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Gastrointestinal pathology > Billiary and pancreatic disease > Flashcards

Billiary and pancreatic disease Flashcards

1
Q

Embryological origin of the liver =

A

Dorsal mesogastrium

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2
Q

What causes the contraction of the gall bladder?

A

CCK

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3
Q

CCK is released from

A

I cells

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4
Q

Where are bile salts resorbed from?

A

Terminal ileum (95%)

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5
Q

Contents of bile =

A

Cholesterol
Bilirubin
Primary bile acids

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6
Q

Primary bile acids fare conjugated to form what

A

Bile salts

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7
Q

What conjugates primary bile acids?

A

Taurine

Glycine

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8
Q

Function of bile

A

Neutralise excess stomach acid
Emulsify fat
Carry IgA
Eliminate bilirubin, cholesterol, xenobiotics

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9
Q

Bilirubin metabolism =

A

Heme - billiverdin - unconjugated bilirubin - conjugated bilirubin - urobilogen - uroblilin or stercobilin

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10
Q

How does unconjugated bilirubin get to liver?

A

Albumin

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11
Q

CB is more what than UCB

A

Water soluble

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12
Q

What is seen in obstructive jaundice?

A

Clay colour/pale stool

Dark urine

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13
Q

Why is stool clay coloured in obstructive jaundice?

A

Lack of sterocobilin

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14
Q

What enzyme conjugates bilirubin?

A

Glucornyl-bilirubin transferase

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15
Q

What is added to UCB to conjugate it?

A

Glucoronic acid

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16
Q

Jaundice can present with/without

A

Puritis

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17
Q

Causes of pre-hepatic jaundice:

A

Hemolysis
Reabsorption of blood from bleed
Gilbert syndrome

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18
Q

Gilbert syndrome =

A

genetic syndrome

Impaired transport of unconjugated bilirubin into the liver

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19
Q

What can be used to help Gilbert syndrome?

A

Diet high in lipid

Liver enzyme inducers (e.g. phenobarbital)

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20
Q

Phenobarbital is a

A

Liver enzyme inducer

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21
Q

Why is a high lipid diet good for Gilbert syndrome?

A

UCB is lipid soluble

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22
Q

Lab findings in pre-hepatic jaundice:

A

Elevated urobilogen in the urine

Elevated UCB in serum

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23
Q

Causes of hepatic jaundice

A

Liver disease - cirrhosis, viral hepatitis, alcoholic liver disease, drugs, toxins, cancer

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24
Q

Lab findings in hepatic jaundice:

A

Elevated urobilogen in urine
Elevated UCB and CB
Hypoalbuminaemia

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25
Post-hepatic jaundice can be due to:
Intrahepatic cholestasis | Extrahepatic cholestasis
26
Intrahepatic cholestasis is obstruction of
Hepatic ducts
27
Common causes of intrahepatic cholestasis =
Cirrhosis Hepatitis Drugs Pregnancy
28
Common causes of extrahepatic cholestasis
gallstones pancreatic carcinoma strictures cholangiocarcinoma
29
Cholangiocarcinoma is
Cancer of the bile ducts
30
Extrahepatic cholestasis is due to obstruction of the
Bile duct
31
Name a condition which causes hepatic and post-hepatic jaundice:
Primary schlerosis cholangitis
32
PSC causes fibrosis of what?
Intrahepatic and extrahepatic ducts
33
Lab findings in PSC:
Increased ALP | Increased GGT
34
GGT is increased when
Liver is damage | Flow of bile obstructed
35
Labfindings in post-hepatic jaundice:
Increased CB | Increased CB in urine, no urobilogen
36
PSC is often linked to what other condition?
IBD (mostly UC)
37
Choleliathiasis =
Gallstones
38
Most gall stones are
Cholesterol
39
How are cholesterol stones formed?
Excess cholesterole | Too little bile salts
40
What other kind of gall stones are they?
Pigmented | Mixed
41
Pigmented stones are mostly made of
UCB
42
Cholecystitis =
Inflammation of the gallbladder
43
Most common cholecystitis:
Calculous
44
Calculous cholecystitis =
Occurs when cystic duct is blocked by stone or sludge
45
Acalculous cholecystitis =
Inflammation of gallbladder w/o evidence of stone/blockage of CD
46
Chronic cholecystitis is almost always due to =
gallstones
47
Other causes of cholecystitis:
Carcinoma Mucocoele Congenital abnormalities
48
Mucocoele =
Mucus filled cyst
49
Typical at risk group for gallstones =
Fat Female Fertile Forty
50
Causes of gallstones =
``` Chronic haemolysis Lithogenic bile Inflammation/infection Stasis Rapid weight reduction ```
51
Causes of gallbladder stasis which can cause gallstones =
Pregnancy | Spinal cord injury
52
Imaging techniques for gallstones:
ERCP MRCP Ultrasound
53
MRCP =
Magnetic resonance cholangiopancreatography
54
ERCP =
Enteroscopic retrograde choliangiopancreatography
55
Gallstones where can cause acute/chronic cholecystitis =
Cystic duct
56
What % of gallstones are silent
>80%
57
Compliations of gallstones in gallbladder/CD?
Acute/chronic cholecycstitis Empyema Perforation Gallstone ileus
58
Gallstone ileus =
Gallstone lodges in small intestine, sticks in terminal ileum and impedes peristalsis
59
Consequences of gallstones in common bile duct:
Intense pain Gallstone ileus Acute cholangitis
60
Acute cholangitis =
Inflammation of the common bile duct
61
What bacteria cause acute cholangitis?
E.coli Klebsiella Enterococcus
62
Charcot's triad is related to what pathology?
Acute cholangitis
63
Charcot's triad =
Fever Jaundice RUQ pain
64
2 types of tumors of the pancreas:
Exocrine | Endocrine
65
Which type of pancreatic tumor is more rare?
Endocrine
66
Acute pancreatitis is due to
Autodigestion of the pancreas - zymogens activated too early or impaired secretion of pro-enzymes
67
Causes of acute pancreatitis (GETSMASHED)
``` GALL STONE ETHANOL TRAUMA STEROID USE MUMPS VIRUS AUTOIMMUNE SCORPION STING HYPERCALCEMIA/HYPERLIPIDEMIA ERCP TEST DRUGS ```
68
Ex of drug which can cause acute pancreatitis
Azathioprine
69
Most common causes of acute pancreatitis =
Ethanol | Gallstones
70
How does ethanol cause acute pancreatitis?
Increase zymogen secretion from acinar cells Decreases fluid and bicarbonate production - Thick, viscous fluid blocks duct
71
Presenting symptoms of acute pancreatitis =
Acute epigastric pain radiates to back | Nausea, vomiting
72
Lab findings for acute pancreatitis =
Rasied serum amylase and lipase Glucose intolerance Hypocalcemia Raised CRP
73
Most common cause of chronic pancreatitis =
Alcohol
74
What cells are involved in narrowing ducts in chronic pancreatitis?
Stellate cells
75
Outcomes of chronic pancreatitis =
``` Pain Weight loss Steatorrhea Diabetes Pancreatic pseudocyst ```
76
Most pancreatic CA occur where in the pancreas?
Head
77
Median survival for pancreatic CA:
2-3 months
78
Ex of endocrine tumors of pancreas:
``` Islet cell tumor Insulinoma Fastrinoma Glucagonoma Somatostatinoma ```

Gastrointestinal pathology (6 decks)

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