12
Q

Apart from stones, name 2 other causes of obstruction that can lead to ascending cholangitis

A
  1. malignancy

2. strictures

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13
Q
  1. What is primary biliary cholangitis?
  2. What is common in patient’s hx
  3. What serological test are characteristic of this disease?
A
  1. autoimmune destruction of the liver
    - progressive destruction of the intrahepatic bile ducts
    - leads to the development of fibrosis, cholestasis and cirrhosis
  2. fam hx of PBC
    hx of other autoimmune conditions
  3. anti-mitochondrial autoantibodies
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14
Q
  1. What is primary sclerosing cholangitis?
  2. What other conditions is this disease associated with?
  3. describe LFT profile
  4. What is seen on MRCP?
  5. What is definitive management
A
  1. idiopathic autoimmune mediated inflammation and scarring of intra- and extra-hepatic bile ducts. Results in progressive liver disease → cirrhosis
  2. IBD (mostly UC); other autoimmune conditions
  3. elevated ALP
  4. irregular beaded appearance of the biliary tract
  5. liver transplant
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15
Q
  1. What is secondary sclerosing cholangitis

2. Name 5 conditions which can cause secondary sclerosing cholangitis

A
  1. condition which mimics primary sclerosing cholangitis but is secondary to other conditions
    • chronic billiary obstruction by stones
    • following recurrent pyogenic cholangitis
    • toxic damage following intra-arterial chemo
    • following ischaemic damage
    • chronic pancreatitis
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16
Q
  1. Define acute pancreatitis

2. Define chronic pancreatitis

A
  1. inflammation of a previously normal pancreas. initiated by acute injury; can return to normal following resolution of episode
  2. continuing inflammation of the pancreatitis, with irreversible structural changes
17
Q

Describe the causes of Acute Pancreatitis

A

I GET SMASHED

  • Idiopathic
  • Gall Stones
  • Ethanol (alcohol causes early activation of trypsinogen)
  • trauma
  • steroids
  • mumps; malignancy
  • autoimmune
  • scorpion bite
  • hypercalcaemia; hypertriglycerideamia
  • ERCP
  • drugs - tetracyclines, furosemide, azathioprine, thiazides)
18
Q

What is the underlying mechanism which causes pancreatitis (all aetiologies)

A

Pancreatic inflammation occurs secondary to premature and exaggerated activation of pancreatic enzymes, within the pancreas

19
Q

How does a patient with a patient with Acute pancreatitis present?

  1. Pain
  2. Associated symptoms
  3. On examination
A
  1. epigasyric pain, radiates to the back
  2. nausea and vomiting
  3. upper abdominal pain
    systemically unwell - tachycardia, hypotension, oliguria
    widespread tenderness with guarding
    periumbilical and flank bruising
20
Q
  1. Which serum marker is sensitive (but not specific) for pancreatitis?
  2. What other tests may be of diagnostic value
A
  1. serum amylase
2. serum lipase
    transabdominal ultrasound (useful if ?biliary aetiology)
21
Q

Name 2 scoring systems which are useful in determining prognosis of acute pancreatitis

A
  1. Atlanta Criteria of Disease Severity

2. Glasgow Prognostic Crtieria

22
Q

Name 3 metabolic complications of acute pancreatitis

A
  1. hyperglycaemia
  2. hypoglycaemia
  3. hypocalcaemia
23
Q
  1. What is a pancreatic pseudocyst?
  2. What type of pancreatitis is it commonly associated with?
  3. What is the risk of a pseudocyst?
A
  1. fluid filled sac rich in pancreatic enzymes, blood and necrotic tissue
  2. acute-on-chronic
  3. can become infected, and can obstruct surrounding structures
24
Q
  1. what is the most common cause of chronic pancreatitis?

2. name 3 other causes of chronic pancreatitis

A
  1. alcohol

2. CF, recurrent acute pancreatitis; autoimmune

25
Q

Describe the pathogenesis of chronic pancreatitis, in relation to the formation of plugs

A

prolonged intrapancreatic enzyme activity leads to protein precipitation within the duct lumen - plugs
these plugs can calcify, leading to further ductal obstruction, ductal hypertension and further pancreatic damage

26
Q
  1. Describe the characteristic pain associated with chronic pancreatitis
  2. Name 4 other clinical features of chronic pancreatitis
A
  1. epigastric pain which radiates to the back. May be episodic or chronic
  2. anorexia and weight loss
    steatorrhoea
    malabsorption
    diabetes
27
Q
  1. Why are serum amylase and lipase not as useful in the investigation of chronic pancreatitis
  2. Which enzyme marker is a useful diagnostic test for chronic pancreatitis?
  3. Name 3 imaging techniques which are useful in the investigation of chronic pancreatitis
A
  1. they may not be elevated in advanced disease
  2. faecal elastase
  3. transabdominal ultrasound
    contrasr CT - can show pancreatic calcification and dilated ducts
    MRCP/ERCP

Phase 2 GI and Surgery (10 decks)

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