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GI lectures > Biliary Tract and Pancreatic Pathology > Flashcards

Biliary Tract and Pancreatic Pathology Flashcards

1
Q

what is cholelithiasis?

A

gallstones

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2
Q

are gallstones always symptomatic?

A

no

often asymptomatic until they cause a problem

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3
Q

what is bile?

A

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

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4
Q

what causes cholesterol gallstones to form?

A

excess cholesterol in relation to bile salts causing the cholesterol to precipitate out and form crystals

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5
Q

what can increase risk of gallstones?

A 
Choleserol excess in bile:
female
obesity
diabetes
genetic
excess cholesterol in diet
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6
Q

do gallstones stay in the gall bladder?

A

not always

can get stuck in common bile duct and cause disease

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7
Q

what can cause black/pigment gallstones?

A 
excess bilirubin (due to excess haem/haemolysis) causes it to precipitate out
E.g - haemolytic anaemia
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8
Q

what factors can contribute to formation of gallstones?

A

gallbladder pH

mucosal glycoproteins

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9
Q

what diseases can gallstones cause?

A 
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
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10
Q

what is cholecystitis?

A

inflammation of the gallbladder usually associated with gallstones
can be acute or chronic

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11
Q

what causes acute cholecystitis?

A

gallstone obstruction

sterile then becomes infected causing empyema, rupture, peritonitis and potentially adhesions

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12
Q

what causes chronic cholecystitis?

A

assoc with gallstones

may develop insidiously or after bouts of acute cholecystitis causing thickened (but not distended gall bladder wall)

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13
Q

what is cancer of the bile duct?

A

adenocarcinoma
rare
assoc with gallstones
poor prognosis

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14
Q

what is cholangiocarcinoma?

A 
carcinoma of bile ducts
rare
assoc with UC and PSC
presents with obstructive jaundice
usually adenocarcinoma
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15
Q

where is the pancreas, why is this significant?

A

posterior
disease can be asymptomatic and present late
disease can cause back pain

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16
Q

the head of the pancreas cant be removed from the duodenm, why is this significant?

A

cant remove one without the other

17
Q

what are the 2 functions of the pancreas?

A

endocrine - islets of Langerhans (insulin etc)

exocrine - acinar cells (enzymes etc)

18
Q

what type of diseases can affect the pancreas?

A

inflammatory

neoplastic

19
Q

how does acute pancreatitis present?

A

sudden onset severe abdo pain
may be severely shocked
elevated serum amylase

20
Q

what causes acute pancreatitis?

A 
alcohol (most common)
cholelithiasis
shock (hypovolaemia)
mumps
hyperparathyroidism
hypothermia
trauma
iatrogenic (post ERCP)
21
Q

what is the pathogenesis of acute pancreatitis?

A

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)

22
Q

what are the possible complications of acute pancreatitis?

A 
death
shock
pseudocyst formation
abscess formation
hypocalcaemia
hyperglycaemia
23
Q

what is chronic pancreatitis?

A

relapsing disorder may develop insidiously or following bouts of acute pancreatitis

24
Q

what can cause chronic pancreatitis?

A 
alcohol
cholelithiasis
cystic fibrosis
hyperparathyroidism
familial
25
Q

describe the pathology of chronic pancreatitis

A

replacement of pancreas by chronic inflammation and scar tissue
destruction of exocrine acini and endocrine islets

26
Q

what type of cancer usually in the pancreas?

A

adenocarcinoma

27
Q

what is associated with pancreatic carcinoma?

A

smoking
diabetes
familial pancreatitis

28
Q

what is the prognosis like for pancreatic carcinoma?

A

Very bad, <5% 5yr survival

awkward place, presents late

29
Q

tumour of the head of the pancreas can cause painless jaundice, how?

A

common bile duct flows through pancreas head on way to ampulla of vater in duodenum so can be obstructed

30
Q

what can occur if the tumour occurs in the tail of the pancreas?

A

presents very late, only when burst into the abdomen etc

can spread to spleen

31
Q

what is the outcome of mild, moderate and severe acute pancreatitis?

A

focal areas of necrosis
intrapancreatic fat necrosis (can bind Ca2+)
Complete pancreatic destruction with haemorrhage and fat necrosis

GI lectures (75 decks)

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