Pathology of the biliary tract and pancreas Flashcards
What liver function test results are usual for post hepatic obstruction?
Raised alkaline phosphatase
only modest elevation of transferases
What are important causes of occlusion of the bile duct?
Gallstones- commonest
Strictures e.g. following previous biliary surgery
Tumours- carcinoma of the extrahepatic bile duct or head of the pancreas
What causes gallstones?
Calculi migrating from the gall bladder to obstruct the common bile duct
What is cholangitis?
When bile stasis above the obstruction in the bile duct predisposes to infection of the biliary tract and the ducts become inflamed, and the patient develops a fever.
What is ascending cholangitis?
The propagation of biliary infection proximally into the intrahepatic ducts, which can lead to the formation of liver abscesses.
Why are dilated intrahepatic ducts detected by ultrasound scan a contraindication to diagnostic liver biopsy in the jaundiced patient?
A risk of biliary leakage
What is cholelithiasis?
Gallstone formation within the biliary system
What are risk factors for cholesterol rich stones?
Female gender and obestiy
Fat, fair, forty, fertile, female
What can gallstones consist of?
Pure cholesterol- yellow, opalescent
Bile pigment- small black
Mixed stones
Why do gallstones form?
When there is an imbalance of the constituents of bile, which results in precipitation.
What are the pathological effects of gallstones?
Inflammation of the gall bladder (cholecystitis) and its complications
Mucocele
Predisposition to carcinoma of the gall bladder
Obstruction of the biliary system, resulting in biliary colic and jaundice
Infection of static bile, causing cholangitis and liver absecesses
Gallstone ileus due to intestinal obstruction by a gallstone that has entered the gut through fistulous connection iwth the gall bladder
Pancreatitis
What is the pathogenesis of pigment stones?
Excess bilirubin which cannot be solubilised in bile salts
Could be due to excess haemolysis e.g. haemolytic anaemia
What may be contributory factors to gallstone pathogenesis?
Gallbladder pH and mucosal glycoproteins
How can gallstones trigger pancreatitis?
By damaging the sphincter off odd which can allow a reflux of duodenal contents up into the pancreas
What is cholecystitis?
What is it almost always associated with?
Inflammation of the gallbladder
Gallstones
Can be acute or chronic
What does acute cholecystitis cause?
It can cause empyema, rupture and peritonitis
causes intense adhesions in 2-3 days
What is chronic cholecystitis?
Associated with Gallstones
May develop insidiously or after bouts of acute cholecystitis
Galbladder wall is thickened but not distended (Cardinal feature)
What is carcinoma of the gallbladder?
Rare Adenocarcinoma Associated with gallstones Local invasion of liver Poor prognosis
What is cholangiocarcinoma associated with?
Ulcerative Colitis and Primary Sclerosing Cholangitis
How does a patient with cholangiocarcinoma present?
with obstructive jaundice
What type of cancer is cholangiocarcinoma?
Adenocarcinoma
What is pancreatitis?
Inflammation of the pancreas- may be acute or chronic
Overlap exists between acute and chronic
Is severe acute pancreatitis a medical emergency?
Yes
How does severe acute pancreatitis present?
Sudden onset of severe abdominal pain often radiating to the back
Nausea
Vomiting
Patient may go into shock with renal and respiratory failure
