lecture 7 biliary and pancreatic pathology Flashcards
where does bile come from
hepatocytes
where is bile stored
gall bladder
what does eating stimulate
CCK
what does CCk secretion induce
bile release
how does the bile enter the bowel
ampulla of vater
what is the bile for
emulsification of fat
where is ile reabsorbed
terminal ileum
where is the gallbladder found
visceral surface
between right lobe and quadratic lobe
how are bile salts reabsorbed
active transport
how are bile salts returned to the liver
enterohepatic circulation
bile contains
bile acids
bilirubin
function of bile
absorbing fats
eliminate waste products
signalling molecules
what are the waste products bile helps to eliminate
excess cholesterol, bilirubin, non water soluble xenobiotics
what are the signalling molecules bile helps with
Activate MAPK pathway, ligands for receptor TGR5, activate hormone receptors
where is bilirubin conjugated
liver
what happens to the iron and globin from the RBC
recycled
where does the bilirubin go
excreted into bile then small intestine and travels to the large intestine
what happens to bilirubin in the large bowel
bacteria convert it to urobilligen
3 pathways of urobilligen
reabsorbed into blood
converted to urobilin and excreted in urine
converted to stercobillin and excreted in poo
jaudice patients wee
dark
jaundice patients poo
light
what is jaundice
high billirubin in the blood
what can occur with jaundice
pruritus - itching
where might you look for jaundice
conjuctiva
Prehepatic jaundice
Haemolysis, resorption from bleed, gilbert syndrome and ineffective erythropoesisis.
gilbert syndrome
bilirubin struggles to get into the liver
how would you know if someone had gilberts syndrome
in times of stress there may be visible jaundice
what are post hepatic causes of jaundice
obstructed bile duct
what can cause hepatic and post hepatic
primary sclerosing cholangiti
Cholesterolosis
accumulation of cholesterol
Cholecystitis
gallbladder infection
Mucocoele
distension of gallbladder by accumulation of mucous
gall stones risk factors
fat, female, forty, fertile, fair
signs of gall stones
murphys sign
right upper quadrants pain
Murphy’s sign
hypersensitivity to deep palpation in the subcostal area when a patient with gallbladder disease takes a deep breath
causes of gall stones
stasis
haemolysis
rapid weight loss
what are most of the stones
cholesterol
empyema
collection of puss in the gallbladder
pancreas exocrine gland arrangement
acini
release of pancreas exocrine gland
trypsin, lipases, and amylases
pancreas endocrine arrangement
islets of langerhans
endocrine pancreas secretion
insulin and glucagon
how does the pancreas form
pancreas develops in two halves one half swings round and joins the other half and fuses
main causes of acute pancreatitis
alcohol
gallstones
surgery
virus
Pseudocysts
inflammatory cysts
treatment of Pseudocysts
draining them
most common place for adenocarcinoma in the pancreas
head
symptoms of pancreatic adenocarcinoma
weight loss, back pain and painless jaundice
are pancreatic symptoms common
no
pancreatic adenocarcinoma signs
trousseau’s sign
causes of acute pancreatitis
Idiopathic gallstones, ethanol, trauma, steroids, malignancy/mumps, autoimmune, scorpion sting, hypertriglyceridemia/hypercalcemia, ERCP drugs
pancreatitis symptoms
Acute abdominal pain - central, severe, and often radiates to back, vomiting and history of alcohol excess, gallstones, and certain drugs
