Biliary and Pancreatic Pathology

Question 1

Where is bile produced?

Answer 1

Bile is produced by hepatocytes.

Question 2

Where is bile stored?

Answer 2

In the gallbladder.

Question 3

What stimulates bile release into the bowel?

Answer 3

Eating stimulates CCK and other factors, leading to bile release.

Question 4

How much bile is reabsorbed in the terminal ileum?

Answer 4

Over 95%.

Question 5

Name the primary bile acids.

Answer 5

Cholic acid and chenodeoxycholic acid.

Question 6

What are the secondary bile acids?

Answer 6

Deoxycholic acid and lithocholic acid.

Question 7

What are bile acids conjugated with?

Answer 7

Glycine and taurine.

Question 8

Besides bile acids, name three other components of bile.

Answer 8

Cholesterol, phosphatidylcholine, and bilirubin.

Question 9

What is bile’s role in fat absorption?

Answer 9

Emulsifies dietary fat to aid absorption.

Question 10

What waste products are eliminated via bile?

Answer 10

Excess cholesterol, bilirubin, and non-water-soluble xenobiotics.

Question 11

Name three signaling functions of bile.

Answer 11

Activates MAPK pathway, acts as ligand for TGR5 receptor, activates hormone receptors like FXRα.

Question 12

Name four pre-hepatic causes of jaundice.

Answer 12

Haemolysis, resorption from bleed, Gilbert syndrome, ineffective erythropoiesis.

Question 13

Give four hepatic causes of jaundice.

Answer 13

Liver disease (e.g., cirrhosis, hepatitis, PBC), drugs, toxins, cancer.

Question 14

List four post-hepatic causes of jaundice.

Answer 14

Gallstones, pancreatic cancer, cholangiocarcinoma (CCA), strictures, biliary atresia.

Question 15

Which condition causes both pre- and post-hepatic jaundice?

Answer 15

Primary sclerosing cholangitis (PSC).

Question 16

What does the gallbladder do to bile?

Answer 16

Concentrates bile 5-10 fold.

Question 17

Name three types of gallstones.

Answer 17

Cholesterol stones, pigment stones, mixed stones.

Question 18

What percentage of chronic cholecystitis cases have stones?

Answer 18

90%.

Question 19

What is a mucocoele?

Answer 19

A distended, mucus-filled gallbladder.

Question 20

Who is at risk of gallstones? Name 5 factors.

Answer 20

Chronic haemolysis, lithogenic bile, infection/inflammation, rapid weight loss, bile stasis (pregnancy, TPN, spinal injuries).

Question 21

What is the most common symptom status of gallstones?

Answer 21

Over 80% are silent.

Question 22

List 4 complications of gallstones in the gallbladder or cystic duct.

Answer 22

Acute cholecystitis, mucocoele, empyema, perforation.

Question 23

Name 3 complications of gallstones in the common bile duct.

Answer 23

Obstruction, cholangitis, gallstone ileus.

Question 24

Are gallbladder and bile duct cancers common or rare?

Answer 24

Rare.

Question 25

Name 3 imaging methods used to investigate bile duct cancer.

Answer 25

Ultrasound, CT, MRCP.

Question 26

What is the 5-year survival rate of bile duct cancer?

Answer 26

Less than 1%.

Question 27

Name 3 digestive enzymes produced by the exocrine pancreas.

Answer 27

Trypsin, lipases, amylase.

Question 28

What are the endocrine hormones of the pancreas?

Answer 28

Insulin and glucagon.

Question 29

Name 4 congenital anomalies of the pancreas.

Answer 29

Agenesis, divisum, annular pancreas, heterotopic pancreas.

Question 30

What are the two main forms of pancreatitis?

Answer 30

Acute and chronic pancreatitis.

Question 31

Name 5 causes of acute pancreatitis.

Answer 31

Gallstones, alcohol, trauma/ERCP, viral infections (mumps), drug

Question 32

What electrolyte abnormality occurs in acute pancreatitis?

Answer 32

Hypocalcaemia (due to fat sequestration).

Question 33

What enzyme is raised in acute pancreatitis?

Answer 33

Serum amylase.

Question 34

Name 4 complications of acute pancreatitis.

Answer 34

Shock, DIC, renal failure, ARDS.

Question 35

What is the most common cause of chronic pancreatitis?

Answer 35

Alcohol.

Question 36

List 4 other causes of chronic pancreatitis.

Answer 36

Biliary tract disease, hypercalcaemia, hyperlipidaemia, cystic fibrosis.

Question 37

Name 3 outcomes of chronic pancreatitis.

Answer 37

Steatorrhoea, diabetes, pseudocysts.

Question 38

What is the most common type of pancreatic cancer?

Answer 38

Adenocarcinoma.

Question 39

Where are most pancreatic adenocarcinomas located?

Answer 39

60% in the head of the pancreas.

Question 40

What sign is associated with pancreatic cancer?

Answer 40

Trousseau’s sign (migratory thrombophlebitis).

Question 41

Name 4 endocrine tumours of the pancreas.

Answer 41

Insulinoma, gastrinoma, glucagonoma, VIPoma.

Question 42

What syndrome is associated with gastrinoma?

Answer 42

Zollinger-Ellison syndrome.

Question 43

What are the symptoms of a VIPoma?

Answer 43

Watery diarrhoea, hypokalaemia, achlorhydria.