Pathology of the Biliary System Flashcards
Pathway of the biliary ducts
Right and left hepatic ducts
hepatic duct
Cystic duct joins
Common bile duct
Pancreatic duct joins
Types of gall stones
Cholesterol
Bile
Mixed
Bile
97% water
500 mls secreted every day
Cholesterol is secreted in bile and is not water soluble. Kept in solution by micelles containing bile acids and phospholipids
Colour of bile is caused by the bile pigment, bilirubin which is a breakdown product of haemoglobin
Lithogenic (stone forming) bile
Disturbance of balance results in Lithogenic stone forming bile Due to: excessive secretion of cholesterol or decreased secretion of bile salts
Epidiemiology of gallstones
Fair
Fat
Forty
Fertile
Will a stone in gall bladder duct or cystic duct lead to jaundice
No
Will a stone in common hepatic duct or bile duct lead to jaundice?
yes
Acute cholecystitis presentation
1/3 pts - severe right upper quadrant pain, tenderness and fever
Leucocytosis and normal serum amylase (diff pancreatisits)
Usually resolves spontaneously but can progress to empyema, gangrene and rupture
Acute cholecystitis is initiation by
supersaturdation of bile and chemical irritation leading to sone formation
Chronic cholecystitis
- sequelel to repeated attaks of acute cholecystitis
- Gallstones virtually always present
- inflammation secondary to chemical damage (supersaturated bile) rather than bacterial infection
Mucocoele of gallbladder
Mucocoele - a space or organ distended with mucus
- exit duct becomes obstructed so that mucus secretions are retained and dilates the cavity of the gallbladder
- stuck in hartmans pouch
Gallstone illeus
“fistula between gallbladder and DD”
Gallstone obstructs the ileum
Gallbladder carcinoma
rare
gallstone present in 80% of cases
-usually adenomacrcinoma
-late presentation (no jaundice)
islets of langerhand cells
alpha- glucagon
B- insulin
Delta- somatostatis
F- pancreatic polypeptide
Two types of cells in the pancreas
Exocrine
- digestive enymes and HCO3
Endocrine
-islets of langerhan
Acute Pancreatitis causes
Inflammation of the pancreas due to:
30% secondary to gallstones
50% secondary to alchol abus
20% other cuases including (post ERCP, hypercalcaemia, drugs (aothiprine), mumps
Acute pancreatitis presentation
Sever upper abdominal pain radiating to back
Fever, leucocytosis and raised serum amylase
(GET SMASHED) Gallstones Ethanol Trauma Shock Mumos Autoimmune Scorpian bites Hyperlipidaemia ERCP Drugs
Acute pancreatitis pathophysiology
Digestive enzymes leak out and autodigest
“pass gallstone, sticks at the ampulla of water, reflux of bile - acute pancreatitis”
Chronic pancreatitis
80% alcohol abuse
Prolonged wine dring (not binge drinking)
Can be hereditary (usually pain on leaning forward)
Complications of acute pancreatitis
Severe - necrosis and gangrene
Local effect
- pancreatic psuedocyst (no epithelial lining, collection of pancreatic juice, anteriorly into the lesser sack)
- Abscess - infected pancreas, no blood supply therfore no defence mounted
Pathophysiology of chronic pancreatitis
pathophysiology similar to acute but with permanent impairment of function
Cystic fibrosis
Autosoma recessive (1in 20) thick mucus secretion
Problems with lungs (bronchiecasis), gut (meconium ileus) and pancreas (exocrine and endocrine failure), infertility (agenesis vas deferens)
Carcinoma of the pancreas
5% cancer deaths
66% in head of pancreas
-ductal adenocarcinoma
Life expectancy
Whipples resecion
Operation for the head of the pancres
Present with jaundice as common bile duct is obstructed
-back pain
Carcinoma of ampulla of vater
presents when smaller than carcinoma of pancreas
- jaundice as in common bile duct
- 25% 5 yr following whipples
Mucinous cystadenoma
Mucin filled benign cystic lesion of the pancreas
Pancreatic endocrine tumours
rare- secrete hormones (functional)
Causes hypoglycaemia - psychosis
90% of insulinoma are benign
malignant endocrine tumous have prognosis that carcinoma
