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GI > Pathology of gall bladder and pancreas > Flashcards

Pathology of gall bladder and pancreas Flashcards

1
Q

What is the medical term for gall stones?

A

Cholelithiasis

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2
Q

Where are gall stones most commonly formed?

A

Gall bladder, occasionally formed in the bile ducts

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3
Q

Can gall stones remain assymptomatic?

A

Yes and they often do

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4
Q

What is normal bile made from?

A

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

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5
Q

What causes the release of bile into the intestines?

A

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

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6
Q

What are the different types of gallstones?

A

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

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7
Q

What is the pathogenesis of cholesterol gallstones?

A

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

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8
Q

What are the risk factors for cholesterol gall stones?

A

Female, obesity, diabetes , genetic

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9
Q

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

A

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

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10
Q

What causes pigment gall stones?

A

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

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11
Q

What do pigment gall stones look like?

A

Black stones

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12
Q

What are the risk factors for pigment gall stones?

A

Excess billirubin due to haemoylictic anaemias

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13
Q

Which gall stones are most common?

A

Mixed gall stones. Cholesterol and bilirubinbut pure sones do occur

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14
Q

What can predispose to gall stones?

A

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

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15
Q

What are some of the consequences of gall stones?

A

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

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16
Q

How is acute choecystitis treated?

A

Antibiotics

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

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17
Q

What is Mucolcele as a consequence of gallstones?

A

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

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18
Q

What is gallstone ileus?

A

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

19
Q

How does gall stones cause pancreatitis?

A

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

20
Q

What are the consequences fo acute cholecystitis?

A 
Gall stones obstruct bile outflow.
Initially sterile but becomes infected,
May cause empyema, rupture and peritonitis
Causes adhesions within 2-3 days.
ACUTE: neutrophils
21
Q

What are happens in chronic cholceystitis?

A

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

22
Q

What type f cancer is found in the gall bladder?

A

Adenocarcinoma

23
Q

What is cancer of the gall bladder associated with?

A

Gall stones

24
Q

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

A

Painless obstructive jaundice
Local liver invastion.
Poor prognosis

25
Q

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

A

Cholangiocarcinoma (Klatskin tumour)

Adenocarcinoma

26
Q

What is cholangiocarcinoma associated with and how does it present?

A

UC and primary sclerosisng cholangitis.

Obstructive jaundice

27
Q

Pancreatitis can be acute or chronic. Can they overlap?

A

Yes- due to infective or neoplastic disease.

28
Q

What are the symptoms of acute pancreatitis?

A

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

29
Q

What is a very good blood test for acute pancretitis?

A

Serum amylase. If elevated it strongly suggests pancreatis

30
Q

What causes acute pancreatitis?

A 
I-idiopathic
G- Gallstones
E-Ethanol
T-trauma
Shock, mumps, hyperpathathyroidism, hypothermia, post ERCP
31
Q

What is the pathogenesis of acute pancreatits?

A

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

32
Q

What is the surgical hallmark of acute pancreatitis?

A

Fat necrosis

33
Q

What is a pancreatic pseudocyst?

A

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

34
Q

What are the complications of acute pancreatitis?

A

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

35
Q

If someones pancreas is removed how do they gain energy?

A

PN nutrition.

Insulin ejected for blood sugar

36
Q

When does chronic pancreatitis occur?

A

After lots of acute pancreatitis

Insidiously

37
Q

What are the causes of chronic pancreatitis?

A 
Alcohol
Cholelithiasis
Cystic Fibrosis
Hyperthyroidism
Familial (rare)
38
Q

What is the pathology of chronic pancreatits

A

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

39
Q

What type of cancer is pancreatic cancer?

A

Adenocarcinoma

40
Q

What causes carcinoma of the pancreas?

A

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

41
Q

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

A

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

42
Q

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

A

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

43
Q

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

A

Metastasis can easily spread to the liver

GI (48 decks)

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