Pathology of the biliary tract and pancreas

Question 1

What are gallstones?

Answer 1

Defined as hard stone like or gravel like material formed within the biliary system most commonly the gallbladder

Question 2

What is normal bile a mixture of?

Answer 2

Micelles of cholesterol, phospholipid bile salts and bilirubin

Question 3

Where is bile stored and what causes it to be released?

Answer 3

Stored in the Gallbladder, released by CCK into the 2nd part of duodenum through common bile duct and ampulla of vater

Question 4

Describe gallstones - why do they form?

Answer 4

Gallstones form when there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation

Question 5

Describe cholesterol stones?

Answer 5

Free crystallisation of cholesterol on micelle surface

Question 6

Describe pigment stones?

Answer 6

Excess bilirubin cannot be solubilised in bile salts

Question 7

What are the risk factors for cholesterol stones?

Answer 7

Female
Obesity
Diabetes
Genetic

Question 8

What are the risk factors for pigment stones?

Answer 8

Excess bilirubin due to excess haemolysis

haemolytic anaemias

Question 9

What type of gallstones are most common?

Answer 9

Mixed cholesterol and pigment

Question 10

What is cholecystitis?

Answer 10

Inflammation of the gallbladder
Usually associate with gallstones
Can be acute or chronic

Question 11

What is acute cholecystitis?

Answer 11

Gallsontes obstructing the outflow of bile
Initially sterile, then becomes infected

May cause empyema, rupture, peritonitis

Question 12

What is chronic cholecystitis?

Answer 12

Associated with gallstones
May develop insidiously or after bouts of acute cholecystitis

Gallbladder wall is thickened but not distended

Question 13

Describe carcinoma of the gallbladder?

Answer 13

Rare
Adenocarcinoma 
Associated with gallstone 
Local invasion of the liver 
Poor prognosis

Question 14

Describe carcinoma of the bile ducts? (cholangiocarcinoma)

Answer 14

Rare
Associated with UC and PSC
Present with obstructive jaundice
Adenocarcinoma

Question 15

What is pancreatitis?

Answer 15

Inflammation of the pancreas - can be acute or chronic

Question 16

Describe acute pancreatitis?

Answer 16

Adults
Sudden onset of severe abdominal pain
Patients may be severely shocked
Elevated serum amylase

Question 17

What might cause acute pancreatitis?

Answer 17

Alcohol 
Cholelithiasis 
Shock 
Mumps
Hyperparathyroidism 
Hypothermia
Trauma 
Iatrogenic (Post ERCP)

Question 18

Describe acute pancreatitis pathogenesis’?

Answer 18

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)

Question 19

What would you see down the microscope of acute pancreatitis?

Answer 19

Fat necrosis - large areas of pancreas and fat are necrotic

Question 20

What are some complications of acute pancreatitis?

Answer 20

Death
Shock
Pseudocyst formation 
Abscess formation 
Hypocalcemia 
Hyperglycaemia

Question 21

What is chronic pancreatitis?

Answer 21

Relapsing disorder mat develop insidiously or following bouts of acute pancreatitis

Question 22

What might cause chronic pancreatitis?

Answer 22

Alcohol 
Cholelithiasis
Cystic fibrosis 
Hyperparathroisism 
Familial

Question 23

What is the pathology of chronic pancreatitis?

Answer 23

Replacement of pancreas by chronic inflammation and scar tissue

Destruction of exocrine acini and islets

Question 24

Describe carcinoma of the pancreas?

Answer 24

Adenocarcinoma
Aetiology unkown
Associated with smoking, diabetes familial pancreatitis
Poor prognosis