intro hepatobiliary and pancreatic system Flashcards
blood supply of the liver ?
portal vein and hepatic artery
physiological function of bile ?
made up of bile salts and bile pigments
bile salts:
fat emulsification
stimullation of peristalsis
antibacterial effect
Absorption of ADEK
liver function test ?
albumin
bilirubin
INR
which marker is elevated with hepatocellular carcinoma ?
alpha fetoprotein
what are the features associated with fibrolamellar hepatocellular carcinoma ?
young patient
normal alpha fetoprotein levels
central hypodense scar
what are hepatic adenomas commonly associated with ?
OCP
steriods
and are mainly seen in younger females
what is the most common benign lesion of the liver ?
cavernous hemangioma
what is seen on ultrasound imaging of simple cysts of the liver ?
posterior acoustic enhancement
what are the different parts of the CBD ?
supraduodenal
retroduodenal
intraduodenal
physiological function of the gallbladder :
storgae of the bilee
conceentration of the bile
normal choleedochoduodenal mechanism
what is the hormonal regulation of the gallbladder ?
secretin
CCK
what is the initial event in acute cholecystitis, and which area is the pain in ?
obstruction of gallbladder emptying
affected area is the right upper quadrant
what are the US findings in acute cholecystitis ?
oedematous GB wall
stones
what sign is positive for gallstones ?
positive murphy sign
ask the patient to take a deep breath and palpate the subcostal area
extreme pain upon palpation
what is the presentation of acute cholecystitis ?
extreme right upper quadrant pain
fever
abdominal guarding
fever
positive murphy’s sign
what is porcelain gallbladder ?
calcification of the inner wall of the gall bladder
what is the problem with porcelain gallbladder ?
increases the risk of gallbladder carcinoma
what is primary sclerosing cholangitis ?
bile ducts inside and outside the liver become inflamed and then fibrosed eventually becoming narrowed and blocked
what is the CT appearance of primary sclerosing cholangitis ?
beaded appearance due to alternating dilatation and stenosis
what is pathognomonic in primary sclerosing cholangitis ?
duct diverticula
what disease is commonly associated with primary sclerosing cholangitis ?
ulcerative colitis
what are choledochal cysts ?
congenital cystic dilatation of the bile ducts
mostly extra hepatic
what is caroli’s disease ?
multiple intra-hepatic cysts
what is Mirizzi syndrome ?
when a stone in the gallbladder or the cystic duct externally compresses the common hepatic duct causing obstructive jaundice
what increases the likelihood of mirizzi syndrome ?
low insertion of the cystic duct
or a long cystic duct in parallel to the CHD
which artery runs along the pancreas ?
the splenic artery
what structure is related to the head of the pancreas ?
c loop of the duodenum
what structures are related to the neck of the pancreas?
lies in front of the junction of the superior mesenteric and splenic veins
the body of the pancreas lies behind the ….
stomach
what are the endocrine functions of the pancreas ?
alpha cells : glucagon
beta cells : Insulin
delta cells : somatostatin
what are the causes of pancreatitis ?
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gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion sting
hypercalcemia
hypertriglyceridemia
ERCP
drugs
what is the range of pathology that happens with pancreatitis ?
mild oedema
hemorrhagic pancreatitis
necrotizing pancreatitis
what is the indication for the drainage of pseudocyst ?
if above 5 cm
