Pathology- Biliary tree and Pancreas

Question 1

what is cholelithiasis

Answer 1

gall stones

Question 2

what are gallstones

Answer 2

hard, stone/gravel like material formed in within the biliary system most commonly the gall bladder

Question 3

what are the components of normal bile

Answer 3

micelles of cholesterol, phospholipid, bile salts and bilirubin

Question 4

are bile salts hydrophillic or phobic

Answer 4

phillic, on outside of micelles

Question 5

is cholesterol hydrophillic or phobic

Answer 5

phobic, on inside of micelles

Question 6

when do gall stones form

Answer 6

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

Question 7

what are the risk factors for gall stones

Answer 7

cholesterol in excess in bile: female, obesity, diabetes, genetic

Question 8

why are gall stones painful

Answer 8

as they irritate the gall bladder lining and cause pain with the gall bladder contracts. can also get stuck

Question 9

what causes pigment stones

Answer 9

when excess bilirubin cannot be solubilised in bile salts

Question 10

what are the risk factors for pigment stones

Answer 10

excess bilirubin: excess haemolysis e.g. haemolytic anaemias

Question 11

how do gall stones affect the biliary lining

Answer 11

cause infections and inflammation

Question 12

what can gallstones cause

Answer 12

gall stone ileus,
acute/ chronic cholecystitis,
mucocoele,
empyema,
carcinoma,
ascending cholangitis,
obstructive jaundice,
acute/chronic pancreatitis,

Question 13

what is mucocoele

Answer 13

when gall bladder is extended with mucous- when this mucous becomes pus= empyema

Question 14

how do gall stones cause ascending cholangitis and what are the symptoms

Answer 14

when it travels into CBD and spreads to liver

swinging fever, pain in right upper quadrant, nausea/ vomiting, jaundice

Question 15

what is cholecystitis

Answer 15

inflammation of the gallbladder

Question 16

what causes acute cholecystitis

Answer 16

when gallstones obstruct the outflow of bile- initially sterile then becomes infected

Question 17

what might be caused by acute cholecystitis

Answer 17

empyema, rupture, peritonitis

Question 18

what causes chronic cholecystitis

Answer 18

may develop insidiously or after bouts of acute cholecystitis

Question 19

what is seen in the gallbladder in chronic cholecystitis

Answer 19

gallbladder wall in thickened but not distended

Question 20

what carcinoma is found in the gallbladder

Answer 20

adenocarcinoma

Question 21

what in cholangiocarcinoma associated with

Answer 21

UC and primary sclerosing cholangitis

Question 22

how does cholangiocarcinoma present

Answer 22

with obstructive jaundice

Question 23

why is resection of the pancreas difficult

Answer 23

as the head is inseparable form the duodenum

Question 24

what is the exocrine function of the pancreas

Answer 24

acinar cells produces enzymes (proteases and lipases) mixed into pancreatic juice which breakdown food

Question 25

what is pancreatitis

Answer 25

inflammation of the pancreas- may be acute or chronic

Question 26

what are the clinical signs of acute pancreatitis

Answer 26

sudden onset severe abdominal pain, patients may be severely shocked, elevated serum amylase (produced by the pancreas when something is wrong)

Question 27

what can cause acute pancreatitis

Answer 27

alcohol, cholelithiasis, shock, mumps, hyperparathyroidism, hypothermia, trauma, iatrogenic

Question 28

what is the pathogenesis (how it happens) of acute pancreatitis

Answer 28

bile reflux (duct obstruction) causes pancreatic duct epithelial injury loss of protective barrier allows autodigestion of pancreatic acini release of lytic pancreatic enzymes proteases and lipasaes intra and peripancreatic fat necrosis (lipases) tissue (and vessel) destruction and haemorrhage (proteases)

Question 29

what are pseudocysts

Answer 29

cystic lesion that lacks endothelial lining

Question 30

what are the complications of acute pancreatitis

Answer 30

death, shock, pseudocyst formation, abscess formation, hypocalcemia, hyperglycemia

Question 31

what causes chronic pancreatitis

Answer 31

alcohol, cholelithiasis, cystic fibrosis, hyperparathyroidism, familial

Question 32

how can cystic fibrosis cause chronic pancreatitis

Answer 32

as it is a disease of the exocrine organs, secretions too viscous and block the ducts and tubes that go to the organs

Question 33

what is the pathology of chronic pancreatitis

Answer 33

replacement of pancreas by chronic inflammation and scar tissue destruction of exocrine acini islets- complete blockage of exocrine pathways and loss of function

Question 34

what are islets of langerhand

Answer 34

clusters of cells making pancreatic islets

Question 35

what type of cancer is found in the pancreas

Answer 35

adenocarcinoma

Question 36

what is cancer of the pancreas associated with

Answer 36

smoking, diabetes, familial pancreatitis

Question 37

what is whipples syndrome

Answer 37

Whipple disease is a systemic disease most likely caused by a gram-positive bacterium, Tropheryma whippelii. malabsorption syndrome with small intestine involvement, the disease also affects the joints, central nervous system, and cardiovascular system

Question 38

what type of jaundice does a adenocarcinoma in the head of the pancreas that blocks the common bile duct cause

Answer 38

painless

Question 39

where does adenocarcinoma of the pancreas directly spread to

Answer 39

other organs e.g. duodenum, stomach, spleen, CBD

Question 40

where does adenocarcinoma of the pancreas spread to via the blood

Answer 40

liver

Question 41

what are the causes of pancreatitis

Answer 41

I GET SMASHED I- idiopathic G-gallstones E-ethanol T- Trauma ``` S-steroids M- malignancy/ mumps (infections) A-autoimmune S-Scorpion stings/ spider bites H hyperlipidaemia/ hypercalcaemia/ hyperparathyroidism (metabolic disorders) E-ERCP D-drugs ```

Question 42

what is ERCP

Answer 42

endoscopic retrograde cholangiopancreatography