L7: Biliary and pancreatic pathology

Question 1

in pancreatic cancer when the tumour grows it presses on

Answer 1

bile duct and side of duodenum

Question 2

what produces bile

Answer 2

hepatocytes

Question 3

where is bile stored

Answer 3

gall bladder

Question 4

when you eat what enzymes stimulates bile release into bowel

Answer 4

CCK

Question 5

where is most bile reabsorbed

Answer 5

terminal ileum

Question 6

3 main parts of bile

Answer 6

bile acids
cholesterol
bilirubin

Question 7

3 roles of bile

Answer 7

-emulsification of fats
-helps eliminate waste products
signalling molecules

Question 8

3 waste products bile helps eliminate

Answer 8

excess cholesterol
bilirubin
non-water-soluble xenobiotics

Question 9

what type of bilirubin arrives at the liver

Answer 9

uncongugated bilirubin

Question 10

what type of bilirubin does the liver release

Answer 10

conjugated bilirubin

Question 11

what type of bilirubin is reabsorbed

Answer 11

urobilinogen

Question 12

where can urobilinogen go after reabsorption

Answer 12

kidney or liver

Question 13

bilirubin secreted in bowel=

Answer 13

stercobiliogen

Question 14

chalky white poo =

Answer 14

lack of stercobilinogen

Question 15

urine goes dark

Answer 15

decreased urobiliogen (maybe increased cogugated bilirubin)

Question 16

jaundice=

Answer 16

hyperbilirubinaemia

Question 17

3 types of jaundice

Answer 17

prehepatic
hepatic
post-hepatic

Question 18

4 causes of prehepatic jaundice

Answer 18

• haemolysis
• resorption from bleed
• gilbert
• ineffective erythropoesis

Question 19

4 causes of hepatic (mixed) jaundice

Answer 19

• liver disease
• drugs
• toxins
• cancer

Question 20

4 causes of post-hepatic jaundice

Answer 20

• gallstones
• Ca pancreas
• Strictures
• Biliaryatresia

Question 21

gilberts syndrome=

Answer 21

congenital condition where uncojugated bilirubin struggles to get into the liver

Question 22

what does the gallbladder do

Answer 22

concentrates bile 5-10 x

Question 23

6 pathologies of the gallbladder

Answer 23

• cholesterolosis
• stones
• cholecystitis
• mucocoele
• carcinoma
• congenital abnormalities

Question 24

3 types of stones

Answer 24

cholesterol
pigment
mixed

Question 25

cholecystitis=

Answer 25

inflammation of gallbladder

Question 26

main cause of cholecystitis=

Answer 26

stones

Question 27

5 causes of gallstones

Answer 27

``` chronic haemolysis lithogenic bile inflammation/ infection rapid weight loss stasis ```

Question 28

main type of gallstones

Answer 28

cholesterol stones

Question 29

3 Fs of gallstones

Answer 29

fat fair forty

Question 30

ERCP=

Answer 30

endoscopic retrograde cholangiopancreatography

Question 31

5 complications of gallbladder/ cystic duct gallstones

Answer 31

-cholecystitis -mucocoele -empyema -perforation gallstone ileus

Question 32

4 complications of gallstones in common bile duct

Answer 32

- obstruction - pain - cholangitis - gallstone ileus

Question 33

main issue of gallstones in common bile duct

Answer 33

very painful

Question 34

how common are carcinoma of gallbladder/ bile duct

Answer 34

rare

Question 35

signs are symptoms of gallbladder carcinoma

Answer 35

few in early stages

Question 36

5 year survival for gallbladder carcinoma

Answer 36

<1%

Question 37

2 functions of pancreas

Answer 37

endocrine | exocrine

Question 38

exocrine pancreas-->

Answer 38

powerful digestive enzyme Trypsin, lipases and amylase

Question 39

endocrine pancreas-->

Answer 39

insulin and glucagon

Question 40

how does the pancreas develop embryonically

Answer 40

in two halves

Question 41

4 diseases of the pancreas

Answer 41

congenital anomalies acute pancreatitis chronic pancreatitis tumours

Question 42

causes of acute pancreatitis (I GET SMASHED)

Answer 42

``` idiopathic gallstones ethanol trauma scorpion sting malignancy/ mumps autoimmune steroids hyperlipidaemia/ hypercalcaemia ERCP drugs ```

Question 43

symptoms of acute pancreatitis

Answer 43

- acute abdominal pain, central, severe often radiates to back - vomiting

Question 44

patient history in acute pancreatitis

Answer 44

alcohol excess | gallstones certain drugs

Question 45

sign of acute pancreatitis

Answer 45

guarding and tenderness in upper abdomen

Question 46

consequences of acute pancreatitis (4)

Answer 46

``` abscess pseudocyst relapse diabetes death ```

Question 47

commonest cause of chronic pancreatitis

Answer 47

alcohol

Question 48

6 other causes of chronic pancreatitis

Answer 48

``` biliary tract disease hypercalcaemia hyperlipidaemia haemochromatosis cystic fibrosis idiopathic ```

Question 49

morphology of chronic pancreatitis

Answer 49

irregular gland with fibrosis, fatty infiltration, calcification

Question 50

what does the appearance of chronic pancreatitis mimic

Answer 50

carcinoma

Question 51

what part of the pancreas is relatively spared in chronic pancreatitis

Answer 51

endocrine pancreas

Question 52

outcomes of chronic pancreatitis (8)

Answer 52

``` pain weight loss steatorrhoea diabetes jaundice hypoalbuminaemia pseudocysts splenic vein thrombosis ```

Question 53

a benign cystic tumour in the exocrine pancreas =

Answer 53

mucinous cystadenoma

Question 54

a malignant cystic tumour in the exocrine pancreas=

Answer 54

mucinous cystadenocarcinoma

Question 55

features of an exocrine pancreatic tumour

Answer 55

pseudocysts | pancreatic abscess

Question 56

where are most adenocarcinomas of the pancreas

Answer 56

in the head

Question 57

symptoms of carcinoma of the pancreas

Answer 57

- often little | - weight loss, back pain, painless jaundice

Question 58

signs of pancreatic cancer

Answer 58

trousseau's sign

Question 59

treatment of pancreatic carcinoma

Answer 59

surgery | chemotherapy

Question 60

medium survival of pancreatic carcinoma

Answer 60

2-3 months

Question 61

5 tumours of the endocrine pancreas

Answer 61

``` islet cell tumours insulinoma gastrinoma glucagonoma somatostatioma ```

Question 62

pre-hepatic jaundice-->

Answer 62

raised uncongugated bilirubin | normal everything else

Question 63

intra-hepatic jaundice-->

Answer 63

``` increased conjugated bilirubin increased unconjugated bilirubin increased ALT, AST, GGT, ALP normal stool dark urine no itchy skin ```

Question 64

post hepatic jaundice-->

Answer 64

conjugated bilirubin pale stool dark urine itchy skin