4- pathology of biliary tract & pancreas Flashcards
what are risk factors for gallstones?
female sex, age, obesity, genetic, diabetes
what are different types of gallstones?
- cholesterol (most common)
- pigment
- calcium
- mixed
what is normal bile made up of?
micelles of cholesterol, phospholipid, bile salts & bilirubin
= stored and concentrated in gallbladder, released by CCK into 2nd part of duodenum through common bile duct & ampulla of vater (more after large fatty meal)
how are pigmented gallstones formed?
- bilirubin (yellow pigment) produced during breakdown of heme, occurs in spleen and then heme molecule metabolised to biliverdin then bilirubin. Bilirubin transported to liver where conjugated with glucuronic acid to form water-soluble bilirubin →these are then excreted into bile where bilirubin remains soluble
- If imbalance in bilirubin metabolism then concentration of bilirubin in bile can exceed it’s soluble threshold and can precipitate as insoluble pigment gallstones
what are complications of gallstones? (11)
- biliary colic
- acute cholecystitis
- chronic cholecystitis
- gallbladder mucocele
- gallbladder empyema
- carcinoma
- choledocholithiasis
- ascending cholangitis
- obstructive jaundice
- gallstone ileus
- acute & chronic pancreatitis
what is biliary colic?
gallstones in gallbladder go up towards neck and cause irritation and temporary obstruction →causes pain (discomfort)
what is acute cholecytitis?
- inflammation of gallbladder →gallstones obstructing gallbladder in neck →blockage →inflammation building up (neutrophils & pus) = fever & pain
- obstruct outflow of bile, starts of sterile but then becomes infected causing fevers and progressing symptoms, can cause adhesions and have further complications like empyema
what is chronic cholecystitis?
grumbling, infective picture that lasts for long time. can develop without cause or can be due to lots of acute cholecystitis, wall of gallbladder thickened but not distended
what is gallbladder mucocele?
blockage of gallbladder outflow →build up of bile and pressure causing it to distend
what is gallbladder empyema?
buildup of pus
what is choledocholithiasis?
gallstone stuck in bile duct (just means stuck) but can lead to other problems
what is ascending cholangitis?
infective, inflammation of bile duct proximal to gallstone itself →gallstone obstructing meaning bile builds up and infects
what is obstructive jaundice?
buildup of bilirubin
what is gallstone ileus?
gallstone can go through biliary tree, when get obstruction of small bowel due to gallstone (usually need to be big gallstone) →usually when gallbladder become inflamed, enlarged and scarred and then erodes through wall into bowel = emergency
what are causes of pancreatitis (mnemonic)?
I GET SMASHED
I – Idiopathic
G - Gallstones
E – Ethanol
T – Trauma ( RTA, seat belt injury)
S - Steroids
M – Mumps/Malignancy
A - Autoimmune
S – Scorpion stings
H – Hypercalcemia/hypertriglicidemia
E - ERCP (iatrogenic)
D – Drugs (Thiazide diuretics; Azathioprin etc)
what pseudocysts?
cystic like spaces that you can get in severe pancreatitis
what is seen histologically for acute pancreatitis?
large areas of pancreas & fat are necrotic
what are complications of pancreatitis?
- shock
- pseudocysts
- abscess formation
- hypocalcaemia
- hyperglycaemia
what is chronic pancreatitis?
= relapsing pancreatitis that occurs multiple times or comes on randomly following bouts of acute
what is seen histologically for chronic pancreatitis?
more chronic inflammatory cells and replacement of pancreas by chronic inflammation & scar tissue = destruction of exocrine acini & islets
- predominantly scar tissue & inflammation
- acini & glands are very disruptive, islets of langerhans disrupted →there are irregular abortive glands in dense stroma
what is seen macroscopically for chronic pancreatitis?
→scarred fibrotic organ common and inflammation & fibrosis can mimic tumours in head of pancreas
what is tumour of pancreas?
adenocarcinoma = uncommon, poor prognosis, unknown cause
what are risk factors for pancreatic cancer?
smoking, diabetes, familial pancreatitis risk factors
what are ways for pancreatic cancer to spread?
- direct spread to organs e.g. duodenum, stomach, spleen
- spread to lymph nodes
- haematogenous spread to liver
