Pathology of biliary tract and pancreatic pathology Flashcards
What is choleithiasis?
Defined as hard stone-like or gravel-like material formed within the biliary system most commonly the gallbladder
What is normal bile composed of?
Micelles of cholesterol, phospholipid, bile salts and bilirubin
How is bile released?
Stored and concentrated in the gallbladder and released by CCK into the 2nd part of the duodenum through the CBD and ampulla of vater
How do cholesterol stones form?
Gallstones form when there is an imbalance between the ratio of cholesterol to bile salts disrupting micells formation
What are the risk factors to cholesterol gall stones?
Female
Obesity
Diabetes
Genetic
What is a pigment stone?
Too much haem in the system, the body is breaking down red blood cells too readily causing a black pigemnt stone
What are the risk factors to pigment stones?
Excess bilirubin due to excess haemolysis i.e. hemolytic anaemia
What is the pathogenesis of gall stones?
Gallbladder pH and mucosal glycoproteins may be contributory factors causing infection and inflammation of the biliary lining
What can cause gallstones?
Acute cholescytitis Chronic cholecystitis Mucocoele Emypema Carcinoma Ascending cholangitis Obstructive jaundice Gallstone ileus Acute pancreatitis Chronic pancreatitis
What is cholecystitis?
Inflammation of the gallbladder which is usually associated with gallstones
What is acute cholecystitis?
Gallstones obstructing outflow of bile
Initially sterile then becomes infected
May cause empyema, rupture and peritonitiis
What is chornic cholecystitis?
Associated with gallstones
May develop insidiously or after bouts of acute cholecystitis
Gallbladder wall is thickened but not distended
What cancer commonly affects the gallbladder?
Adenocarcinoma
Associated with gallstones
Local invasion of the lvier `
What conditions are associated with cholangiocarcinoma?
Associated with ulcerative colitis and primary sclerosing cholangitis
Presents with painless obstructive jaundice
Adenocarcinoma
What are the two functions of the pancreas?
Endocrine - islet cells of langerhan, somatostatin, glucoagon and insluin
Exocrine - acinar cells - enzymes and proteases
What is pancreatitis?
Inflammation of the pancreas may be acute of chronic
Overlap exists between acute and chronic
What is acute pancreatitis?
Sudden onset severe abdo pain
Patients may be severely shocked
Elevated serum amylase
What are the differential diagnoses for severe abdo pain?
Appendicitis Diverticulitis Perforation Obstruction Acute pancreatitis
What can cause acute pancreatitis?
Alcohol Cholelithiasis Shock Mumps Hyperparathyrodism Hypothermia Trauma Iatrogenic
What is the pathogenesis of acute pancreatitis?
Bile reflux leads to duct obstruction due to stone famage to the sphincter of oddi which all cause pancreatic duct epithelial injury
The loss of the protective barrier allows autodigestion of pancreatic acini
Release of lytic pancreatic enzymes proteases and lipases leads to intra and peripancreatic fat necrosis and tissue destruction and haemorrhage
What are some complications of acute pancreatitis?
Death Shock Pseudocyst formation Abscess formation Hypocalcaemia Hyperglycaemia
What is chronic pancreatitis?
Relapsing disorder may develop insidiously or following bouts of acute pancreatitis
What causes acute pancreatitits?
Alcohol Cholelithiasis CF Hyperparathyrodism Familial
What is the pathogenesis of chronic pancreatitis?
Replacement of pancreas by chronic inflammation and scar tisue
Destruction of exocrine acini and islets
What cancer can affect the pancreas?
Adenocarcinoma
Associated with smoking, diabetes and familial pancreatitis
Where can adenocarcinoma of the pancreas spread?
Direct spread to other organs e.g duodenum, stomach, spleen, left adrenal gland, transverse colon and CBD
Spread to local lymph nodes
Haematogenous spread to liver
