Pathology of gall bladder and pancreas

Question 1

What is the medical term for gall stones?

Answer 1

Cholelithiasis

Question 2

Where are gall stones most commonly formed?

Answer 2

Gall bladder, occasionally formed in the bile ducts

Question 3

Can gall stones remain assymptomatic?

Answer 3

Yes and they often do

Question 4

What is normal bile made from?

Answer 4

Micelles of cholesterol, phospholipid, bile salts and bilirubin (Cholesterol at the centre)

Question 5

What causes the release of bile into the intestines?

Answer 5

CCK released from duodenumcauses the call bladder to contract and bile to flow into the second part of the duodenum.

Question 6

What are the different types of gallstones?

Answer 6

1) Cholesterol gallstones
2) Pigment stones
3) Calcium carbonate stones

Question 7

What is the pathogenesis of cholesterol gallstones?

Answer 7

Too much cholesterol in the micelles causing them to precipitate out of solution and form crystals of cholesterol

Question 8

What are the risk factors for cholesterol gall stones?

Answer 8

Female, obesity, diabetes , genetic

Question 9

What do cholestereol gall stones look like and when do they cause pain?

Answer 9

Cuboidal and variable in size. Normally a creamy colour. Irritate the gall bladder lining causing inflammation and thickening and cause pain after a meal when the gall bladder contracts

Question 10

What causes pigment gall stones?

Answer 10

Too much bilirubin which cannot be solubalised in bile salts so precipitates out of solution.

Question 11

What do pigment gall stones look like?

Answer 11

Black stones

Question 12

What are the risk factors for pigment gall stones?

Answer 12

Excess billirubin due to haemoylictic anaemias

Question 13

Which gall stones are most common?

Answer 13

Mixed gall stones. Cholesterol and bilirubinbut pure sones do occur

Question 14

What can predispose to gall stones?

Answer 14

Gall bladder pH and mucosal glycoproteins => infection and inflammation of biliary lining

Question 15

What are some of the consequences of gall stones?

Answer 15

1) Acute cholecystitis
2) Chronic cholecystitis
3) Mucocoele
4) Empyema
5) Carcinoma
6) Ascending cholangitis
7) Obstructive jaundice
8) Gall stone Ileus
9) Acute pancreatitis
10) Chronic pancreatitis

Question 16

How is acute choecystitis treated?

Answer 16

Antibiotics

Tend not to operate in the acute phase but the gall bladder can be removed in the chronic phase

Question 17

What is Mucolcele as a consequence of gallstones?

Answer 17

Mucus build up within the gall bladder which can lead to empyema. Treated surgically

Question 18

What is gallstone ileus?

Answer 18

Bowel obstruction as a result of gall stones impacting on the ileocaecal valve

Question 19

How does gall stones cause pancreatitis?

Answer 19

Gall stone blocks the entery of the pancreatic duct into the common bile duct a few cm before the sphincter of Oddi.
Iatrogenic. ERCP to try to remove a gallstone can result in pancreatitis

Question 20

What are the consequences fo acute cholecystitis?

Answer 20

Gall stones obstruct bile outflow.
Initially sterile but becomes infected,
May cause empyema, rupture and peritonitis
Causes adhesions within 2-3 days.
ACUTE: neutrophils

Question 21

What are happens in chronic cholceystitis?

Answer 21

Gall bladder wall is thickened but not distended (normal wall is 3-5mm) Fibrotic sac.
Can develop insidiously or after repeated acute episodes.

Question 22

What type f cancer is found in the gall bladder?

Answer 22

Adenocarcinoma

Question 23

What is cancer of the gall bladder associated with?

Answer 23

Gall stones

Question 24

How may a patient with cancer of the gall bladder present?

Answer 24

Painless obstructive jaundice
Local liver invastion.
Poor prognosis

Question 25

What is carcinoma of the bile ducts called and what type of cancer is it?

Answer 25

Cholangiocarcinoma (Klatskin tumour) | Adenocarcinoma

Question 26

What is cholangiocarcinoma associated with and how does it present?

Answer 26

UC and primary sclerosisng cholangitis. | Obstructive jaundice

Question 27

Pancreatitis can be acute or chronic. Can they overlap?

Answer 27

Yes- due to infective or neoplastic disease.

Question 28

What are the symptoms of acute pancreatitis?

Answer 28

Affects adults Sudden onset severe abdo pain In shock Elevated serum amylase (amylase shouldn't normally be in the blood)

Question 29

What is a very good blood test for acute pancretitis?

Answer 29

Serum amylase. If elevated it strongly suggests pancreatis

Question 30

What causes acute pancreatitis?

Answer 30

``` I-idiopathic G- Gallstones E-Ethanol T-trauma Shock, mumps, hyperpathathyroidism, hypothermia, post ERCP ```

Question 31

What is the pathogenesis of acute pancreatits?

Answer 31

Loss of protective barrier allows autodigestion of pancreatic acinar cells because the enzymes produce get stuck and are cleaved to the active form. => Release of lipases and proteases => Intra and extra hepatic fat necrosis (attracts calcium) and tissue destruction and haemorrhage

Question 32

What is the surgical hallmark of acute pancreatitis?

Answer 32

Fat necrosis

Question 33

What is a pancreatic pseudocyst?

Answer 33

A complication of pancreatitis which can errode and bleed into themselves and obstruct other organs

Question 34

What are the complications of acute pancreatitis?

Answer 34

Death Shock Pseudocyst formation Abscess formation Hypocalcemia (calcium is attracted to fat necrosis) Hyperglycemia (no insulin being produced to regulate blood sugar.

Question 35

If someones pancreas is removed how do they gain energy?

Answer 35

PN nutrition. | Insulin ejected for blood sugar

Question 36

When does chronic pancreatitis occur?

Answer 36

After lots of acute pancreatitis | Insidiously

Question 37

What are the causes of chronic pancreatitis?

Answer 37

``` Alcohol Cholelithiasis Cystic Fibrosis Hyperthyroidism Familial (rare) ```

Question 38

What is the pathology of chronic pancreatits

Answer 38

Replacement of pancreas by chronic inflammation and scar tissue Destruction of exocrine acinar cells and islets of langerhans.

Question 39

What type of cancer is pancreatic cancer?

Answer 39

Adenocarcinoma

Question 40

What causes carcinoma of the pancreas?

Answer 40

Idiopathic- we do not know but associated with smoking, diabetes and familial pancreatitis.

Question 41

What is the one surgical operation which can be used in early carcinoma of the pancreas?

Answer 41

Wipples operation. You cannot detach the head of the pancreas form the duodenum. You must remove the duodenum and reanastamose and cut the common bile duct. High risk procedure

Question 42

The pancreas is intimately related to many other structures which it can invade. ist some?

Answer 42

Stomach, duodenum, spleen, Liver, gall bladder, Hepatic portal vein. IMPORTANT: Superior mesenteric artery and superior mesenteric vain pass behind the next of the pancreas and infront of the uncinate process

Question 43

The pancreas drains blood directly into the splenic vein and into the liver, what are the consequences if there is cancer?

Answer 43

Metastasis can easily spread to the liver