Biliary and pancreatic pathology Flashcards
gallstoes (cholelithiasis) formed from?
Formed from constituents of the bile:
–cholesterol
–calcium salts (phosphates, carbonates)
–bilirubin (calcium bilirubinate)
two types of gallstones?
Two main types
–Cholesterol stones
–Pigment stones
what increases bile cholesterol?
Obesity, females, increasing age
what decreaes bile acids?
Oestrogens
•Excessive gut loss (terminal ileal disease eg Crohn’s)
•Bile salts have been used to dissolve stones
3 types of pigmented galstones?
Calcium bilirubinate
•Chronic biliary infections
•Abnormal red cell breakdown (haemolytic anaemia)
what is chronic cholecystitis?
Longstanding irritation of gall bladder
•Thickening of gall bladder wall
–Muscle hypertrophy
–Low grade chronic inflammation
–Fibrosis
–Diverticula - misplacement of mucosa into wall
•“Rokitansky-Aschoff sinuses”
Motility disorders
–Dyspepsia
–Right upper quadrant pain, often related to fatty foods
what causes duct obstruction?
Secondary infection by bowel bacteria
–Purulent bile
–Empyema
–Septicaemia
–Perforation
acalculous cholcystitis?
Usually a complication of some other critical illness
–Sepsis, trauma, burns
–Total parenteral nutrition
•Due to increased bile viscosity and ischaemia
cystic duct obstuction?
Acute (on chronic) cholecystitis
•“Mucocoele” of gall bladder
Common duct stones?
Biliary colic
•Obstructive jaundice
–Dilated bile ducts (ultrasound)
–Enlarged green stained liver
extrahepatbic bile duct obstruction?
Extrahepatic bile duct obstruction
–Pale stools, dark urine
–Conjugated hyperbilirubinaemia
–Raised alkaline phosphatase
–Mildly raised transaminases
–Malabsorption of fat and vitamin K
–Itching
–Ascending cholangitis
–Septicaemia
–Liver abscess
causes of obstructive jaundice?
Benign bile duct strictures
–Instrumentation / surgery
–Sclerosing cholangitis
–HIV cholangiopathy (CMV, cryptosporidiosis)
–Parasites (Clonorchis, Ascaris, Fasciola)
•Carcinoma of
–the bile duct
–The duodenum (ampulla of Vater)
–The pancreas
•Compression of bile ducts by extrinsic masses
carcinoma of the biliary tract?
Associated with long-standing chronic irritation that leads to reparative epithelial hyperproliferation
•Carcinoma of the Gall Bladder
•Carcinoma of the Bile Ducts
carcinoma of the gall bladr?
Adenocarcinoma
•Preceded by dysplasia
•Rare
•Elderly women
•90% have gall stones
•Local structures (especially liver) usually invaded at presentation
•Poor prognosis
–Median survival 6 months
carcinoma of the bile duct?
Associated with
–Gall stones
–Clonorchis sinensis
–Inflammatory bowel disease (sclerosing cholangitis)
–Congenital abnormalities (eg choledochal cyst)
•Often multifocal
•Painless obstructive jaundice, cholangitis
•Poor prognosis