Pathology of bile ducts and exocrine pancreas

Question 1

Gallbladder inter- and digestive period

Answer 1

Interdigestive period:
• Gallbladder stores bile and modifies the concentration of its components,

Digestive period:
• When food enters duodenum, especially fat, it promotes the release of colecistokinine (CCK),

Question 2

Clinical evalution of gallbladder

Answer 2

• Exploration: palpable gallbladder (Normal conditions gallbladder is not palpable!)
• Laboratory tests: GOT, GPT, Gamma GT, total bilirubin
• Image tests: CT scan, MRI, ultrasound, laparoscopy

Question 3

Lithogenesis?

Answer 3

Gallsten

Question 4

3 main types of gallstones/bladderstones

Answer 4

1. Cholesterol

Pigmented

2. Black
3. Brown

Question 5

Causes if gallstone?

Answer 5

Blood sugar imbalance
Stress
Obesity
Low fat diets
Low stomach acid production
Low fiber diet
Cholesterol rich diets

Question 6

Extrahepatic obstructive bile syndrome: caused by 3 types of lesions

Answer 6

3 types:

1. Lumen: Stones
2. Parietal: Tumors
3. Extraparietal: compression from structures

Usually occurs in small diameter areas, cystic duct or odd sphincter

• Transient obstruction: short pain episodes right hypochondrium area
• Prolonged obstruction: Choalngitis (inflammation biles)
  & Cholestasis (no flow of bile to duodenum)

Question 7

Exocrine pancreas: Regulation?

Answer 7

Acetylcholine released by vagus nerve terminals (PNS).

• Cholecystokinin (CCK) released by duodenal and jejunum mucosa upon food arrival to intestine.
• Both acetylcholine and cholecystokinin favor rich digestive enzymatic secretion.
• Secretion released by duodenal and jejunum mucosa when acidic content of the stomach reaches the intes,ne, increases production of bicarbonate.

Question 8

Regulation phases?

Answer 8

CEPHALIC PHASE = 20% of juice
- Nerve stimulation of pancreatic secretion by acetylcholine.

GASTRIC PHASE = 10% of juice
- It continues nerve stimulation.

INTESTINAL PHASE 70% of juice
- Chyme in the duodenum and secretin stimulate copious secretion of pancreatic juice

Question 9

Acute pancreatitis pathogenesis

Answer 9

Pathogenesis: neutrophilic inflammatory reaction

inflamed pancreas due to many causes:

• Causing agent
• Intraaccinar phenomena
• Extraacinar phenomena

Question 10

Acute pancreatitis & gallstone

Answer 10

Cholelithiasis increases the risk of developing acute pancreatitis by 7 times

Question 11

Acute pancreatitis: symptoms and diagnosis

Answer 11

Symptoms:

Local manifestations:
- Epigastric pain, nausea vomiting

Distant manifestations:

• Hypovolemic shock
• Skin lesion

Diagnosis:
Laboratory test: Amylase and lipase increased!!

Imaging: CT, X-ray thorax, ultrasound

Question 12

Chronic pancreatitis pathogenesis

Answer 12

Pathogenesis: mononuclear cells infiltration and necrosis

Permanent structural changes due to inflammation

Triggerings risk factors: alcohol, autoimmune or idiopathic

Question 13

Chronic pancreatitis: symptoms & diagnosis

Answer 13

Pain after meal
Malabsoprtion of lipids
SITOPHOBIA = scared to eat !!!
Diabetes

Diagnosis:
1. Clinical manifestation

2. image test: increased pancreas
3. Lab test: Hypocalcemia, Hypoalbuminemia, Hypocholesterolemia,
   • increased alkaline phosphatase and gamma GT if common bile duct stenosis,
   • Amylase and lipase increase.