Pathology of the Biliary Tract and Pancreas Flashcards
What does Cholelithiasis mean?
Gall stones
What are gall stones?
hard stone-like or gravel-like material formed within the biliary system most commonly the gallbladder
What is normal bile made up of?
cholesterol
phospholipid
bile salts
bilirubin
When do cholesterol gallstones form?
when there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation
Free crystalisation of cholesterol on micelle surface
What are the predisposing factors of gallstones?
female
obesity
diabetes
genetic
Describe pigment stones?
Excess bilirubin cannot be solubilised in bile salts
What can cause gallstones?
Acute Cholecystitis Chronic Cholecystitis Mucocoele Empyema Carcinoma Ascending Cholangitis Obstructive Jaundice Gallstone Ileus Acute Pancreatitis Chronic Pancreatitis
What is Cholecystitis?
inflammation of the gallbladder - usually associated with gallstones
Describe Acute Cholecystitis?
Gallstones obstructing outflow of bile
Initially sterile, then becomes infected
May cause empyema, rupture, peritonitis
Causes intense adhesions within 2-3 days
Describe Chronic Cholecystitis?
Associated with Gallstones
May develop insidiously or after bouts of acute cholecystitis
Galbladder wall is thickened (due to fibrosis) but not distended
What are the characteristics of gallbladder carcinoma?
Rare Adenocarcinoma Associated with gallstones Local invasion of liver Poor prognosis
What are the characteristics of Cholangiocarcinoma?
Rare
Associated with Ulcerative Colitis and Primary Sclerosing Cholangitis
Presents with obstructive jaundice
Adenocarcinoma
What is a Klatskin tumour?
Cholangiocarcinoma at the bifurcation of the hepatic duct
What is elevated in acute pancreatitis?
serum amylase
What are the causes of acute pancreatitis?
I:idiopathic G:gallstones E:ethanol (alcohol) T:trauma S:steroids M:mumps(and other infections) / malignancy A:autoimmune S:scorpion stings/spider bites H:hyperlipidaemia/hypercalcaemia/hyperparathyroidism (metabolic disorders) E:ERCP D:drugs
Of tha acroynm - IGETSMASHED - which causes are for acute?
G:gallstones
E:ethanol (alcohol)
T:trauma
What can cause pancreatic duct epithelial injury?
Bile reflux
duct obstruction due to stone
damage to sphincter of Oddi
What does loss of the pancreatic protective barrier cause?
autodigestion of pancreatic acini
What do pancreatic lipases do to the pancreas?
Intra- and peripancreatic fat necrosis
What do pancreatic proteases do to the pancreas?
Tissue destruction and haemorrhage
What are some consequences of acute pancreatitis?
Death Shock Pseudocyst formation Abscess formation Hypocalcemia Hyperglycemia
How may chronic pancreatitis develop?
develop insidiously
following bouts of acute pancreatitis
What is the pathology of chronic pancreatitis?
Replacement of pancreas by chronic inflammation and scar tissue
Destruction of exocrine acini and islets
Is the cause of pancreatic cancer known?
NO
How is pancreatic cancer spread?
- Direct spread to other organs eg duodenum, stomach, spleen
- Spread to local lymph nodes
- Haematogenous spread to liver
