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xB15W2 > BILIARY AND PANCREATIC PATHOLOGY > Flashcards

BILIARY AND PANCREATIC PATHOLOGY Flashcards

1
Q

what is in bile?

A

bile salts, bilirubin phospholipid, cholesterol, amino acids, steroids, enzymes, porphyrins, vitamins, and heavy metals, as well as exogenous drugs, xenobiotics and environmental toxins

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2
Q

what are the functions of bile?

A

helps break down fats by emulsification
helps elimate waste products e.g. bilirubin and excess cholesterol
contains some signalling molecules

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3
Q

what breaks down cholesterol and what does it break down into?

A

7 alpha hydroxylase breaks it down into 2 primary bile acids - cholic acid and chenodeoxycholic acid
(hepatocytes)

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4
Q

where do the primary bile acids get broken down and into what?

A

in the intestines they get de-hydroxylated into 2 secondary bile acids deoxycholic acid and lithocholic acid

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5
Q

what gives rise to bile salts?

A

primary and secondary bile acids are conjugated by the liver with glycine and taurine

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6
Q

what are some pre-hepatic causes of jaundice?

A 
Gilbert disease
haemolytic anaemias
drugs
resorption from a bleed
ineffective erythropoeisis
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7
Q

what is gilberts disease?

A

It is an inherited metabolic disorder that causes excess unconjugated bilirubin due to defective conjugating enzymes in the hepatocytes. 3% of the population have it

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8
Q

what are some hepatic causes of jaundice?

A 
hepatitis
drugs
toxins
cancer
primary sclerosing cholangitis
alcohol
non-alcoholic fatty liver disease
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9
Q

what are some post-hepatic causes of jaundice?

A 
gallstones
pancreatic cancer
CCA
strictures
biliary atresia
primary sclerosing cholangitis
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10
Q

what is primary sclerosing cholangitis?

A

inflammation causes scars within the bile ducts

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11
Q

what are some gallbladder pathologies?

A 
cholecystoses
stones
cholecystitis
carcinoma
congenital anomalies
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12
Q

what are cholecystoses?

A

conditions characterised by the accumulation of cholesterol and other fats in the gallbladder

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13
Q

what are the 2 main types of cholecystoses?

A

cholesterolosis

adenomyomatosis

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14
Q

what are some risk factors of gallstones?

A 
rapid weight loss
obesity
being female
being >40
being pregnant
not moving/stasis
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15
Q

why are women more at risk than men of gallstones?

A

oestrigen increases cholesterol stone formation

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16
Q

why is obesity associated with increased gallstone risk?

A

obesity is linked to increased levels of cholesterol

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17
Q

why is rapid weight loss a risk factor for gallstones?

A

asthebody starts to metabolize fats so more cholesterol is released

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18
Q

what are most gallstones composed of?

A

80% cholesterol

rest are bilirubin

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19
Q

what are the 3 general reasons for gallstones?

A

bile contains too much cholesterol, too much bilirubin or not enough bile salts

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20
Q

outline the pathology of cholesterol stones?

A

bile becomes supersaturated with cholesterol/not enough bile salts/gallbladder stasis
= cholesterol precipitates out of bile and forms solid stones

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21
Q

outline the pathology of bilirubin stones?

A

too much bilirubin in bile = combines with Ca2+ to form calcium bilirubinate which is a solid precipitate

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22
Q

what are brown pigmented gallstones usually caused by?

A

gallbladder/biliary tract infection

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23
Q

outline the pathology of brown pigmented gallstones?

A

bacteria causing the infection brings hydrolytic enzymes which hydrokyze conjugated bilirubin and phospholipids. These then combine with Ca2+ and precipitate out to form stones

24
Q

which population is brown gallstones common?

why

A

China, Korea, Vietnam

clonochis sinensis is an endemic infection there that causes this

25
Q

what does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

26
Q

what is ERCP used for?

A

a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope

27
Q

what does MRCP stand for?

A

Magnetic resonance cholangiopancreatography

28
Q

what is MRCP used for?

A

examine diseases of the liver, gallbladder, bile ducts, pancreas and pancreatic duct

29
Q

which type of gallstones cant be seen on X-ray?

A

cholesterol (but you usuaully can see all as they tend to be partially mixed with some radio opaque material)

30
Q

what are some complications of gallstones?

A 
cholecystitis
mucocoele
empyema
perforation
gallstone ileus
cholangitis
31
Q

whats the exocrine fucntion of the pancreas?

A

powerful digestive enzymes released into the small intestine e.g. trypsin/lipases/amylase

32
Q

whats the endocrine function of the pancreas?

A

insulin and glucagon

33
Q

outline the pathology of alcohol induced pancreatitis?

A

alcohol increases zymogen secretion from acinar cells as well as decreasing fluid and bicarbonate from ducts
pancreatic juice becomes really thick and viscous and can block ducts
pancreatic juices back up, increasing presure and distending the ducts
membrane traffiking becomes chaotic which can lead to random enzyme activation which causes autodigestion of the pancreas

34
Q

whats a zymogen?

A

an inactive precursor of an enzyme

35
Q

outline the pathophysiology of gallstone induced pancreatitis?

A

gallstones can get lodged and block the release of pancreatic juices
pancreatic juices back up, increasing presure and distending the ducts
membrane traffiking becomes chaotic which can lead to random enzyme activation which causes autodigestion of the pancreas

36
Q

what are some causes of acute pancreatitits?

A

trauma, steroids use, infections like mumps, autoimmune, scorpion stings, hypertriglyceridaemia, hypercalcaemia, drugs, gallstones, alcohol

37
Q

what are the symptoms of acute pancreatitis?

A

acute abdo paiin in epigastric area that radiates to the back
vomiting

38
Q

what are some signs of acute pancreatitis?

A

gaurding
tenderness in epigastric area
cullens sign
grey turners sign

39
Q

what is cullens sign?

A

bruising around the periumbilical region

40
Q

what is grey turners sign?

A

bruising along the flank of the body

41
Q

what will be raised in pancreatitis?

A

amylase and lipase srum levels

CRP and white cell count

42
Q

what are some complications of acute pancreatitis?

A

abscesses, pseudocyst, chronic pancreatitis, diabetes, haemorrhage, acute respiratory distress syndrome and death

43
Q

outline the pathology behind chronic pancreatitis?

A

persistent inflamamtion of the pancreas causes ductal dilation and damaged tissue. In response, stellate cells in the pancreas lay down fibrotic tissue causing duct stenosis and acinar atrophy. As acinar cells become impaired, they produce fewer digestive enzymes which leads to pancreatic insufficiency

44
Q

how does pancreatic insufficiency caused by pancreatitis present?

A

trouble absorbing food and fat so we see weigt loss, vit ADEK deficiencies and steatorrhoea

45
Q

why can chronic pancreatitis cause the development of diabetes mellitus?

A

the inflammation of the pancreas destroys alpha and beta pancreatic cells

46
Q

why may amylase and lipase serum levels be raised in acute pancreatitis but not chronic?

A

it could be but there may not be enough tissue to make lipase and amylase in the first place

47
Q

what are some causes of pancreatitits?

A 
alcohol
cystic fibrosis
hyperriglyceridaemia
tumour
pancreatic resection
familial
congenital abnormalities
autoimmune
48
Q

whst are some risk factors of pancreatitis?

A

excessive alcohol\
obesity
diabetes
Fhx

49
Q

what are some complications of chronic pancreatitis?

A 
calcification of the pancreas
chronic pain
diabetes
gallstones
kidney failure
pseudocysts
pancreatic cancer
acute flare ups
50
Q

where do most pancreatic carcinomas form?

A

the head of the pancreas

51
Q

do pancreatic tumours usually develop in the exocrine or endocrine glands?

A

exocrine

52
Q

what type of carcinoma are most pancreatic tumours?

A

adenocarcinomas

53
Q

what are risk factors for pancreatic cancer?

A 
smoking
obesity
diet high in red meat
male
african american
>65
having diabetes chronic pancreatitits or liver cirrhosis
Fhx (particularly BRCA2 and PALB2)
54
Q

what are symptoms of pancreatic cancer?

A 
nausea
vomiting
fatigue
weight loss
epigastric pain
back pain
painless jaundice
troisseas sign
couvoisiers sign
55
Q

what is troisseaus sign?

A

blood clots appearing in the superficial veins causing lumps

56
Q

what is Courvoisier sign?

A

an enlarged, palpable but non tender gallbladder

57
Q

what is the medium survival of pancreatic tumours?

A

2-3 months

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