*Biliary tree and pancreas disorders 1 (Lecture 8)

Question 1

What is the scientific name for Gallstones?

Answer 1

Cholelithiasis

Question 2

what are gallstones (cholelithiasis)?

Answer 2

“Hard stone-like or gravel-like material formed within the biliary system most commonly the gallbladder”

Question 3

What is normal bile formed from? (4)

Answer 3

Micelles of cholesterol, phospholipid, bile salts and bilirubin

Question 4

What is bilirubin formed from?

Answer 4

The breakdown of RBCs in the spleen

Question 5

Where are bile salts formed?

Answer 5

In the hepatocytes

Question 6

Where is bile formed?

Answer 6

In the liver

Question 7

Where is bile stored and concentrated?

Answer 7

In the gallbladder

Question 8

Where is bile released?

Answer 8

Into the 2nd part of the duodenum through the common bile duct and Ampulla of vater

Question 9

What hormone stimulates the release of bile from the gallbladder into the the 2nd part of the duodenum?

Answer 9

Cholecystokinin (CCK)

Question 10

What causes gallstones to form?

Answer 10

When there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation

Question 11

What are the 3 different types of gallstones that can form? - different gallstones depends on the different concentrations of constituents

Answer 11

Cholesterol stones
Pigement stones
Mixed stones

Question 12

When do cholesterol stones form?

Answer 12

When there is an excess of cholesterol in bile

Question 13

What are the risk factors for the formation of cholesterol bile stones? (4)

Answer 13

Female gender
Obesity
Diabetes
Genetics

Question 14

What do cholesterol gallstones often look like?

Answer 14

Large and often solitary

Question 15

When do pigment stones form?

What can cause this (risk factor)?

Answer 15

When excess bilirubin cannot be solubilised in bile salts

Excess haemolysis e.g. haemolytic anaemia

Question 16

Appearance of cholesterol gallstones?

Answer 16

Small, friable, irregular

Question 17

Other than the composition of bile, what may also contribute to the formation of gallstones?

Answer 17

Gallbladder pH and mucosal glycoproteins

Question 18

What type of gallstones are most gallstones?

Answer 18

Mixed

Question 19

In general, what problems do gallstones cause?

Answer 19

Infection and inflammation of the biliary lining

Question 20

What conditions can gallstones cause? (10)

Answer 20

Acute cholecystitis
Chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Ascending cholangitis
Obstructive jaundice
Gallstone ileus
Acute pancreatitis
Chronic pacnreatitis

Question 21

What is cholecystitis?

Answer 21

Inflammation of the gallbladder

Question 22

What is cholecystitis usually associated with?

Answer 22

Gallstones

Question 23

What causes acute cholecystitis?

Answer 23

Gallstones obstructing outflow of bile (initially sterile and then becomes infected)

Question 24

What complications can acute cholecystitis cause? (4)

Answer 24

Empyema
Rupture
Peritonitis
Intense adhesions form within 2-3 days

Question 25

What leukocyte signals acute inflammation?

Answer 25

Neutrophils

Question 26

What is chronic cholecystitis?

Answer 26

Chronic inflammation of the gallbladder

Question 27

What causes chronic cholecystitis?

Answer 27

Usually associated with gallstones - may develop insidiously or after bouts of acute cholecystitis

Question 28

What is the appearance of the gallbladder in chronic cholecystitis?

Answer 28

Gallbladder wall is thickened (due to fibrosis) but not distended

Question 29

What are Rokitansky-Aschoff sinuses?

Answer 29

Histologically, they are outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. They are usually referred to as adenomyomatosis - usually due to increased pressure and recurrent damage of the gallbladder wall

Question 30

What is cholestasis?

Answer 30

A condition where bile can not flow from the liver to the duodenum

Question 31

What type of jaundice would stones in the common bile duct cause?

Answer 31

Obstructive jaundice

Question 32

What type of cancers do gallbladder cancers tend to be?

Answer 32

Adenocarcinoma (poor prognosis - rare)

Question 33

What is the most common risk factor for carcinoma of the gallbladder?

Answer 33

Gallstones

Question 34

Where do gallbladder carcinomas locally invade?

Answer 34

The liver

Question 35

What is cholangiocarcinoma?

Answer 35

Carcinoma of the bile ducts (rare)

Question 36

What is cholangiocarcinoma associated with? (2)

Answer 36

Ulcerative colitis | Primary sclerosing cholangitis

Question 37

How does cholangiocarcinoma present?

Answer 37

With obstructive jaundice?

Question 38

What type of cancer is cholangiocarcinoma?

Answer 38

Adenocarcinoma

Question 39

What is a Klatskin tumour?

Answer 39

Cholangiocarcinoma at the bifurcation of hepatic ducts

Question 40

What are stromal cells?

Answer 40

Connective tissue cells of any organ

Question 41

Histological appearance of cholangiocarcinoma?

Answer 41

Densely packed small glands in a fibrous stroma

Question 42

What are the 2 types of pancreatitis?

Answer 42

Acute or chronic (overlap exists between these 2 types)

Question 43

what is the main symptoms of acute pancreatitis?

Answer 43

Sudden onset severe abdominal pain (patients may be severely shocked)

Question 44

What blood test will be elevated in acute pancreatitis?

Answer 44

Serum amylase

Question 45

What age are patients who get acute pancreatitis?

Answer 45

Adults

Question 46

What are the causes of pancreatitis?

Answer 46

Gallstones Ethanol Trauma ``` Scorpion stings Mumps/ other infections/ malignancy Autoimmune Steroids/ shock Hyperlipidaemia/ hypercalcaemia/ hyperparathyroidism/ hypothermia ERCP Drugs ```

Question 47

What causes pancreatic duct epithelial injury? (2)

Answer 47

Bile reflux | Duct obstruction due to stone damage to sphincter of Oddi

Question 48

What does pancreatic epithelial injury cause?

Answer 48

loss of protective barrier allowing autodigestion of pancreatic acini by lytic pancreatic enzymes proteases and lipases

Question 49

What does lytic pancreatic lipase cause to the pancreas?

Answer 49

Intra- and peripancreatic fat necrosis

Question 50

What does lytic pancreatic proteases cause to the pancreas?

Answer 50

Tissue destruction and haemorrhage

Question 51

What can intrapancreatic fat necrosis bind?

Answer 51

Large amounts of calcium

Question 52

What is a pancreatic pseudocyst? (complication of pancreatitis)

Answer 52

collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen.

Question 53

What are 6 complications of acute pancreatitis?

Answer 53

``` Death Shock Pseudocyst formation Abscess formation Hypocalcaemia Hyperglycaemia ```

Question 54

What is chronic pancreatitis?

Answer 54

Long standing inflammation of the pancreas - can develop insidiously or following bouts of acute pancreatitis

Question 55

Causes of chronic pancreatitis? (5)

Answer 55

``` Alcohol Cholelithiasis CF Hyperparathyroidism Familial ```

Question 56

What happens to the composition of the pancreas during chronic pancreatitis?

Answer 56

Replacement of pancreas by chronic inflammation and scar tissue (destruction of exocrine acini and islets)

Question 57

What type of cancer occurs in the pancreas?

Answer 57

Adenocarcinoma

Question 58

What is carcinoma of the pancreatic associated with? (3)

Answer 58

Smoking Diabetes Familial pancreatitis

Question 59

What does adenocarcinoma of the pancreas look like microscopically?

Answer 59

Irregular abortive glands in a dense stroma

Question 60

Where do adenocarcinomas of the pancreas haematogenously spread to?

Answer 60

Liver