Biliary tract and pancreatic pathology Flashcards
What are gallstones?
These are hard stones formed within the biliary system, most commonly the gallbladder
What are the 2 main types of gallstone?
Cholesterol stones
Pigmented stones
(Also mixed and high Ca2+)
How do cholesterol stones form?
An excess intake of cholesterol means that there are not enough phospholipids or bile salts to contain it all in the bile, and so cholesterol in the gallbladder moves out of solution to form a solid
How do pigmented stones form?
Normal bile contains ~98% conjugated bilirubin and ~2% unconjugated bilirubin
In cases of increased RBC break down, such as in haemolytic anaemia, there is an increase in unconjugated bile, which has a negative charge and binds to Ca2+, therefore forming calcium bilirubinate
This can also be caused by a decrease in bile salts, therefore causing an increased release of calcium, and so more calcium binds to the normal level of unconjugated bilirubin, forming stones
What are some risk factors for cholelithiasis (Gallstones)?
4Fs:
F - Fat - Obesity
F - Female - Oestrogen increases HMG-CoA
F - Fertile - Pregnancy
F - Forty
Also rapid weight loss and haemolytic anaemia
What is biliary colic?
This is pain caused by contraction of smooth muscle around a gallstone or gallstones
How does biliary colic usually present?
Colicky RUQ pain
Radiating to right shoulder
Worse around 30 minutes after a fatty meal
Nausea
Vomiting
No fever or LFT derangement
What are some possible complications of gallstones?
Acute or chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Ascending cholangitis
Obstructive jaundice
Gallstone ileus
Acute or chronic pancreatitis
What is mucocoele?
This is the build up of mucus in the gallbladder, caused by blockage of the cystic duct by a gallstone
What is mucocoele?
This is the build up of mucus in the gallbladder, caused by blockage of the cystic duct by a gallstone
What is meant by obstructive jaundice?
Obstruction of the cystic duct can cause build up of bile into the liver, and then into the blood, causing jaundice
What is gallstone ileus?
This is a condition in which a large gallstone erodes through the wall of the gallbladder and into the duodenum, before passing into the ileum, around 2 feet before the ileocaecal valve, at the narrowest point
How can gallstones cause pancreatitis?
Blockage of the ampulla of Vater can cause build up of pancreatic enzymes back into the pancreas causing autolysis
What is cholecystitis?
This is a condition, usually caused by gallstone blockage, leading to infection of the gallbladder, which grows behind the blockage and causes inflammation and pus build up
What type of cancer is most common in the gallbladder?
Adenocarcinoma
Why do pancreatic cancers have a poor prognosis?
You can’t remove the pancreas without also removing parts of the stomach and duodenum, so cancers are rarely suitable for surgery
What is pancreatitis?
This is inflammation of the pancreas
How does pancreatitis usually present?
Adults presenting with sudden onset abdominal pain
Describe the histology of pancreatitis?
Build up of pancreatic enzymes in the pancreas lead to destruction of tissue, causing intrapancreatic fat necrosis with possible binding of calcium
Digestive enzymes can also damage blood vessels causing haemorrhage
What are some complications of pancreatitis?
Death
Shock
Pseudocyst formation
Abscess formation
Hypocalcaemia
Hyperglycaemia
What are HPB disorders?
Hepato-Pancreatico-Biliary disorders
What are some investigations that can be performed in cases of gallstones?
U&E
FBC
LFTs
AUSS
What are the treatment options for gallstones?
Change in diet
Analgesia
Laprascopic cholecystectomy
What are some symptoms of acute cholecystitis?
RUQ pain
Radiating to back or right shoulder
Nausea
Vomiting
Fever
