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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
Q

Post-hepatic jaundice can be due to:

A

Intrahepatic cholestasis

Extrahepatic cholestasis

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26
Q

Intrahepatic cholestasis is obstruction of

A

Hepatic ducts

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27
Q

Common causes of intrahepatic cholestasis =

A

Cirrhosis
Hepatitis
Drugs
Pregnancy

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28
Q

Common causes of extrahepatic cholestasis

A

gallstones
pancreatic carcinoma
strictures
cholangiocarcinoma

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29
Q

Cholangiocarcinoma is

A

Cancer of the bile ducts

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30
Q

Extrahepatic cholestasis is due to obstruction of the

A

Bile duct

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31
Q

Name a condition which causes hepatic and post-hepatic jaundice:

A

Primary schlerosis cholangitis

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32
Q

PSC causes fibrosis of what?

A

Intrahepatic and extrahepatic ducts

33
Q

Lab findings in PSC:

A

Increased ALP

Increased GGT

34
Q

GGT is increased when

A

Liver is damage

Flow of bile obstructed

35
Q

Labfindings in post-hepatic jaundice:

A

Increased CB

Increased CB in urine, no urobilogen

36
Q

PSC is often linked to what other condition?

A

IBD (mostly UC)

37
Q

Choleliathiasis =

A

Gallstones

38
Q

Most gall stones are

A

Cholesterol

39
Q

How are cholesterol stones formed?

A

Excess cholesterole

Too little bile salts

40
Q

What other kind of gall stones are they?

A

Pigmented

Mixed

41
Q

Pigmented stones are mostly made of

A

UCB

42
Q

Cholecystitis =

A

Inflammation of the gallbladder

43
Q

Most common cholecystitis:

A

Calculous

44
Q

Calculous cholecystitis =

A

Occurs when cystic duct is blocked by stone or sludge

45
Q

Acalculous cholecystitis =

A

Inflammation of gallbladder w/o evidence of stone/blockage of CD

46
Q

Chronic cholecystitis is almost always due to =

A

gallstones

47
Q

Other causes of cholecystitis:

A

Carcinoma
Mucocoele
Congenital abnormalities

48
Q

Mucocoele =

A

Mucus filled cyst

49
Q

Typical at risk group for gallstones =

A

Fat
Female
Fertile
Forty

50
Q

Causes of gallstones =

A 
Chronic haemolysis
Lithogenic bile
Inflammation/infection
Stasis
Rapid weight reduction
51
Q

Causes of gallbladder stasis which can cause gallstones =

A

Pregnancy

Spinal cord injury

52
Q

Imaging techniques for gallstones:

A

ERCP
MRCP
Ultrasound

53
Q

MRCP =

A

Magnetic resonance cholangiopancreatography

54
Q

ERCP =

A

Enteroscopic retrograde choliangiopancreatography

55
Q

Gallstones where can cause acute/chronic cholecystitis =

A

Cystic duct

56
Q

What % of gallstones are silent

A

> 80%

57
Q

Compliations of gallstones in gallbladder/CD?

A

Acute/chronic cholecycstitis
Empyema
Perforation
Gallstone ileus

58
Q

Gallstone ileus =

A

Gallstone lodges in small intestine, sticks in terminal ileum and impedes peristalsis

59
Q

Consequences of gallstones in common bile duct:

A

Intense pain
Gallstone ileus
Acute cholangitis

60
Q

Acute cholangitis =

A

Inflammation of the common bile duct

61
Q

What bacteria cause acute cholangitis?

A

E.coli
Klebsiella
Enterococcus

62
Q

Charcot’s triad is related to what pathology?

A

Acute cholangitis

63
Q

Charcot’s triad =

A

Fever
Jaundice
RUQ pain

64
Q

2 types of tumors of the pancreas:

A

Exocrine

Endocrine

65
Q

Which type of pancreatic tumor is more rare?

A

Endocrine

66
Q

Acute pancreatitis is due to

A

Autodigestion of the pancreas - zymogens activated too early or impaired secretion of pro-enzymes

67
Q

Causes of acute pancreatitis (GETSMASHED)

A 
GALL STONE
ETHANOL
TRAUMA
STEROID USE
MUMPS VIRUS
AUTOIMMUNE
SCORPION STING
HYPERCALCEMIA/HYPERLIPIDEMIA
ERCP TEST
DRUGS
68
Q

Ex of drug which can cause acute pancreatitis

A

Azathioprine

69
Q

Most common causes of acute pancreatitis =

A

Ethanol

Gallstones

70
Q

How does ethanol cause acute pancreatitis?

A

Increase zymogen secretion from acinar cells
Decreases fluid and bicarbonate production
- Thick, viscous fluid blocks duct

71
Q

Presenting symptoms of acute pancreatitis =

A

Acute epigastric pain radiates to back

Nausea, vomiting

72
Q

Lab findings for acute pancreatitis =

A

Rasied serum amylase and lipase
Glucose intolerance
Hypocalcemia
Raised CRP

73
Q

Most common cause of chronic pancreatitis =

A

Alcohol

74
Q

What cells are involved in narrowing ducts in chronic pancreatitis?

A

Stellate cells

75
Q

Outcomes of chronic pancreatitis =

A 
Pain
Weight loss
Steatorrhea
Diabetes
Pancreatic pseudocyst
76
Q

Most pancreatic CA occur where in the pancreas?

A

Head

77
Q

Median survival for pancreatic CA:

A

2-3 months

78
Q

Ex of endocrine tumors of pancreas:

A 
Islet cell tumor
Insulinoma
Fastrinoma
Glucagonoma
Somatostatinoma

Gastrointestinal pathology (6 decks)

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