Liver, etc. 8 - Pathology of Biliary tree and panceas Flashcards
What is the scientific name for Gallstones?
Cholelithiasis
what are gallstones (cholelithiasis)?
“Hard stone-like or gravel-like material formed within the biliary system most commonly the gallbladder”
What is normal bile formed from? (4)
Micelles of cholesterol, phospholipid, bile salts and bilirubin
What is bilirubin formed from?
The breakdown of RBCs in the spleen
Where are bile salts formed?
In the hepatocytes
Where is bile formed?
In the liver
Where is bile stored and concentrated?
In the gallbladder
Where is bile released?
Into the 2nd part of the duodenum through the common bile duct and Ampulla of vater
What hormone stimulates the release of bile from the gallbladder into the the 2nd part of the duodenum?
Cholecystokinin (CCK)
What causes gallstones to form?
When there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation
What are the 3 different types of gallstones that can form? - different gallstones depends on the different concentrations of constituents
Cholesterol stonesPigement stonesMixed stones
When do cholesterol stones form?
When there is an excess of cholesterol in bile
What are the risk factors for the formation of cholesterol bile stones? (4)
Female genderObesityDiabetesGenetics
What do cholesterol gallstones often look like?
Large and often solitary
When do pigment stones form?What can cause this (risk factor)?
When excess bilirubin cannot be solubilised in bile saltsExcess haemolysis e.g. haemolytic anaemia
Appearance of cholesterol gallstones?
Small, friable, irregular
Other than the composition of bile, what may also contribute to the formation of gallstones?
Gallbladder pH and mucosal glycoproteins
What type of gallstones are most gallstones?
Mixed
In general, what problems do gallstones cause?
Infection and inflammation of the biliary lining
What conditions can gallstones cause? (10)
Acute cholecystitisChronic cholecystitisMucocoeleEmpyemaCarcinomaAscending cholangitisObstructive jaundiceGallstone ileusAcute pancreatitisChronic pacnreatitis
What is cholecystitis?
Inflammation of the gallbladder
What is cholecystitis usually associated with?
Gallstones
What causes acute cholecystitis?
Gallstones obstructing outflow of bile (initially sterile and then becomes infected)
What complications can acute cholecystitis cause? (4)
EmpyemaRupturePeritonitisIntense adhesions form within 2-3 days
What leukocyte signals acute inflammation?
Neutrophils
What is chronic cholecystitis?
Chronic inflammation of the gallbladder
What causes chronic cholecystitis?
Usually associated with gallstones - may develop insidiously or after bouts of acute cholecystitis
What is the appearance of the gallbladder in chronic cholecystitis?
Gallbladder wall is thickened (due to fibrosis) but not distended
What are Rokitansky-Aschoff sinuses?
Histologically, they are outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. They are usually referred to as adenomyomatosis - usually due to increased pressure and recurrent damage of the gallbladder wall
What is cholestasis?
A condition where bile can not flow from the liver to the duodenum
What type of jaundice would stones in the common bile duct cause?
Obstructive jaundice
What type of cancers do gallbladder cancers tend to be?
Adenocarcinoma (poor prognosis - rare)
What is the most common risk factor for carcinoma of the gallbladder?
Gallstones
Where do gallbladder carcinomas locally invade?
The liver
What is cholangiocarcinoma?
Carcinoma of the bile ducts (rare)
What is cholangiocarcinoma associated with? (2)
Ulcerative colitisPrimary sclerosing cholangitis
How does cholangiocarcinoma present?
With obstructive jaundice?
What type of cancer is cholangiocarcinoma?
Adenocarcinoma
What is a Klatskin tumour?
Cholangiocarcinoma at the bifurcation of hepatic ducts
What are stromal cells?
Connective tissue cells of any organ
Histological appearance of cholangiocarcinoma?
Densely packed small glands in a fibrous stroma
What are the 2 types of pancreatitis?
Acute or chronic (overlap exists between these 2 types)
what is the main symptoms of acute pancreatitis?
Sudden onset severe abdominal pain (patients may be severely shocked)
What blood test will be elevated in acute pancreatitis?
Serum amylase
What age are patients who get acute pancreatitis?
Adults
What are the causes of pancreatitis?
GallstonesEthanolTraumaScorpion stingsMumps/ other infections/ malignancyAutoimmuneSteroids/ shockHyperlipidaemia/ hypercalcaemia/ hyperparathyroidism/ hypothermiaERCPDrugs
What causes pancreatic duct epithelial injury? (2)
Bile refluxDuct obstruction due to stone damage to sphincter of Oddi
What does pancreatic epithelial injury cause?
loss of protective barrier allowing autodigestion of pancreatic acini by lytic pancreatic enzymes proteases and lipases
What does lytic pancreatic lipase cause to the pancreas?
Intra- and peripancreatic fat necrosis
What does lytic pancreatic proteases cause to the pancreas?
Tissue destruction and haemorrhage
What can intrapancreatic fat necrosis bind?
Large amounts of calcium
What is a pancreatic pseudocyst? (complication of pancreatitis)
collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen.
What are 6 complications of acute pancreatitis?
DeathShockPseudocyst formationAbscess formationHypocalcaemiaHyperglycaemia
What is chronic pancreatitis?
Long standing inflammation of the pancreas - can develop insidiously or following bouts of acute pancreatitis
Causes of chronic pancreatitis? (5)
AlcoholCholelithiasisCFHyperparathyroidismFamilial
What happens to the composition of the pancreas during chronic pancreatitis?
Replacement of pancreas by chronic inflammation and scar tissue(destruction of exocrine acini and islets)
What type of cancer occurs in the pancreas?
Adenocarcinoma
What is carcinoma of the pancreatic associated with? (3)
SmokingDiabetesFamilial pancreatitis
What does adenocarcinoma of the pancreas look like microscopically?
Irregular abortive glands in a dense stroma
Where do adenocarcinomas of the pancreas haematogenously spread to?
Liver
