GI Path: Gallbladder - Pancreas

Question 1

Describe the Gallbladder duct system

Answer 1

Cystic Duct –> joins the common hepatic duct to form the common bile duct –> joins the pancreatic duct –> enters duodenum through ampulla of Vater

Question 2

Describe the Gallbladder

Answer 2

-Located on the inferior surface of the liver
-Sphincter of Oddi controls bile movement at ampulla of Vater
-Capacity = 30-50ml

Question 3

What is the function of the Gallbladder

Answer 3

1) Stores bile
2) Concentrates bile
3) Releases bile –> stimulated by Cholecystokinin (CCK)

Question 4

Gallbladder Bile

Answer 4

-Produced in liver –> stored in gallbladder
-Secreted via Cholecystokinin –> 95%

Question 5

What is the composition of Bile? The functions?

Answer 5

Composition:
1) Bile salts - 67%
2) Phospholipids - 22%

Functions:
1) Emulsification of fats
2) Absorption of fatty acids/cholesterol

Question 6

Cholelithiasis - Gallstones

Answer 6

Solid round stones in the gallbladder
*cholesterol stones = 80%
*bilirubin stones = 20%

Question 7

What are the complications of Cholelithiasis - Gallstones

Answer 7

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

Question 8

What is Cholelithiasis associated with? The incidence?

Answer 8

Associated with:
1) estrogen
2) diet
3) obesity
4) heredity

Incidence:
10-20%

Question 9

What are the oral/clinical signs of Cholelithiasis?

Answer 9

“Rule of 4 F’s”
-Female + Fat + Forty + Fertile
-Usually asymptomatic
-URQ pain - spasmotic

Question 9

Acute Cholecystitis

Answer 9

Inflammation of the gallbladder
*usually due to gallstone lodged in cystic duct

Question 10

What is the pathogenesis of Acute Cholecystitis? The oral/clinical signs?

Answer 10

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

Question 11

Chronic Cholecystitis

Answer 11

Chronic inflammation of the gallbladder
*usually due to gallstone lodged in cystic duct

Question 12

What are the oral/clinical signs of Carcinoma of the Gallbladder?

Answer 12

• 70+yrs
  -Females
• *asymptomatic
  -Jaundice

*19% 5-yr survival

Question 12

What is the pathogenesis of Chronic Cholecystitis? The oral/clinical signs?

Answer 12

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

Question 12

Carcinoma of Gallbladder

Answer 12

Most common malignancy of extrahepatix biliary tract
*usually adenocarcinomas - 95%

Question 13

Pancreas

Answer 13

-Glandular organ
-Retroperitoneal organ –> extends from C-loop of duodenum to the hilum of spleen

Question 14

Describe the endocrine and exocrine portions of the pancreas

Answer 14

Endocrine portion = 2% –> islets of Langerhans

Exocrine portion = 98% –> acinar cells and ducts
*produce alkaline enzymes
*1.5L daily
*secreted via ampulla of Vater

Question 15

What is the function of the Exocrine portion of the Pancreas?

Answer 15

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)

Question 16

What is the function of the Endocrine portion of the Pancreas?

Answer 16

Regulation of blood sugar levels
*secretes insulin + glucagon via islets of Langerhans

Question 17

Acute Pancreatitis

Answer 17

Sudden inflammation and hemorrhage of pancreas
*reversible inflammatory disorder
*varies from focal edema (80%) to widespread hemorrhagic necrosis

Question 18

What is the pathogenesis of Acute Pancreatitis? What is it associated with? The oral/clinical signs?

Answer 18

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

Question 19

Chronic Pancreatitis

Answer 19

Long-standing inflammation and fibrosis of pancreas
*non-reversible inflammatory disorder

Question 20

What is the pathogenesis of Chronic Pancreatitis? What is it associated with? The oral/clinical signs?

Answer 20

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

Question 21

Pancreatic Carcinoma

Answer 21

3rd most common cause of cancer death

Question 22

What is the pathogenesis of Pancreatic Carcinoma? What is it associated with? The oral/clinical signs?

Answer 22

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

Question 23

What condition of the gallbladder is caused by Neoplasia

Answer 23

Carcinoma of Gallbladder

Question 24

What condition of the Pancreas is caused by Neoplasia

Answer 24

Pancreatic Carcinoma