Pathology of the biliary tract and pancreas Flashcards
What are gallstones?
Defined as hard stone like or gravel like material formed within the biliary system most commonly the gallbladder
What is normal bile a mixture of?
Micelles of cholesterol, phospholipid bile salts and bilirubin
Where is bile stored and what causes it to be released?
Stored in the Gallbladder, released by CCK into the 2nd part of duodenum through common bile duct and ampulla of vater
Describe gallstones - why do they form?
Gallstones form when there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation
Describe cholesterol stones?
Free crystallisation of cholesterol on micelle surface
Describe pigment stones?
Excess bilirubin cannot be solubilised in bile salts
What are the risk factors for cholesterol stones?
Female
Obesity
Diabetes
Genetic
What are the risk factors for pigment stones?
Excess bilirubin due to excess haemolysis
haemolytic anaemias
What type of gallstones are most common?
Mixed cholesterol and pigment
What is cholecystitis?
Inflammation of the gallbladder
Usually associate with gallstones
Can be acute or chronic
What is acute cholecystitis?
Gallsontes obstructing the outflow of bile
Initially sterile, then becomes infected
May cause empyema, rupture, peritonitis
What is chronic cholecystitis?
Associated with gallstones
May develop insidiously or after bouts of acute cholecystitis
Gallbladder wall is thickened but not distended
Describe carcinoma of the gallbladder?
Rare Adenocarcinoma Associated with gallstone Local invasion of the liver Poor prognosis
Describe carcinoma of the bile ducts? (cholangiocarcinoma)
Rare
Associated with UC and PSC
Present with obstructive jaundice
Adenocarcinoma
What is pancreatitis?
Inflammation of the pancreas - can be acute or chronic
Describe acute pancreatitis?
Adults
Sudden onset of severe abdominal pain
Patients may be severely shocked
Elevated serum amylase
What might cause acute pancreatitis?
Alcohol Cholelithiasis Shock Mumps Hyperparathyroidism Hypothermia Trauma Iatrogenic (Post ERCP)
Describe acute pancreatitis pathogenesis’?
Bile reflux, duct obstruction due to stone 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)
What would you see down the microscope of acute pancreatitis?
Fat necrosis - large areas of pancreas and fat are necrotic
What are some complications of acute pancreatitis?
Death Shock Pseudocyst formation Abscess formation Hypocalcemia Hyperglycaemia
What is chronic pancreatitis?
Relapsing disorder mat develop insidiously or following bouts of acute pancreatitis
What might cause chronic pancreatitis?
Alcohol Cholelithiasis Cystic fibrosis Hyperparathroisism Familial
What is the pathology of chronic pancreatitis?
Replacement of pancreas by chronic inflammation and scar tissue
Destruction of exocrine acini and islets
Describe carcinoma of the pancreas?
Adenocarcinoma
Aetiology unkown
Associated with smoking, diabetes familial pancreatitis
Poor prognosis
