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Gastrointestinal > Pathology of Biliary Tract and Pancreas > Flashcards

Pathology of Biliary Tract and Pancreas Flashcards

1
Q

what are gallstones (cholelithiasis)

A

hard stone-like or gravel-like material formed within biliary system

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2
Q

most common site for gallstones

A

gallbladder

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3
Q

contents of bile

A

micelles of cholesterol (hydrophobic)
phospholipid
bie salts (hydrophilic)
bilirubin

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4
Q

how is bile released

A

by CCK

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5
Q

where is bile released to

A

2nd part of duodenum through common bile duct and ampulla of vater

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6
Q

pathogenesis of cholesterol gallstones

A

imbalance between ratio of cholesterol to bile salts disrupting micelle formation - free crystallisation of cholesterol on micelle surface

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7
Q

risk factors for cholesterol gallstones

A

female
obesity
diabetes
genetics

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8
Q

pathogenesis of pigment gallstones

A

excess bilirubin cannot be solubilised in bile salts due to excess haemolysis

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9
Q

contributory factors of gallstones

A

gallbladder pH

mucosal glycoproteins

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10
Q

pathogenesis of gallstones

A

infection and inflammation of biliary lining
can be mixture of cholesterol and pigment or pure
calcium carbonate stones occur <10%

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11
Q

what is cholecystitis

A

inflammation of gallbladder - can be acute or chronic

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12
Q

what is acute cholecystitis

A

gallstones obstructing outflow of bile

initially sterile, then becomes infected

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13
Q

consequences of acute cholecystitis

A

intense adhesions (2-3 days)
empyema
rupture
peritonitis

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14
Q

pathology of acute cholecystitis

A

mixed gallstones embedded in pus

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15
Q

microscopy of acute cholecystitis

A

acute inflammation indicted by neutrophils

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16
Q

describe development of chronic cholecystitis

A

develops insidiously or after bouts of acute cholecystitis

associated with gallstones

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17
Q

pathology of chronic cholecystitis

A

mixed stones

gallbladder wall is thickened (not distended) due to fibrosis

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18
Q

microscopy of chronic cholecystitis

A

chronic inflammation

rokitansky-aschoff sinuses

19
Q

what do stones in common bile duct cause

A

obstructive jaundice

20
Q

describe adenocarcinoma of gallbladder

A

rare

associated with gallstones

21
Q

invasion of adenocarcinoma of gallbladder

A

local invasion of liver

22
Q

describe adenocarcinoma of bile ducts (cholangiocarcinoma)

A

rare

associated with ulcerative colitis and primary sclerosing cholangitis

23
Q

presentation of cholangiocarcinoma

A

klatskin tumour

obstructive jaundice

24
Q

microscopy of cholangiocarincoma

A

densely packed small glands in fibrous storm

25
Q

what is pancreatitis

A

inflammation of pancreas

acute or chronic (can overlap)

26
Q

epidemiology of acute pancreatitis

27
Q

symptoms/signs of acute pancreatitis

A

sudden onset severe abdominal pain

elevated serum amylase

28
Q

aetiology of acute pancreatitis

A 
alcohol 
cholelithiasis 
shock
mumps
hyperparathyroidism 
hypothermia 
trauma
iatrogenic (post ERCP)
29
Q

pathogenesis of acute pancreatitis

A

pancreatic duct epithelial injury
loss of protective barrier
release of lytic pancreatic enzymes and proteases and lipase

30
Q

how is pancreatic duct epithelium injured in acute pancreatitis

A

bile reflux

duct obstruction die to stone damage to sphincter of Oddi

31
Q

describe loss of protective barrier in acute pancreatitis

A

allows auto digestion of pancreatic acini

32
Q

what do lipase cause in acute pancreatitis

A

intra- and peri-pancreatic fat necrosis

33
Q

what do proteases cause in acute pancreatitis

A

tissue destruction and haemorrhage

34
Q

complications of acute pancreatitis

A 
pseudocyst 
death
shock 
abscess
hypocalcaemia 
hyperglycaemia
35
Q

microscopy of pancreatitis

A

fat necrosis

36
Q

development of chronic pancreatitis

A

relapsing disorder may develop insidiously or following bouts of acute pancreatitis

37
Q

aetiology of chronic pancreatitis

A 
alcohol 
cholelithiasis 
cystic fibrosis 
hyperparathyroidism 
familial
38
Q

pathology of chronic pancreatitis

A

replacement of pancreas by chronic inflammation and fibrotic tissue
destruction of exocrine acini and islets

39
Q

microscopy of chronic pancreatitis

A

exocrine pancreas is replaced by chronic inflammation and fibrosis

40
Q

adenocarcinoma of pancreas associations

A

(aetiology unknown)
smoking
diabetes
familial pancreatitis

41
Q

consequences of adenocarcinoma head of pancreas

A

constricts common bile duct

can invade duodenal wall

42
Q

invasion of adenocarcinoma of pancreas

A

direct invasion - spleen, duodenum, stomach
spread to local lymph noes
haematogenous spread to liver

43
Q

microscopy of adenocarcinoma of pancreas

A

irregular abortive glands in dense stroma

Gastrointestinal (71 decks)

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