Pathology of the Biliary System

Question 1

Pathway of the biliary ducts

Answer 1

Right and left hepatic ducts

hepatic duct

Cystic duct joins

Common bile duct

Pancreatic duct joins

Question 2

Types of gall stones

Answer 2

Cholesterol
Bile
Mixed

Question 3

Bile

Answer 3

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

Question 4

Lithogenic (stone forming) bile

Answer 4

Disturbance of balance results in 
Lithogenic stone forming bile 
 Due to: 
excessive secretion of cholesterol or 
decreased secretion of bile salts

Question 5

Epidiemiology of gallstones

Answer 5

Fair
Fat
Forty
Fertile

Question 6

Will a stone in gall bladder duct or cystic duct lead to jaundice

Answer 6

No

Question 7

Will a stone in common hepatic duct or bile duct lead to jaundice?

Answer 7

yes

Question 8

Acute cholecystitis presentation

Answer 8

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

Question 9

Acute cholecystitis is initiation by

Answer 9

supersaturdation of bile and chemical irritation leading to sone formation

Question 10

Chronic cholecystitis

Answer 10

• sequelel to repeated attaks of acute cholecystitis
• Gallstones virtually always present
• inflammation secondary to chemical damage (supersaturated bile) rather than bacterial infection

Question 11

Mucocoele of gallbladder

Answer 11

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

Question 12

Gallstone illeus

Answer 12

“fistula between gallbladder and DD”

Gallstone obstructs the ileum

Question 13

Gallbladder carcinoma

Answer 13

rare
gallstone present in 80% of cases
-usually adenomacrcinoma
-late presentation (no jaundice)

Question 14

islets of langerhand cells

Answer 14

alpha- glucagon
B- insulin
Delta- somatostatis
F- pancreatic polypeptide

Question 15

Two types of cells in the pancreas

Answer 15

Exocrine
- digestive enymes and HCO3

Endocrine
-islets of langerhan

Question 16

Acute Pancreatitis causes

Answer 16

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

Question 17

Acute pancreatitis presentation

Answer 17

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

Question 18

Acute pancreatitis pathophysiology

Answer 18

Digestive enzymes leak out and autodigest

“pass gallstone, sticks at the ampulla of water, reflux of bile - acute pancreatitis”

Question 19

Chronic pancreatitis

Answer 19

80% alcohol abuse
Prolonged wine dring (not binge drinking)
Can be hereditary (usually pain on leaning forward)

Question 20

Complications of acute pancreatitis

Answer 20

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

Question 21

Pathophysiology of chronic pancreatitis

Answer 21

pathophysiology similar to acute but with permanent impairment of function

Question 22

Cystic fibrosis

Answer 22

Autosoma recessive (1in 20) 
thick mucus secretion 

Problems with lungs (bronchiecasis), gut (meconium ileus) and pancreas (exocrine and endocrine failure), infertility (agenesis vas deferens)

Question 23

Carcinoma of the pancreas

Answer 23

5% cancer deaths
66% in head of pancreas
-ductal adenocarcinoma
Life expectancy

Question 24

Whipples resecion

Answer 24

Operation for the head of the pancres
Present with jaundice as common bile duct is obstructed
-back pain

Question 25

Carcinoma of ampulla of vater

Answer 25

presents when smaller than carcinoma of pancreas

• jaundice as in common bile duct
• 25% 5 yr following whipples

Question 26

Mucinous cystadenoma

Answer 26

Mucin filled benign cystic lesion of the pancreas

Question 27

Pancreatic endocrine tumours

Answer 27

rare- secrete hormones (functional)
Causes hypoglycaemia - psychosis
90% of insulinoma are benign
malignant endocrine tumous have prognosis that carcinoma