Pathology of the biliary tract and pancreas Flashcards Preview

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Flashcards in Pathology of the biliary tract and pancreas Deck (40):
1

What liver function test results are usual for post hepatic obstruction?

Raised alkaline phosphatase
only modest elevation of transferases

2

What are important causes of occlusion of the bile duct?

Gallstones- commonest
Strictures e.g. following previous biliary surgery
Tumours- carcinoma of the extrahepatic bile duct or head of the pancreas

3

What causes gallstones?

Calculi migrating from the gall bladder to obstruct the common bile duct

4

What is cholangitis?

When bile stasis above the obstruction in the bile duct predisposes to infection of the biliary tract and the ducts become inflamed, and the patient develops a fever.

5

What is ascending cholangitis?

The propagation of biliary infection proximally into the intrahepatic ducts, which can lead to the formation of liver abscesses.

6

Why are dilated intrahepatic ducts detected by ultrasound scan a contraindication to diagnostic liver biopsy in the jaundiced patient?

A risk of biliary leakage

7

What is cholelithiasis?

Gallstone formation within the biliary system

8

What are risk factors for cholesterol rich stones?

Female gender and obestiy
(Fat, fair, forty, fertile, female)

9

What can gallstones consist of?

Pure cholesterol- yellow, opalescent
Bile pigment- small black
Mixed stones

10

Why do gallstones form?

When there is an imbalance of the constituents of bile, which results in precipitation.

11

What are the pathological effects of gallstones?

Inflammation of the gall bladder (cholecystitis) and its complications
Mucocele
Predisposition to carcinoma of the gall bladder
Obstruction of the biliary system, resulting in biliary colic and jaundice
Infection of static bile, causing cholangitis and liver absecesses
Gallstone ileus due to intestinal obstruction by a gallstone that has entered the gut through fistulous connection iwth the gall bladder
Pancreatitis

12

What is the pathogenesis of pigment stones?

Excess bilirubin which cannot be solubilised in bile salts
Could be due to excess haemolysis e.g. haemolytic anaemia

13

What may be contributory factors to gallstone pathogenesis?

Gallbladder pH and mucosal glycoproteins

14

How can gallstones trigger pancreatitis?

By damaging the sphincter off odd which can allow a reflux of duodenal contents up into the pancreas

15

What is cholecystitis?
What is it almost always associated with?

Inflammation of the gallbladder
Gallstones
Can be acute or chronic

16

What does acute cholecystitis cause?

It can cause empyema, rupture and peritonitis
causes intense adhesions in 2-3 days

17

What is chronic cholecystitis?

Associated with Gallstones

May develop insidiously or after bouts of acute cholecystitis

Galbladder wall is thickened but not distended (Cardinal feature)

18

What is carcinoma of the gallbladder?

Rare
Adenocarcinoma
Associated with gallstones
Local invasion of liver
Poor prognosis

19

What is cholangiocarcinoma associated with?

Ulcerative Colitis and Primary Sclerosing Cholangitis

20

How does a patient with cholangiocarcinoma present?

with obstructive jaundice

21

What type of cancer is cholangiocarcinoma?

Adenocarcinoma

22

What is pancreatitis?

Inflammation of the pancreas- may be acute or chronic
Overlap exists between acute and chronic

23

Is severe acute pancreatitis a medical emergency?

Yes

24

How does severe acute pancreatitis present?

Sudden onset of severe abdominal pain often radiating to the back
Nausea
Vomiting
Patient may go into shock with renal and respiratory failure

25

What is biochemical marker associated with severe acute pancreatitis?

Raised serum amylase

26

What are most cases of acute pancreatitis related to?

Alcohol or gallstones

27

What are other causes of acute pancreatitis?

Vascular insufficiency (e.g. shock)
certain infections, e.g. mumps
hyperthyroidism
hyperlipidaemia
hypothermia
trauma
iatrogenic factors e.g. after ERCP or an operation
certain drugs

28

What is the pathogenesis of acute pancreatitis?

Bile reflux, duct obstruction due to stone and damage to sphincter of Oddi all cause pancreatic duct epithelial injury

Loss of protective barrier allows autodigestion of pancreatic acini
Release of lytic pancreatic enzymes proteases and lipases
Intra- and peripancreatic fat necrosis (lipases)
Tissue destruction and haemorrhage (proteases)

29

What is a cardinal histological sign of pancreatitis?

Fat necrosis

30

What is Grey turner's sign?
What causes it?

Skin discolouration on the flanks
The lipolytic enzymes cause fat necrosis which can be extensive if it involves the anterior abdominal wall it can cause skin discolouration.

31

What are complications of acute pancreatitis?

Death
Shock
Pseudocyst formation
Abscess formation
Hypocalcemia
Hyperglycemia

32

What are pseudocysts?

Cysts without epithelial lining

33

What happens in chronic pancreatitis?

There is continuing inflammatory process with exocrine atrophy and replacement of pancreatic tissue with fibrosis

34

What is the commonest cause of chronic pancreatitis?

Chronic alcohol excess

35

What are other causes of chronic pancreatitis?

Conditions obstructing the pancreatic duct:
pancreatic divisum
inflammatory strictures
tumours
cholelithiasis

cystic fibrosis
hyperparathyroidism

Hereditary pancreatitis (defect in the trypsinogen gene)
tropical calculus pancreatitis related to malnutrition
Autoimmune pancreatitis

36

What is the commonest carcinoma of the pancreas?

Ductal adenocarcinoma

37

What is the most important risk factor for pancreatic carcinoma?

Smoking

38

What is the prognosis for pancreatic carcinoma?

Very poor

39

What are symptoms of pancreatic carcinoma?

Symptoms occur at a late stage
They include weight loss and obstructive jaundice

40

Metastatic spread of pancreatic cancer to which organ is common?

The liver

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