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Study Notes - Gastroenterology > *Biliary tree and pancreas disorders 1 (Lecture 8) > Flashcards

*Biliary tree and pancreas disorders 1 (Lecture 8) Flashcards

1
Q

What is the scientific name for Gallstones?

A

Cholelithiasis

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2
Q

what are gallstones (cholelithiasis)?

A

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

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3
Q

What is normal bile formed from? (4)

A

Micelles of cholesterol, phospholipid, bile salts and bilirubin

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4
Q

What is bilirubin formed from?

A

The breakdown of RBCs in the spleen

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5
Q

Where are bile salts formed?

A

In the hepatocytes

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6
Q

Where is bile formed?

A

In the liver

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7
Q

Where is bile stored and concentrated?

A

In the gallbladder

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8
Q

Where is bile released?

A

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

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9
Q

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

A

Cholecystokinin (CCK)

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10
Q

What causes gallstones to form?

A

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

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11
Q

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

A

Cholesterol stones
Pigement stones
Mixed stones

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12
Q

When do cholesterol stones form?

A

When there is an excess of cholesterol in bile

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13
Q

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

A

Female gender
Obesity
Diabetes
Genetics

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14
Q

What do cholesterol gallstones often look like?

A

Large and often solitary

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15
Q

When do pigment stones form?

What can cause this (risk factor)?

A

When excess bilirubin cannot be solubilised in bile salts

Excess haemolysis e.g. haemolytic anaemia

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16
Q

Appearance of cholesterol gallstones?

A

Small, friable, irregular

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17
Q

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

A

Gallbladder pH and mucosal glycoproteins

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18
Q

What type of gallstones are most gallstones?

A

Mixed

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19
Q

In general, what problems do gallstones cause?

A

Infection and inflammation of the biliary lining

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20
Q

What conditions can gallstones cause? (10)

A 
Acute cholecystitis
Chronic cholecystitis
Mucocoele
Empyema
Carcinoma
Ascending cholangitis
Obstructive jaundice
Gallstone ileus
Acute pancreatitis
Chronic pacnreatitis
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21
Q

What is cholecystitis?

A

Inflammation of the gallbladder

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22
Q

What is cholecystitis usually associated with?

A

Gallstones

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23
Q

What causes acute cholecystitis?

A

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

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24
Q

What complications can acute cholecystitis cause? (4)

A

Empyema
Rupture
Peritonitis
Intense adhesions form within 2-3 days

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25
Q

What leukocyte signals acute inflammation?

A

Neutrophils

26
Q

What is chronic cholecystitis?

A

Chronic inflammation of the gallbladder

27
Q

What causes chronic cholecystitis?

A

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

28
Q

What is the appearance of the gallbladder in chronic cholecystitis?

A

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

29
Q

What are Rokitansky-Aschoff sinuses?

A

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

30
Q

What is cholestasis?

A

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

31
Q

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

A

Obstructive jaundice

32
Q

What type of cancers do gallbladder cancers tend to be?

A

Adenocarcinoma (poor prognosis - rare)

33
Q

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

A

Gallstones

34
Q

Where do gallbladder carcinomas locally invade?

A

The liver

35
Q

What is cholangiocarcinoma?

A

Carcinoma of the bile ducts (rare)

36
Q

What is cholangiocarcinoma associated with? (2)

A

Ulcerative colitis

Primary sclerosing cholangitis

37
Q

How does cholangiocarcinoma present?

A

With obstructive jaundice?

38
Q

What type of cancer is cholangiocarcinoma?

A

Adenocarcinoma

39
Q

What is a Klatskin tumour?

A

Cholangiocarcinoma at the bifurcation of hepatic ducts

40
Q

What are stromal cells?

A

Connective tissue cells of any organ

41
Q

Histological appearance of cholangiocarcinoma?

A

Densely packed small glands in a fibrous stroma

42
Q

What are the 2 types of pancreatitis?

A

Acute or chronic (overlap exists between these 2 types)

43
Q

what is the main symptoms of acute pancreatitis?

A

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

44
Q

What blood test will be elevated in acute pancreatitis?

A

Serum amylase

45
Q

What age are patients who get acute pancreatitis?

A

Adults

46
Q

What are the causes of pancreatitis?

A

Gallstones
Ethanol
Trauma

Scorpion stings
Mumps/ other infections/ malignancy
Autoimmune
Steroids/ shock
Hyperlipidaemia/ hypercalcaemia/ hyperparathyroidism/ hypothermia
ERCP
Drugs
47
Q

What causes pancreatic duct epithelial injury? (2)

A

Bile reflux

Duct obstruction due to stone damage to sphincter of Oddi

48
Q

What does pancreatic epithelial injury cause?

A

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

49
Q

What does lytic pancreatic lipase cause to the pancreas?

A

Intra- and peripancreatic fat necrosis

50
Q

What does lytic pancreatic proteases cause to the pancreas?

A

Tissue destruction and haemorrhage

51
Q

What can intrapancreatic fat necrosis bind?

A

Large amounts of calcium

52
Q

What is a pancreatic pseudocyst? (complication of pancreatitis)

A

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

53
Q

What are 6 complications of acute pancreatitis?

A 
Death
Shock
Pseudocyst formation
Abscess formation
Hypocalcaemia
Hyperglycaemia
54
Q

What is chronic pancreatitis?

A

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

55
Q

Causes of chronic pancreatitis? (5)

A 
Alcohol
Cholelithiasis
CF
Hyperparathyroidism
Familial
56
Q

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

A

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

57
Q

What type of cancer occurs in the pancreas?

A

Adenocarcinoma

58
Q

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

A

Smoking
Diabetes
Familial pancreatitis

59
Q

What does adenocarcinoma of the pancreas look like microscopically?

A

Irregular abortive glands in a dense stroma

60
Q

Where do adenocarcinomas of the pancreas haematogenously spread to?

A

Liver

Study Notes - Gastroenterology (42 decks)

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