GI Path: Gallbladder - Pancreas Flashcards
Describe the Gallbladder duct system
Cystic Duct –> joins the common hepatic duct to form the common bile duct –> joins the pancreatic duct –> enters duodenum through ampulla of Vater
Describe the Gallbladder
-Located on the inferior surface of the liver
-Sphincter of Oddi controls bile movement at ampulla of Vater
-Capacity = 30-50ml
What is the function of the Gallbladder
1) Stores bile
2) Concentrates bile
3) Releases bile –> stimulated by Cholecystokinin (CCK)
Gallbladder Bile
-Produced in liver –> stored in gallbladder
-Secreted via Cholecystokinin –> 95%
What is the composition of Bile? The functions?
Composition:
1) Bile salts - 67%
2) Phospholipids - 22%
Functions:
1) Emulsification of fats
2) Absorption of fatty acids/cholesterol
Cholelithiasis - Gallstones
Solid round stones in the gallbladder
*cholesterol stones = 80%
*bilirubin stones = 20%
What are the complications of Cholelithiasis - Gallstones
1) Obstruction of common bile duct/cystic duct
2) Increased risk for acute/chronic cholecystitis
3) Increased risk for biliary colic
4) Increased risk for acute pancreatitis
5) Increased risk for adenocarcinoma
What is Cholelithiasis associated with? The incidence?
Associated with:
1) estrogen
2) diet
3) obesity
4) heredity
Incidence:
10-20%
What are the oral/clinical signs of Cholelithiasis?
“Rule of 4 F’s”
-Female + Fat + Forty + Fertile
-Usually asymptomatic
-URQ pain - spasmotic
Acute Cholecystitis
Inflammation of the gallbladder
*usually due to gallstone lodged in cystic duct
What is the pathogenesis of Acute Cholecystitis? The oral/clinical signs?
Pathogenesis:
-Gallstone obstruction of cystic duct –> dilation of gallbladder –> pressure ischemia + increased bacterial growth + inflammation
Oral/Clinical:
-URQ pain - radiates to R scapula
-Nausea/vomitting
-Increased WBCs/fever
Chronic Cholecystitis
Chronic inflammation of the gallbladder
*usually due to gallstone lodged in cystic duct
What are the oral/clinical signs of Carcinoma of the Gallbladder?
- 70+yrs
-Females - *asymptomatic
-Jaundice
*19% 5-yr survival
What is the pathogenesis of Chronic Cholecystitis? The oral/clinical signs?
Pathogenesis:
1) Repeated acute cholecystitis –> gallstone obstruction
2) Chemical irritation of longstanding gallstones
*both lead to herniation
*marked by recurrent attacks of URQ pain
Oral/Clinical:
-URQ severe pain - after eating for 6hr+
-Nausea/vomitting
-Increased WBCs/fever
Carcinoma of Gallbladder
Most common malignancy of extrahepatix biliary tract
*usually adenocarcinomas - 95%
Pancreas
-Glandular organ
-Retroperitoneal organ –> extends from C-loop of duodenum to the hilum of spleen
Describe the endocrine and exocrine portions of the pancreas
Endocrine portion = 2% –> islets of Langerhans
Exocrine portion = 98% –> acinar cells and ducts
*produce alkaline enzymes
*1.5L daily
*secreted via ampulla of Vater
What is the function of the Exocrine portion of the Pancreas?
Neutralize and digest food within intestines
*under PNS control via:
1) secretin
2) cholecystokinin (CCK)
-Acinar ducts –> secrete alkaline fluids - flow into main pancreatic duct
-Acinar cells –> produce digestive enzymes:
1) pancreatic amylase (CHO digestion)
2) pancreatic lipase (fat digestion)
3) tryspin/chymotrypsin (protein digestion)
What is the function of the Endocrine portion of the Pancreas?
Regulation of blood sugar levels
*secretes insulin + glucagon via islets of Langerhans
Acute Pancreatitis
Sudden inflammation and hemorrhage of pancreas
*reversible inflammatory disorder
*varies from focal edema (80%) to widespread hemorrhagic necrosis
What is the pathogenesis of Acute Pancreatitis? What is it associated with? The oral/clinical signs?
Pathogenesis:
-Reversible auto-digestion by inappropriately activated pancreatic enzymes
Associated with:
1) Alcohol abuse
*Cholelithiasis (gallstones)
Oral/Clinical:
-Sudden severe mid-abdominal pain - toward back
-Increased serum lipase/amylase
-Hypocalcemia
Chronic Pancreatitis
Long-standing inflammation and fibrosis of pancreas
*non-reversible inflammatory disorder
What is the pathogenesis of Chronic Pancreatitis? What is it associated with? The oral/clinical signs?
Pathogenesis:
-Auto-digestion of pancreas by inappropriately activated pancreatic enzymes due to cell injury –> replaced with fibrosis = non-reversible
Associated with:
1) Alcoholism
2) Cystic Fibrosis
Oral/Clinical:
-Repeated bouts of acute pancreatitis
-Persistent mild abdominal and back pain
-Secondary diabetes
**increased risk for pancreatic carcinoma
Pancreatic Carcinoma
3rd most common cause of cancer death
What is the pathogenesis of Pancreatic Carcinoma? What is it associated with? The oral/clinical signs?
Pathogenesis:
1) genetic
2) smoking
3) chronic pancreatitis if obese
Associated with:
1) alcoholism/bulimia
2) hiatal hernia
Oral/Clinical:
-elderly men - 70+yrs
-asymptomatic
-intractable pain/new onset diabetes
*very poor prognosis –> 8% 5-yr survival
What condition of the gallbladder is caused by Neoplasia
Carcinoma of Gallbladder
What condition of the Pancreas is caused by Neoplasia
Pancreatic Carcinoma
