Biliary Tree, Gallbladder and Pancreas Flashcards
list risk factors for cholesterol stones
- common in Western/developed countries
- advancing age
- female gender
- estrogen (OCP, pregnancy)
- obesity
- rapid weight reduction
- gall bladder stasis
- inborn error of bile salt metabolism
- hyperlipidemima
list risk factors for pigment stones
- common in Asians
- rural > urban
- chronic hemolysis
- biliary infections
- GI disorders
- ileal diseases
- Crohns or ileal resection or bypass
- ileal diseases
- CF
the clinical presentation of cholelithiasis is mainly ___ but can also present with ____ pain
the clinical presentation of cholelithiasis is mainly asymptomatic but can also present with colicky pain
list the complications of cholelithiasis
- complications:
- empyema
- perforation
- fistulas
- cholangitis
- pancreatitis
- gallstone ileus
- increased risk of carcinoma
describe the pathogenesis of gallstones
- bile is supersaturated with cholesterol
- GB hypomotility promotes nucleation (precipitation from bile into vesicles)
- cholesterol nucleation in bile is accelerated
- mucus hypersecretion traps the crystal, permitting aggregation into stones (acts like glue)
describe the pathogenesis of acute cholecystitis
- chemical irritation and inflammation in setting of obstruction to flow
- mucosal phospholipase convert lecithin to lysolecithin
- damage to glycoprotein layer of mucosa
- further release of PGs from mucosa
- cumulatively leads to mucosal and mural inflammation
- gallbladder dysmotility and increased intraluminal pressure
- superimposed bacterial contamination
describe chronic cholecystitis
- sequel of repeated acute cholecystitis
- rarely extensive dystrophic calcification aka porcelain gallbladder (increased association with cancer)
in chronic cholecystitis, there could be extensive dystrophic calcification aka ____ which has an increased association with ___
in chronic cholecystitis, there could be extensive dystrophic calcification aka porcelain gallbladder which has an increased association with cancer
describe carcinoma of the gallbladder
- most common in 7th decade of life
- slightly more -common in females
- gallstones in 60-90% of patients
- other risk factors:
- pyogenic and parasitic infections of the biliary tract
- carcinogenic derivatives of bile may play a role
- mostly adenocarcinoma
- most have invaded or spread to liver at diagnosis
other risk factors for carcinoma of the gallbladder include ___ and ___ infections of the biliary tract
other risk factors for carcinoma of the gallbladder include pyogenic and parasitic infections of the biliary tract
describe the image
gallbladder adenocarcinoma
malignant glands are seen infiltrating a densely fibrotic gallbladder wall
the most common causes of pancreatic insufficiency are ___ and ____
the most common causes of pancreatic insufficiency are pancreatitis and CF
describe exocrine dysfunction seen in pancreatic insufficiency
- exocrine dysfunction
- fat malabsorption (steatorrhea)
- lipolytic activity decreases faster than proteolysis
- loose greasy foul-smelling stool
- fat-soluble vitamins (ADEK and B12) not absorbed
- fat malabsorption (steatorrhea)
describe endocrine dysfunction seen in pancreatic insufficiency
- endocrine dysfunction
- glucose intolerance, diabetes mellitus
80% of acute pancreatitis cases are associated with ___ and ___
80% of acute pancreatitis cases are associated with gallstones and alcohol
list the clinical features of acute pancreatitis
- leukocytosis
- DIC
- hemolysis
- peripheral vascular collapse
- shock with acute tubular necrosis (ATN), ARDS
- hypocalcemia, tetany
- raised amylase levels in first 24 hours
- followed by lipase within 72-96 hours
in acute pancreatitis, ___ levels are increased in the first ____ hours, followed by ___ levels within ____ hours
in acute pancreatitis, amylase levels are increased in the first 24 hours, followed by lipase levels within 72-96 hours
describe the image
describe the image
chronic pancreatitis
extensive fibrosis and atrophy has left only residual islets (left) and ducts (right) with a sprinkling of chronic inflammatory cells and a few islands of acinar tissue
list the stroma-rich vs. stroma-poor pancreatic tumors
- solid, stroma-rich
- ductal adenocarcinoma
- solid, stroma-poor
- neuroendocrine tumors (islet cell tumors)
- acinar cell carcinoma
- solid pseudopapillary tumor
- pancreatoblastoma
describe pancreatic adenocarcinoma
pancreatic adenocarcinoma is associated with ____ sign (migratory ____)
explain this
pancreatic adenocarcinoma is associated with Trousseau’s sign (migratory thrombophlebitis)
- release of platelet activating factors and procoagulants from tumor
there is no single specific marker for pancreatic adenocarcinoma, but sometimes there is raised ____
there is no single specific marker for pancreatic adenocarcinoma, but sometimes there is raised CA 19-9
____ is the usually the first symptom of pancreatic adenocarcinoma (because of invasion of _____)
pain is the usually the first symptom of pancreatic adenocarcinoma (because of invasion of the posterior abdominal wall and nerves)
describe pancreatic neuoendocrine tumors (NET)
describe insulinoma
pancreatic neuroendocrine tumor
- arise from B-cells
- hypoglycemia
- accentuated by fasting, relieved with intake of glucose
- clinically may manifest as Whipple triad
- low blood glucose
- presence of symptoms
- resolution with the blood glucose is normalized
- insulin levels are increased
describe gastrinomas
seen in pancreatic neuroendocrine tumors
- gastrin-producing neuroendocrine tumors
- result in ZE syndrome
- multiple duodenal peptic ulcers
- prominent gastric rugal folds due to increased oxyntic gland mass
- steatorrhea
- associated with Multiple Endocrine Neoplasia (MEN-1)
gastrinomas are associated with ____
gastrinomas are associated with Multiple Endocrine Neoplasia (MEN-1)
describe intraductal papillary mucinous neoplasm (IPMN)
- arise within the ductal system
- majority in the head
- dilated duct filled with mucin
- cysts can be multiloculated; lined by tall columnar mucin-secreting cells
mucinous cystic neoplasms (MCN) are not connected to ____ and its characteristic feature is the ____ stroma
mucinous cystic neoplasms (MCN) are not connected to the ductal system and its characteristic feature is the ovarian-type stroma
describe the image
the ovarian-like stroma seen in MCN
