Pathology of Biliary Tract and Pancreas

Question 1

what are gallstones (cholelithiasis)

Answer 1

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

Question 2

most common site for gallstones

Answer 2

gallbladder

Question 3

contents of bile

Answer 3

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

Question 4

how is bile released

Answer 4

by CCK

Question 5

where is bile released to

Answer 5

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

Question 6

pathogenesis of cholesterol gallstones

Answer 6

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

Question 7

risk factors for cholesterol gallstones

Answer 7

female
obesity
diabetes
genetics

Question 8

pathogenesis of pigment gallstones

Answer 8

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

Question 9

contributory factors of gallstones

Answer 9

gallbladder pH

mucosal glycoproteins

Question 10

pathogenesis of gallstones

Answer 10

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

Question 11

what is cholecystitis

Answer 11

inflammation of gallbladder - can be acute or chronic

Question 12

what is acute cholecystitis

Answer 12

gallstones obstructing outflow of bile

initially sterile, then becomes infected

Question 13

consequences of acute cholecystitis

Answer 13

intense adhesions (2-3 days)
empyema
rupture
peritonitis

Question 14

pathology of acute cholecystitis

Answer 14

mixed gallstones embedded in pus

Question 15

microscopy of acute cholecystitis

Answer 15

acute inflammation indicted by neutrophils

Question 16

describe development of chronic cholecystitis

Answer 16

develops insidiously or after bouts of acute cholecystitis

associated with gallstones

Question 17

pathology of chronic cholecystitis

Answer 17

mixed stones

gallbladder wall is thickened (not distended) due to fibrosis

Question 18

microscopy of chronic cholecystitis

Answer 18

chronic inflammation

rokitansky-aschoff sinuses

Question 19

what do stones in common bile duct cause

Answer 19

obstructive jaundice

Question 20

describe adenocarcinoma of gallbladder

Answer 20

rare

associated with gallstones

Question 21

invasion of adenocarcinoma of gallbladder

Answer 21

local invasion of liver

Question 22

describe adenocarcinoma of bile ducts (cholangiocarcinoma)

Answer 22

rare

associated with ulcerative colitis and primary sclerosing cholangitis

Question 23

presentation of cholangiocarcinoma

Answer 23

klatskin tumour

obstructive jaundice

Question 24

microscopy of cholangiocarincoma

Answer 24

densely packed small glands in fibrous storm

Question 25

what is pancreatitis

Answer 25

inflammation of pancreas | acute or chronic (can overlap)

Question 26

epidemiology of acute pancreatitis

Answer 26

adults

Question 27

symptoms/signs of acute pancreatitis

Answer 27

sudden onset severe abdominal pain | elevated serum amylase

Question 28

aetiology of acute pancreatitis

Answer 28

``` alcohol cholelithiasis shock mumps hyperparathyroidism hypothermia trauma iatrogenic (post ERCP) ```

Question 29

pathogenesis of acute pancreatitis

Answer 29

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

Question 30

how is pancreatic duct epithelium injured in acute pancreatitis

Answer 30

bile reflux | duct obstruction die to stone damage to sphincter of Oddi

Question 31

describe loss of protective barrier in acute pancreatitis

Answer 31

allows auto digestion of pancreatic acini

Question 32

what do lipase cause in acute pancreatitis

Answer 32

intra- and peri-pancreatic fat necrosis

Question 33

what do proteases cause in acute pancreatitis

Answer 33

tissue destruction and haemorrhage

Question 34

complications of acute pancreatitis

Answer 34

``` pseudocyst death shock abscess hypocalcaemia hyperglycaemia ```

Question 35

microscopy of pancreatitis

Answer 35

fat necrosis

Question 36

development of chronic pancreatitis

Answer 36

relapsing disorder may develop insidiously or following bouts of acute pancreatitis

Question 37

aetiology of chronic pancreatitis

Answer 37

``` alcohol cholelithiasis cystic fibrosis hyperparathyroidism familial ```

Question 38

pathology of chronic pancreatitis

Answer 38

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

Question 39

microscopy of chronic pancreatitis

Answer 39

exocrine pancreas is replaced by chronic inflammation and fibrosis

Question 40

adenocarcinoma of pancreas associations

Answer 40

(aetiology unknown) smoking diabetes familial pancreatitis

Question 41

consequences of adenocarcinoma head of pancreas

Answer 41

constricts common bile duct | can invade duodenal wall

Question 42

invasion of adenocarcinoma of pancreas

Answer 42

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

Question 43

microscopy of adenocarcinoma of pancreas

Answer 43

irregular abortive glands in dense stroma