Biliary Tract and Pancreatic Pathology Flashcards
what is cholelithiasis?
gallstones
are gallstones always symptomatic?
no
often asymptomatic until they cause a problem
what is bile?
micelles of cholesterol, phospholipid, bile salts and bilirubin
Stored and concentrated in gall bladder and released by CKK into 2nd part of duodenum through common bile duct and ampulla of vater
Emulsifies fats
what causes cholesterol gallstones to form?
excess cholesterol in relation to bile salts causing the cholesterol to precipitate out and form crystals
what can increase risk of gallstones?
Choleserol excess in bile: female obesity diabetes genetic excess cholesterol in diet
do gallstones stay in the gall bladder?
not always
can get stuck in common bile duct and cause disease
what can cause black/pigment gallstones?
excess bilirubin (due to excess haem/haemolysis) causes it to precipitate out E.g - haemolytic anaemia
what factors can contribute to formation of gallstones?
gallbladder pH
mucosal glycoproteins
what diseases can gallstones cause?
acute or chronic cholecystitis mucocoele Empyema (pus in gallbladder mucosa) Carcinoma Ascending cholangitis Obstructive jaundice Gallstone Ileus (stone reaches ileocaecal valve causing obstruction) Acute/chronic pancreatitis
what is cholecystitis?
inflammation of the gallbladder usually associated with gallstones
can be acute or chronic
what causes acute cholecystitis?
gallstone obstruction
sterile then becomes infected causing empyema, rupture, peritonitis and potentially adhesions
what causes chronic cholecystitis?
assoc with gallstones
may develop insidiously or after bouts of acute cholecystitis causing thickened (but not distended gall bladder wall)
what is cancer of the bile duct?
adenocarcinoma
rare
assoc with gallstones
poor prognosis
what is cholangiocarcinoma?
carcinoma of bile ducts rare assoc with UC and PSC presents with obstructive jaundice usually adenocarcinoma
where is the pancreas, why is this significant?
posterior
disease can be asymptomatic and present late
disease can cause back pain
the head of the pancreas cant be removed from the duodenm, why is this significant?
cant remove one without the other
what are the 2 functions of the pancreas?
endocrine - islets of Langerhans (insulin etc)
exocrine - acinar cells (enzymes etc)
what type of diseases can affect the pancreas?
inflammatory
neoplastic
how does acute pancreatitis present?
sudden onset severe abdo pain
may be severely shocked
elevated serum amylase
what causes acute pancreatitis?
alcohol (most common) cholelithiasis shock (hypovolaemia) mumps hyperparathyroidism hypothermia trauma iatrogenic (post ERCP)
what is the pathogenesis of acute pancreatitis?
1) bile reflux > duct obstruction (stone damage to sphincter of oddi etc) cause pancreatic duct epithelial injury > loss of protective barrier allows autodigestion of pancreatic acini
OR
2) lytic pancreatic enzymes, proteases and lipases released > intra- and peri pancreatic fat necrosis (lipases) > tissue destruction and haemorrhage (proteases)
what are the possible complications of acute pancreatitis?
death shock pseudocyst formation abscess formation hypocalcaemia hyperglycaemia
what is chronic pancreatitis?
relapsing disorder may develop insidiously or following bouts of acute pancreatitis
what can cause chronic pancreatitis?
alcohol cholelithiasis cystic fibrosis hyperparathyroidism familial
describe the pathology of chronic pancreatitis
replacement of pancreas by chronic inflammation and scar tissue
destruction of exocrine acini and endocrine islets
what type of cancer usually in the pancreas?
adenocarcinoma
what is associated with pancreatic carcinoma?
smoking
diabetes
familial pancreatitis
what is the prognosis like for pancreatic carcinoma?
Very bad, <5% 5yr survival
awkward place, presents late
tumour of the head of the pancreas can cause painless jaundice, how?
common bile duct flows through pancreas head on way to ampulla of vater in duodenum so can be obstructed
what can occur if the tumour occurs in the tail of the pancreas?
presents very late, only when burst into the abdomen etc
can spread to spleen
what is the outcome of mild, moderate and severe acute pancreatitis?
focal areas of necrosis
intrapancreatic fat necrosis (can bind Ca2+)
Complete pancreatic destruction with haemorrhage and fat necrosis
