Gallbladder

Question 1

Q45.

What are the major gallstones?

CHOLECYSTOLITHIASIS = stones in gallbladder
CHOLEDOCHOLITHIASIS = gallstones in common bilde duct/biliary system

Answer 1

1. CHOLESTEROL STONES

2. BILIRUBIN Ca STONES = PIGMENTED STONES

Question 2

Q45.

WHAT IS GALLSTONE ILEUS?

Answer 2

gall stone in small bowel.
e.g. gallstone in cystic duct –> cholestasis –> mucosal irritation, inflammation and pressure build up/distention.
If stone large >2.5cm –> repeated inflammation, walls become edematous, sticky - can adhere to nearby structures and wall can erode away to form fistulas - esp. to duodenum = cholecystoeneteric fistula.
Gall stones can pass thorough bowel, large ones can get stuck at ileocecal valve/terminal valve –> partial/complete mechanical obstruction.

Question 3

Q46. LESIONS OF PANCREAS

WHAT ARE THEY?

Answer 3

1. CF
   - AR, often in childhood = cystic pancreatofibrosis
   - defect CFTR in duct ep cells –> thick mucus –> obstruction, dilation of ducts, pressure atrophy of pancreas.
   - pancreatic enzymes can back up and destroy parenchyma (pancreatitis) w. eventual fibrosis and cyst (ductal origin) formation –> pancreatic insufficiency.
   - leads to malabsorption of fat, fat soluble vitamin (steatorrhea) + affects endocrine function –> insulin-dep diabetes.
2. Congenital
   - Agenesis
   - Pancreas divusum (short main Wirsung pancreatic duct)
   - Pancreas annulare
   - Ectopic/accessory pancreas
   - Cysts of pancreas
3. Acute pancreatitis - reversible
   - destruction of pancreas by autodigestion - premature activation of pancreatic enzymes
   causes:
   - gallstones obstructing ampulla vater –> bileo-pancreatic reflux
   - heavy drinking esp combined w. fatty meal - direct effect on parenchyma, enzyme activation, spasms of sphincter of Oddi
   - other - mumps, coxsackie, trauma/shock, mutations in enzymes/inhibitors
4. proteases - digests pancreatic tissue, vessels - hemorrhagic..interstitial edema
5. lipases - digests fat (Balzer necrosis) w periph neutrophil infiltration
   - die or if survives healing by liquefaction (absorption) forming pseudocyst that can rupture –> peritoneal bleeding
   - if infected by e.g. E.coli - pancreatic abscess can form
   - often associated w. ascites, secondary infections e.g.
   - if severe necrosis, shock –> scattered Balzer necrosis + amylase, lipase, protease elevation in blood + involvm. of other organs
   - CT, other complications - ARDS, DIC
   - can die from shock, peritonitis 10-15% mortality
6. Chronic pancreatitis
   - repeated mild attacks of pancreatitis
   - fibroproductive inflammation - parenchyma replaced by fibrous tissue
   - irreversible impairment in pancreatic function
   - small organ, firm on palpation
   - may have pancreolithiasis
   - pain, diarrhea, malabsorption, pancreastic pseudocytsts
   - fibrosis, may dystrophic calcification
   - late compl. second. diabetes, obstructive jaundice
   - increased risk for pancreatic Ca