Biliary Tree, Gallbladder and Pancreas Flashcards Preview

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Flashcards in Biliary Tree, Gallbladder and Pancreas Deck (35)
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1

list risk factors for cholesterol stones

  • common in Western/developed countries
  • advancing age
  • female gender
    • estrogen (OCP, pregnancy)
  • obesity
  • rapid weight reduction
  • gall bladder stasis
  • inborn error of bile salt metabolism
  • hyperlipidemima

2

list risk factors for pigment stones

  • common in Asians
  • rural > urban
  • chronic hemolysis
  • biliary infections
  • GI disorders
    • ileal diseases 
      • Crohns or ileal resection or bypass
  • CF

3

the clinical presentation of cholelithiasis is mainly ___ but can also present with ____ pain

the clinical presentation of cholelithiasis is mainly asymptomatic but can also present with colicky pain

4

list the complications of cholelithiasis

  • complications:
    • empyema
    • perforation
    • fistulas
    • cholangitis
    • pancreatitis
    • gallstone ileus
    • increased risk of carcinoma

5

describe the pathogenesis of gallstones

  • bile is supersaturated with cholesterol
  • GB hypomotility promotes nucleation (precipitation from bile into vesicles)
  • cholesterol nucleation in bile is accelerated
  • mucus hypersecretion traps the crystal, permitting aggregation into stones (acts like glue)

6

describe the pathogenesis of acute cholecystitis

  1. chemical irritation and inflammation in setting of obstruction to flow
  2. mucosal phospholipase convert lecithin to lysolecithin
  3. damage to glycoprotein layer of mucosa
  4. further release of PGs from mucosa
  5. cumulatively leads to mucosal and mural inflammation
  6. gallbladder dysmotility and increased intraluminal pressure
  7. superimposed bacterial contamination

7

describe chronic cholecystitis

  • sequel of repeated acute cholecystitis
  • rarely extensive dystrophic calcification aka porcelain gallbladder (increased association with cancer)

8

in chronic cholecystitis, there could be extensive dystrophic calcification aka ____ which has an increased association with ___

in chronic cholecystitis, there could be extensive dystrophic calcification aka porcelain gallbladder which has an increased association with cancer

9

10

describe carcinoma of the gallbladder

  • most common in 7th decade of life
  • slightly more -common in females
  • gallstones in 60-90% of patients
  • other risk factors:
    • pyogenic and parasitic infections of the biliary tract
  • carcinogenic derivatives of bile may play a role
  • mostly adenocarcinoma
  • most have invaded or spread to liver at diagnosis

11

other risk factors for carcinoma of the gallbladder include ___ and ___ infections of the biliary tract

other risk factors for carcinoma of the gallbladder include pyogenic and parasitic infections of the biliary tract

12

describe the image

gallbladder adenocarcinoma

malignant glands are seen infiltrating a densely fibrotic gallbladder wall

13

the most common causes of pancreatic insufficiency are ___ and ____

the most common causes of pancreatic insufficiency are pancreatitis and CF

14

describe exocrine dysfunction seen in pancreatic insufficiency

  • exocrine dysfunction
    • fat malabsorption (steatorrhea)
      • lipolytic activity decreases faster than proteolysis
      • loose greasy foul-smelling stool
      • fat-soluble vitamins (ADEK and B12) not absorbed

15

describe endocrine dysfunction seen in pancreatic insufficiency

  • endocrine dysfunction
    • glucose intolerance, diabetes mellitus

16

80% of acute pancreatitis cases are associated with ___ and ___

80% of acute pancreatitis cases are associated with gallstones and alcohol

17

list the clinical features of acute pancreatitis

  • leukocytosis
  • DIC
  • hemolysis
  • peripheral vascular collapse
  • shock with acute tubular necrosis (ATN), ARDS
  • hypocalcemia, tetany
  • raised amylase levels in first 24 hours
  • followed by lipase within 72-96 hours

18

in acute pancreatitis, ___ levels are increased in the first ____ hours, followed by ___ levels within ____ hours

in acute pancreatitis, amylase levels are increased in the first 24 hours, followed by lipase levels within 72-96 hours

19

 list the 3 possible complications of acute pancreatitis

  • ARDS
  • acute tubular necrosis (ATN)
  • pancreatic abscess

20

describe the image

21

chronic pancreatitis is caused by repeated bouts of mild to moderate pancreatic inflammation with loss of ____ and replacement by ____

chronic pancreatitis is caused by repeated bouts of mild to moderate pancreatic inflammation with loss of pancreatic parenchyma and replacement by fibrous tissue

22

describe the image

chronic pancreatitis

extensive fibrosis and atrophy has left only residual islets (left) and ducts (right) with a sprinkling of chronic inflammatory cells and a few islands of acinar tissue

23

list the stroma-rich vs. stroma-poor pancreatic tumors

  • solid, stroma-rich
    • ductal adenocarcinoma
  • solid, stroma-poor
    • neuroendocrine tumors (islet cell tumors)
    • acinar cell carcinoma
    • solid pseudopapillary tumor
    • pancreatoblastoma

24

describe pancreatic adenocarcinoma

25

pancreatic adenocarcinoma is associated with ____ sign (migratory ____)

explain this 

pancreatic adenocarcinoma is associated with Trousseau's sign (migratory thrombophlebitis)

  • release of platelet activating factors and procoagulants from tumor

26

there is no single specific marker for pancreatic adenocarcinoma, but sometimes there is raised ____

there is no single specific marker for pancreatic adenocarcinoma, but sometimes there is raised CA 19-9

27

____ is the usually the first symptom of pancreatic adenocarcinoma (because of invasion of _____)

pain is the usually the first symptom of pancreatic adenocarcinoma (because of invasion of the posterior abdominal wall and nerves)

28

describe pancreatic neuoendocrine tumors (NET)

29

describe insulinoma

pancreatic neuroendocrine tumor

  • arise from B-cells
    • hypoglycemia
    • accentuated by fasting, relieved with intake of glucose
  • clinically may manifest as Whipple triad
    • low blood glucose
    • presence of symptoms
    • resolution with the blood glucose is normalized
  • insulin levels are increased

30

describe Whipple triad and what it is seen in

seen in insulinomas

  • low blood glucose
  • presence of symptoms
  • resolution when the blood glucose is normalized