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GI > Pathology of the biliary tract and pancreas > Flashcards

Pathology of the biliary tract and pancreas Flashcards

1
Q

What liver function test results are usual for post hepatic obstruction?

A

Raised alkaline phosphatase

only modest elevation of transferases

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2
Q

What are important causes of occlusion of the bile duct?

A

Gallstones- commonest
Strictures e.g. following previous biliary surgery
Tumours- carcinoma of the extrahepatic bile duct or head of the pancreas

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3
Q

What causes gallstones?

A

Calculi migrating from the gall bladder to obstruct the common bile duct

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4
Q

What is cholangitis?

A

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.

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5
Q

What is ascending cholangitis?

A

The propagation of biliary infection proximally into the intrahepatic ducts, which can lead to the formation of liver abscesses.

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6
Q

Why are dilated intrahepatic ducts detected by ultrasound scan a contraindication to diagnostic liver biopsy in the jaundiced patient?

A

A risk of biliary leakage

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7
Q

What is cholelithiasis?

A

Gallstone formation within the biliary system

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8
Q

What are risk factors for cholesterol rich stones?

A

Female gender and obestiy

Fat, fair, forty, fertile, female

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9
Q

What can gallstones consist of?

A

Pure cholesterol- yellow, opalescent
Bile pigment- small black
Mixed stones

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10
Q

Why do gallstones form?

A

When there is an imbalance of the constituents of bile, which results in precipitation.

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11
Q

What are the pathological effects of gallstones?

A

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

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12
Q

What is the pathogenesis of pigment stones?

A

Excess bilirubin which cannot be solubilised in bile salts

Could be due to excess haemolysis e.g. haemolytic anaemia

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13
Q

What may be contributory factors to gallstone pathogenesis?

A

Gallbladder pH and mucosal glycoproteins

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14
Q

How can gallstones trigger pancreatitis?

A

By damaging the sphincter off odd which can allow a reflux of duodenal contents up into the pancreas

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15
Q

What is cholecystitis?

What is it almost always associated with?

A

Inflammation of the gallbladder
Gallstones
Can be acute or chronic

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16
Q

What does acute cholecystitis cause?

A

It can cause empyema, rupture and peritonitis

causes intense adhesions in 2-3 days

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17
Q

What is chronic cholecystitis?

A

Associated with Gallstones

May develop insidiously or after bouts of acute cholecystitis

Galbladder wall is thickened but not distended (Cardinal feature)

18
Q

What is carcinoma of the gallbladder?

A 
Rare
Adenocarcinoma
Associated with gallstones
Local invasion of liver
Poor prognosis
19
Q

What is cholangiocarcinoma associated with?

A

Ulcerative Colitis and Primary Sclerosing Cholangitis

20
Q

How does a patient with cholangiocarcinoma present?

A

with obstructive jaundice

21
Q

What type of cancer is cholangiocarcinoma?

A

Adenocarcinoma

22
Q

What is pancreatitis?

A

Inflammation of the pancreas- may be acute or chronic

Overlap exists between acute and chronic

23
Q

Is severe acute pancreatitis a medical emergency?

A

Yes

24
Q

How does severe acute pancreatitis present?

A

Sudden onset of severe abdominal pain often radiating to the back
Nausea
Vomiting
Patient may go into shock with renal and respiratory failure

25
Q

What is biochemical marker associated with severe acute pancreatitis?

A

Raised serum amylase

26
Q

What are most cases of acute pancreatitis related to?

A

Alcohol or gallstones

27
Q

What are other causes of acute pancreatitis?

A 
Vascular insufficiency (e.g. shock)
certain infections, e.g. mumps
hyperthyroidism
hyperlipidaemia
hypothermia
trauma
iatrogenic factors e.g. after ERCP or an operation
certain drugs
28
Q

What is the pathogenesis of acute pancreatitis?

A

Bile reflux, duct obstruction due to stone and damage to sphincter of Oddi all cause pancreatic duct epithelial injury

Loss of protective barrier allows autodigestion of pancreatic acini
Release of lytic pancreatic enzymes proteases and lipases
Intra- and peripancreatic fat necrosis (lipases)
Tissue destruction and haemorrhage (proteases)

29
Q

What is a cardinal histological sign of pancreatitis?

A

Fat necrosis

30
Q

What is Grey turner’s sign?

What causes it?

A

Skin discolouration on the flanks
The lipolytic enzymes cause fat necrosis which can be extensive if it involves the anterior abdominal wall it can cause skin discolouration.

31
Q

What are complications of acute pancreatitis?

A 
Death
Shock
Pseudocyst formation 
Abscess formation
Hypocalcemia
Hyperglycemia
32
Q

What are pseudocysts?

A

Cysts without epithelial lining

33
Q

What happens in chronic pancreatitis?

A

There is continuing inflammatory process with exocrine atrophy and replacement of pancreatic tissue with fibrosis

34
Q

What is the commonest cause of chronic pancreatitis?

A

Chronic alcohol excess

35
Q

What are other causes of chronic pancreatitis?

A 
Conditions obstructing the pancreatic duct:
pancreatic divisum
inflammatory strictures
tumours
cholelithiasis

cystic fibrosis
hyperparathyroidism

Hereditary pancreatitis (defect in the trypsinogen gene)
tropical calculus pancreatitis related to malnutrition
Autoimmune pancreatitis

36
Q

What is the commonest carcinoma of the pancreas?

A

Ductal adenocarcinoma

37
Q

What is the most important risk factor for pancreatic carcinoma?

A

Smoking

38
Q

What is the prognosis for pancreatic carcinoma?

A

Very poor

39
Q

What are symptoms of pancreatic carcinoma?

A

Symptoms occur at a late stage

They include weight loss and obstructive jaundice

40
Q

Metastatic spread of pancreatic cancer to which organ is common?

A

The liver

GI (59 decks)

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