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Block 15 > Biliary And Pancreatic Pathology > Flashcards

Biliary And Pancreatic Pathology Flashcards

1
Q
  1. Where does bile come from and stored?
  2. What is the histology of gallbladder?
  3. What stimulates CKK?
  4. What is the role of bile
A
  1. Bile from hepatocytes and is stored in the gallbladder
  2. Simple columnar with Rugae
  3. Eating which results in bile release into bowel through ampulla of vater
  4. Helps small intestine digest fats and absorb fats, cholesterol and some vitamins >95% of bile is reabsorbed in terminal ileum and return to liver
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2
Q

What is contained in bile?

A

Bile acid (cholic acid, chenodeoxycholic acid, glycine and taurine conjugates, secondary bile acids; deoxycholic acid lithocholic acid)
Phoshatidycholine
Bilirubin
Cholesterol

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3
Q

What is the function of bile?

A

Absorb necessary fats-emulsification of dietary fat
Help eliminate waste products
Signalling molecules-MAPK pathway, ligand receptor for TGR5, active hormone receptors

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4
Q

How are bile salts reabsorbed?

A

Active transport

Returned to live via anterohepatic circulation

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5
Q

What is jaundice?

A

Hyperbilirbinaemia (high bilirubin in blood)

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6
Q

What affect does obstructive jaundice have on bowels and urine?

A

Dark urine due to bilirubin and chalky white stools due to lack of stercobilinogen

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7
Q

How can causes of jaundice be split up?

A

Pre-hepatic (unconjugated bilirubin)
Hepatic (mixed bilirubin)
Post hepatic (conjugated bilirubin)

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8
Q

What are pre-hepatic causes of jaundice

A

Haemolytic (RBCs broken down too quickly)
Resorption from bleed eg dissected aortic aneurysms, breakdown of blood products is slowly reabsorbed
Gilbert congenital condition where unconjugated bilirubin struggles to get into liver made worse at times of stress
Ineffective erythropoiesis

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9
Q

What are hepatic (mixed bilirubin) causes of jaundice?

A 
Liver disease 
Drugs 
Toxins 
Cancer 
PSC (primary sclerosing cholangitis
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10
Q

What are post hepatic causes of jaundice?

A 
Obstruction of bile duct
Gallstones 
Ca pancreas 
CCA (cholangiocarcinoma) 
Strictures
Biliary atresia
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11
Q

What is cholesterolosis?

A

Accumulation of cholesterol

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12
Q

What causes stones?

A

Cholesterol
Pigment
Mixed

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13
Q

What causes cholecystitis?

A

Infection (calculus, acalculous (5-10%), chronic stones (90%)-in elderly this carries a significant mortality

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14
Q

What is mucocoele?

A

Distension of gallbladder by accumulation of mucous

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15
Q

What are the risk factors for gallstones

A 
Female 
Forty 
Fat 
Fertile 
Fair
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16
Q

What are the signs and symptoms of gallstones

A

Right upper quadrant pain

Murphys sign

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17
Q

What are the causes of gallstones

A 
Chronic haemolytic 
Lithogenic bile
Infection/inflammation
Rapid weight reduction 
Stasis (pregnancy, TPN, spinal cord injuries
18
Q

What are the majority of gall stones?

A

80% are cholesterol stones

>50% crystalline cholesterol mono hydrate

19
Q

How to test for gallstones?

A

ERCP (endoscopic retrograde choangiopancretogaphy)

MRCP (magnetic resonance choangiopancreatograpy)

20
Q

What are the complications of gallstones in the cystic duct?

A 
80% are silent 
Acute/chronic cholecystitis 
Mucocoele 
Emphyema-gallbladder fill with pus, can perforate, life threatening 
Performation 
Gallstone ileum
21
Q

What are the complications of gallstones in the common bile duct?

A

Partial, total or intermittent obstruction
Pain
Cholangitis
Gallstone ileus

22
Q

What are the investigations for carcinoma of the gallbladder and bile duct?

A

Blood tests
Imaging (ultrasound, CT, EUS, MRCP, RECP)
Laparoscopy

23
Q

What is the treatment for carcinoma of the gallbladder and bile duct?

A 
Rare cure
Surgery 
ERCP
Chemotherapy 
(<1% 5 yr survival)
24
Q

What is the exocrine function of the pancreas?

A

Powerful digestive enzymes (trypsin, lipases and amylase) released into small intestine to aid digestion of carbohydrates, proteins and fats

25
Q

What is the endocrine function of the pancreas?

A

Insulin and glucagon for glucose regulation

26
Q

Describe the embryology of the pancreas and why may it lead to abnormalities?

A

Develops in 2 parts
Join at week 8
‘Swinging round’ process to join the 2 parts doesn’t always occur and can lead to anomalies, it can also cause infective and inflammatory problems as a failure of the rotation

27
Q

Give examples of diseases of the pancreas?

A

Congenital anomalies-agnesis, divisum, annular pancreas, heterotrophic pancreas, pancreatic cysts
Acute pancreatitis
Chronic pancreatitis
Tumour

28
Q

What is pancreatic pseudocyst?

A

Inflammatory cyst forming anterior to the pancreas, source of infection ad treatment is to drain endoscopically or percutaneously

29
Q

What are the types of exocrine pancreatic tumours?

A

Pseudocyst (contain fibrosis, organising blood clot, cholesterol crystals, debris)
Pancreatic abscess
Cystic tumour-benign (mucinous cystadenoma), malignant (mucinous cystadenocarcinoma)
Carcinoma of the pancreas

30
Q

What is carcinoma of the pancreas?

A

Adenocarcinoma (60% head, 25% body, 15% tail)

31
Q

What are the symptoms and signs of carcinoma of the pancreas

A 
Few symptoms and signs 
Weight loss 
Back pain 
Painless jaundice 
Trousseau’s sign (migratory thrombophlebitis)
32
Q

What investigations would be done for a patient with carcinoma of the pancreas?

A 
CT
USS
EUS
ERCP
MRI 
Biopsy diagnosis difficult
33
Q

What is the treatment for carcinoma of the pancreas?

A

Surgery (<20%)-only 20% cured
Chemotherapy
Median survival 2-3 months

34
Q

Describe endocrine tumours of the pancreas?

A 
Islet cell tumours
Insulinoma
Gastrinoma (zollinger-Ellison syndrome)
Glucagonoma 
Somatostatinoma 
VIPoma-watery diarhea, hypokalaemia, achlorhydria 
Can be small, multiple or malignant 
Difficult to diagnose and rare
35
Q

What are the causes of acute pancreatitis

A 
Idiopathic 
Gallstones
Ethanol
Trauma
Steroids
Mumps/malignancy
Autoimmune
Scorpion sting
Hypercalcaemia 
ERCP 
Drugs
36
Q

What are the symptoms of acute pancreatitis?

A

Acute abdominal pain
Central, severe radiates to back
Vomiting
Alcohol excess history

37
Q

What are the signs of acute pancreatitis?

A

Guarding and tenderness in upper abdomen

Complicated by shock, DIC, renal failure, haemolysis, ARDS

38
Q

What would be seen on investigation in acute pancreatitis?

A 
Raised serum amylase
Glucose intolerance 
Hypocalcaemia 
Raised CRP, white cell count
Haemorrhaging peritoneal effusion
39
Q

What is the outcome for acute pancreatitis?

A 
Abscess
Pseudocyst
Relapse
Diabetes
Death
40
Q
  1. What is the commonest cause of chronic pancreatitis

2. What are other causes

A
  1. Alcohol
  2. Biliary tract disease
    Hypercalcaemia
    Hyperlipidaemia
    Haemochromatosis
    Cystic fibrosis
    Idiopathic
41
Q

Describe the morphology of chronic pancreatitis?

A

Irregular gland with fibrosis, fatty infiltration, calcification
Appearance mimics carcionma (difficult to biopsy diagnosis)

42
Q

What are the outcomes of chronic pancreatitis?

A 
Endocrine pancrease relatively spared
Pain
Weight loss
Steatorhoea
Diabetes
Jaundice
Hypoalbuinaemia 
Pseudocyst 
Scenic vein thrombosis

Block 15 (11 decks)

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