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GI > Pathology of the Biliary Tree and Pancreas > Flashcards

Pathology of the Biliary Tree and Pancreas Flashcards

1
Q

What 4 components make up the micelles found in normal bile?

A

Cholesterol
Phospholipid
bile salts
bilirubin

the four of these join together to form spherical shaped lipid molecules (micelles)

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2
Q

Where is bile normally stored and how is it released into the duodenum?

A
  • Stored and concentrated in Gall Bladder
  • Released by Cholecystokinin (CCK)
  • flows through common bile duct and Ampulla of Vater into 2nd part of duodenum
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3
Q

What causes cholesterol gallstones to form?

A
  • an imbalance between the ratio of cholesterol to bile salts
    => disrupting micelle formation
    => cholesterol crystallises on the micelle surface
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4
Q

What puts patients at risk of high cholesterol and cholesterol gallstone formation?

A
  • female
  • obesity
  • diabetes
  • genetic
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5
Q

How do cholesterol gallstones and pigment gallstones differ in appearance?

A

Cholesterol stones = Pale and larger in size

Pigment stones = dark and smaller

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6
Q

When do pigment gallstones occur?

A
  • When there is excess bilirubin present that cant be dissolved in bile salts
  • e.g. in haemolytic anaemias or conditions where excess haemolysis takes place
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7
Q

Most gallstones are a mixture of cholesterol and pigment. TRUE/FALSE?

A

TRUE

  • Pure cholesterol and pure pigment stones do occur though
  • Calcium carbonate stones also occur < 10%
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8
Q

Gallstones can cause a variety of complications. Give examples of these.

A

IN GALL BLADDER

  • Acute/Chronic Cholecystitis
  • Mucocoele
  • Carcinoma

IN LIVER
- Ascending Cholangitis

IN BILE DUCTS

  • Obstructive Jaundice
  • Gallstone Ileus

IN PANCREAS
- Acute/Chronic Pancreatitis

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9
Q

What happens in acute cholecystitis?

A
  • Gallstones obstruct outflow of bile
  • Initially sterile, then becomes infected
  • May cause empyema, rupture, peritonitis
  • Causes intense adhesions within 2-3 days
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10
Q

How does acute cholecystitis appear on histology?

A
  • Acute inflammation indicated by neutrophils
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11
Q

What happens in chronic cholecystitis? How does this look on histology?

A
  • Galbladder wall is thickened but not distended

- Chronic inflammation and Rokitansky-Aschoff sinuses

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12
Q

What type of carcinoma can gallstones cause to occur in the gallbladder?

A

Adenocarcinoma

  • Usually has local invasion of liver
  • Poor prognosis
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13
Q

What is cholangiocarcinoma and what conditions is this associated with?

A
  • Rare cancer of the BILE DUCTS

- Associated with UC and PSC

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14
Q

How does cholangiocarcinoma usually present?

A
  • obstructive jaundice
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15
Q

HOw does cholangiocarcinoma look on histology?

A
  • Densely packed small glands (as its an adenocarcinoma)

- in a fibrous stroma

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16
Q

How do patients usually present with acute pancreatitis?

A
  • Adults
  • Sudden onset severe abdominal pain
  • Patients may be severely shocked
  • Elevated serum amylase
17
Q

What are the main causes of pancreatitis?

A

Acronym GET SMASHED

Gallstones
Ethanol (alcohol)
Trauma

Shock
Mumps
Autoimmune
Scorpion 
Hyperparathyroid
ERCP
Drugs (e.g. steroids)
18
Q

How is pancreatitis thought to occur pathologically?

A
  • Bile reflux / duct obstruction due to stone
    => damage sphincter of Oddi
    => cause pancreatic duct epithelial injury
  • Loss of protective barrier allows autodigestion of pancreatic acini
  • Release of lytic enzymes (proteases and lipases) which break pancreas down
19
Q

How do proteases and lipases break the pancreas down?

A

Proteases cause tissue destruction and haemorrhage

Lipases cause Intra- and peripancreatic fat necrosis

20
Q

What complications can arise from acute pancreatitis?

A
  • Death
  • Shock
  • Pseudocyst formation
  • Abscess formation
  • Hypocalcemia
  • Hyperglycemia
21
Q

What is thought to cause chronic pancreatitis?

A 
Alcohol
Gallstones
Cystic fibrosis
Hyperparathyroidism
Familial
22
Q

What happens to the pancreas pathologically in chronic pancreatitis?

A
  • Exocrine pancreas is replaced by chronic inflammation and fibrosis
23
Q

What type of carcinoma can be found in the pancreas?

A

Adenocarcinoma (due to presence of glands)

24
Q

Pancreatic carcinoma is associated with what other conditions?

A
  • smoking
  • diabetes
  • familial pancreatitis
25
Q

Why do patients with pancreatic cancer often present with obstructive jaundice?

A

Tumour can constrict the common bile duct

26
Q

Where can pancreatic cancer spread to by direct local invasion?

A
  • duodenum
  • spleen
  • stomach
27
Q

HOw does pancreatic carcinoma appear on histology?

A
  • Irregular abortive glands in a dense stroma
28
Q

Where does pancreatic carcinoma often spread to via the blood?

A

Liver

- causes many metastases to appear in the liver

GI (33 decks)

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