Pathology of the Biliary Tract and Pancreas Flashcards
What is cholelithiasis
Gallstones
hard stone-like or gravel like material formed within the biliary system - most commonly the gall bladder
What is in normal bile
Micelles of cholesterol, phospholipids, bile salts and bilirubin
Where is bile stored and concentrated
Gallbladder
Where is bile released into
By CCK into the 2nd part of the duodenum through the common bile duct and the ampulla of Vater
How do gallstones form
When there is an imbalance in the ratio of cholesterol to bile salts disrupting micelles formation
Leads to crystallisation of cholesterol
What are risk factors for galls tones
Cholesterol excess in bile females obesity diabetes genetics
What causes pigment stones
Excess bilirubin cannot be solubilised in bile salts
What are the risk factors for pigment stones
Excess bilirubin due to excess haemolysis eg. haemolytic anaemia
Most gallstones are a mixture
Gallstones cause __ and ___of the biliary lining
Infection and inflammation
What is cholecystitis
Inflammation of Gallbladder
Usually associated with Gallstones
Acute or chronic
What s acute cholecystitis
Gallstones obstruction outflow of bile
Initially sterile but can then become infected
What could come complications of acute cholecystitis be
May cause empyema, rupture, peritonitis
What WBC is associated with ACUTE inflammation
neutrophils
What is a main feature of chronic cholecystitis
Gallbladder wall is thickened but not distended
What carcinoma do you get in the gall bladder and how common is it
What organ does it invade
Adenocarcinoma
Rare
associated with gall stones
causes local invasion of the live r
What carcinoma do you get in the bile duct
common or rare
how does it present
Rare cholangiocarcinoma associated with UC and PSC presents with obstructive jaundice type of adenocarcinoma
How does acute pancreatitis present
Adults
Sudden onset severe and abdominal pain
Patients may be shocked
Elevated serum amylase
Causes of acute pancreatitis
Alcohol Cholelithiasis (gall stones) Shock Mumps Hyperparathyriodism Hypothermia Trauma Iatrogenic
How can gallstones cause acute pancreatitis
Bile duct obstruction
damage to spinchter of odd
causes pancreatic duct epithelial cell injury
Hoe can lytic pancreatic enzymes cause acute pancreatitis
Release into pancreas causing fat necrosis
causes tissue destruction and haemorrhage
Complications of acute pancreatitis
death shock pseudocyst formation abscess formation hypocalcemia hyperglycemia
What is chronic pancreatitis
Following bouts of acute pancreatitis
Can form a fibrosis mass mimicking a tumour at the head of the pancreas
What causes chronic pancreatitis
Alcohol Cholelirhiasis Cystic fibrosis Hyperparathyroidism Familial
Pathology of chronic pancreatitis
Replacement fo pancreas by chronic inflammation and scar tissue
distraction of exocrine acini and islets
What causes carcinoma of the pancreas
Aetiology unknown
What are pancreas carcinomas associated with
Smoking
Diabetes
Familial pancreatitis
Poor prognosis
How to treat carcinoma of the pancreas
Surgery
VERY risky
Only done on those who are very fit
How can patients with a carcinoma at the head of the pancreas present if it constricts the common bile duct
Painless jaundice
How does an adenocarcinoma of the pancreas kill you
- Direct spread to other organs eg. duodenum, stomach, spleen
- spread to local lymph notes
- haematogenous spread to liver
