Pathology of the Biliary Tract and Pancreas

Question 1

What does Cholelithiasis mean?

Answer 1

Gall stones

Question 2

What are gall stones?

Answer 2

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

Question 3

What is normal bile made up of?

Answer 3

cholesterol
phospholipid
bile salts
bilirubin

Question 4

When do cholesterol gallstones form?

Answer 4

when there is an imbalance between the ratio of cholesterol to bile salts disrupting micelle formation
Free crystalisation of cholesterol on micelle surface

Question 5

What are the predisposing factors of gallstones?

Answer 5

female
obesity
diabetes
genetic

Question 6

Describe pigment stones?

Answer 6

Excess bilirubin cannot be solubilised in bile salts

Question 7

What can cause gallstones?

Answer 7

Acute Cholecystitis
Chronic Cholecystitis
Mucocoele
Empyema
Carcinoma
Ascending Cholangitis
Obstructive Jaundice
Gallstone Ileus
Acute Pancreatitis
Chronic Pancreatitis

Question 8

What is Cholecystitis?

Answer 8

inflammation of the gallbladder - usually associated with gallstones

Question 9

Describe Acute Cholecystitis?

Answer 9

Gallstones obstructing outflow of bile
Initially sterile, then becomes infected
May cause empyema, rupture, peritonitis
Causes intense adhesions within 2-3 days

Question 10

Describe Chronic Cholecystitis?

Answer 10

Associated with Gallstones
May develop insidiously or after bouts of acute cholecystitis
Galbladder wall is thickened (due to fibrosis) but not distended

Question 11

What are the characteristics of gallbladder carcinoma?

Answer 11

Rare
Adenocarcinoma
Associated with gallstones
Local invasion of liver
Poor prognosis

Question 12

What are the characteristics of Cholangiocarcinoma?

Answer 12

Rare
Associated with Ulcerative Colitis and Primary Sclerosing Cholangitis
Presents with obstructive jaundice
Adenocarcinoma

Question 13

What is a Klatskin tumour?

Answer 13

Cholangiocarcinoma at the bifurcation of the hepatic duct

Question 14

What is elevated in acute pancreatitis?

Answer 14

serum amylase

Question 15

What are the causes of acute pancreatitis?

Answer 15

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

Question 16

Of tha acroynm - IGETSMASHED - which causes are for acute?

Answer 16

G:gallstones
E:ethanol (alcohol)
T:trauma

Question 17

What can cause pancreatic duct epithelial injury?

Answer 17

Bile reflux
duct obstruction due to stone
damage to sphincter of Oddi

Question 18

What does loss of the pancreatic protective barrier cause?

Answer 18

autodigestion of pancreatic acini

Question 19

What do pancreatic lipases do to the pancreas?

Answer 19

Intra- and peripancreatic fat necrosis

Question 20

What do pancreatic proteases do to the pancreas?

Answer 20

Tissue destruction and haemorrhage

Question 21

What are some consequences of acute pancreatitis?

Answer 21

Death
Shock
Pseudocyst formation
Abscess formation
Hypocalcemia
Hyperglycemia

Question 22

How may chronic pancreatitis develop?

Answer 22

develop insidiously

following bouts of acute pancreatitis

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

Is the cause of pancreatic cancer known?

Answer 24

NO

Question 25

How is pancreatic cancer spread?

Answer 25

1. Direct spread to other organs eg duodenum, stomach, spleen
2. Spread to local lymph nodes
3. Haematogenous spread to liver