Gallbladder/bile ducts/pancreas - Kaplan Flashcards
What are two types of gallstones?
Cholesterol stones (80% of stones in the US) Pigment stones (20% of stones in the US)
9/10 cases of acute cholecystitis are caused by?
Choleliths
4/10 cases of acute pancreatitis are caused by?
Choleliths
At what rate are gallstones symptomatic?
2% per year.
An asian with a biliary infection (for example a parasite) will be more likely to have which type of gallstone?
Pigment stone
What is gallstone ileus?
Gallstones passing from the gallbladder through the small intestine (and causing blockage?). Gallstones impact throughout the small intestine, with higher rates near the terminal ileum.
What is the pathophysiology of cholelith-based acute cholecystitis?
Mechanical obstruction of the bile duct PLUS mucosal irritation and destruction from the remaining gallstones (mucosal damage–> enzyme release–> inflammation). This leads to distension, ischemia or hemorrhage, and a vicious cycle of inflammation.
What differentiates acute from chronic cholecystitis?
Chronic cholecystitis is a “histopathologic term for INFLAMMATION and FIBROSIS of the gallbladder”
Correlation with clinical symptoms is poor.
Correlation with gallstones is 95% (ie 95% of ppl with chronic cholecystitis will have gallstones)
Pathophysiology is not well understood.
Gallbladder carcinoma is very (common OR rare) and has a (dismal OR good) prognosis.
Rare, dismal
1% @ 5 years.
What are two major risk factors for gallbladder carcinoma?
Gallstones Liver flukes (chronic infection)
By far the most common type of gallbladder carcinoma is _____.
The worst (they are all terrible) is ______.
Adenocarcinoma.
Small cell.
An infiltrative, gland forming neoplasm in the wall of the gallbladder would be a finding indicative of ____.
Adenocarcinoma.
The major cause of ascending cholangitis is _____.
Choledocholithiasis.
Choledocholith definition?
“Bile duct stone”
Stone within the biliary tree. Can drop from the gallbladder (90%) or arise within the duct (10%).
What is a choledochal cyst?
A congenital dilatation of the common bile duct. Typically present in young patients (biliary obstruction–> jaundice, etc).
There are many classified types, based on the number, size, location.
Bile duct carcinoma are (rare OR common) and are nearly all what type?
Very rare, adenocarcinoma.
What are risk factors for bile duct carcinoma?
Choledochal cyst in adult (which is why these are repaired in kids)
Primary sclerosing cholangitis
Infections (liver flukes)
4 sequelae of pancreatitis.
Pseudocysts
Secondary Diabetes
Pancreatic insufficiency
Abscesses
What is the pathogenesis of acute pancreatitis caused by a cholelith?
Not simply due to mechanical obstruction.
Gallstone causes and increase in intraductal pressure (trapping of enzyme rich fluids). Causes backflow into the pancreatic parenchyma, leads to activation of proenzymes and tissue injury, inflammation, edema, ischemia, etc.
What is the pathogenesis of acute pancreatitis caused by alcohol?
Alcohol causes increased secretion, as well as contraction of the sphincter of Oddi. Combination of increased stimulation and contraction of sphincter causes back pressure, similar to the gallstone picture.
Alcohol also causes mis-packaging of the pre-enzymes.
Irreversible parenchymal destruction and fibrosis of the pancreas is called ____.
Causes?
Chronic pancreatitis
Alcohol abuse (majority)
Longstanding duct obstruction
Idiopathic (40%)
hereditary forms
95% of all pancreatic tumors are ____.
Ductal adenocarcinoma.
2% = endocrine neoplasms 3% = other
Gastrinoma, a pancreatic endocrine neoplasm, will often present with____.
Gastric ulcers. Gastrin increases acid secretion.
Zollinger-Ellison syndrome
