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Lecture 12
Gallbladder and Extrahepatic Biliary System
| Question | Answer |
|---|---|
| Treatment options for extrahepative biliary atresia | (1) Kasai procedure can be performed if the prximal common bile duct is preserved (2) liver transplantation before the age of 2 |
| Dilatation of biliary ducts. May be solitary or mutliple. Usually presents with biliary obstruction. | Choledochal cyst |
| Outpouching of biliary ducts | Choledochal diverticulum |
| (T or F) Choledochal cyst and diverticulum increases the risk for cholangiocarcinoma. | True |
| What is the most common type of gallstone? | 80% of cholelithiasis is due to cholesterol gallstones. |
| Type of gallstone composed of cholesterol, calcium, bile pigments and protein. Typically multiple in number with facted surfaces. | Mixed cholesterol gallstone |
| (T or F) Most cases of cholelithiasis can be detected by plain abdominal films. | False. Most cases of cholelithiasis won't be detected by xray. Only a minority of cholesterol gallstones contain enough calcium to be radiopaque. |
| Risk factors for cholelithiasis | (1) Female (2) obesity (3) parity (4) familial and ethinic predisposition |
| Type of gallstone composed primarily of calcium bilirubinate. They are associated with infections of the biliary tract and hemolytic diseases, but majority of cases have no apparent etiology. | Pigment gallstones |
| Complications of cholelithiasis | (1)acute/chronic cholecysitis (2)choledocolithiasis (3)pancreatitis (4)fistulas (5)gallstone ileus (4)gallbladder carcinoma |
| Inflammation of the gallbladder usually due to obstruction of the cystic duct by gallstones. | Acute cholecysitis |
| Pathogenesis of acute cholecysitis | Gallstone obstructs the cystic duct, interfering with bile secretions. This leads to secondary infection by gut organisms leading to inflammation and damage of gallbladder wall. |
| Acalculous cholecystitis | Acute cholecystitis not associated with gallstones. Typically associated with sepsis, Salmonella infection, or vasculitis. |
| Gangrenous cholecystitis | Acute cholecystitis in which distension ofhte organ leads to ischemic necrosis of the gallbaldder wall. This may lead to perforation of the gallbladder and bile peritonitis. |
| Diffuse inflammation ofhte peritoneal lining due to contact with bile. | Bile peritonitis |
| A condition characterized by thickening of the gallbladder wall by fibrosis due to repeated bouts of acute cholecysititis and/or chronic irriation by gallstones. | Chronic cholecystitis |
| Porcelain gallbladder | Calcification of the gallbladder wall due to chronic cholecystitis. |
| Why is prophylactic surgical resection of a procelain gallbladder indicated? | There is an elevated risk of gallbladder carinoma in a porcelain gallbladder. |
| What percentage of resected gallbladders contain carcinoma? | Less than 2% |
| (T or F) 75% of gallbladder carcinomas occur in women. | True. This is a consequence of the increased incidence of gallstones in females vs. males. |
| What are the secretory products of islets of Langerhans cells? | (1) insulin (2) glucagon (3) somatostain |
| What are the secretory products of acinar cells of the pancreas? | Digestive enzymes |
| A congential condition where the duodenum is encircled by pancreatic tissue. It is associated with duodenal atresia. | Annular pancreas |
| A congential condition where the ventral and dorsal pancreatic ducts fial to fuse resulting in two separate glands. | Pancreatic divisum |
| (T or F) Pancreas divisum is not a cause of pancreatitis. | False. Pancreatic divisum increases the risk of developing recurrent pancreatitis, presumably due to suboptimal darinage of pancreatic secretions. |
| Common locations of ectopic pancreas | Stomach and small intestine |
| What blood serum markers are indicative of active pancreatitis? | Serum amylase rises within 24 hours of onset and serum lipase rises within 72 hours of onset. |
| Pathogenesis of gallstone acute pancreatitis | Gallstone impact in teh ampulla of Vater, causing pancreatic obstruction. The rising pressure injures or ruptures the smaller pancreatic ductules, spilling zymogens to the interstitium. This activates the digestive enzymes causing further tissue injury. |
| What are the 2 major causes of acute pancreatitis? | (1) Cholelithiasis (2) Alcoholism |
| What are the clinical manifestation of acute pancreatitis? | (1) Severe epigastric pain (constant and intense) with radiation of pain to the upper back (2) Nausea (3) Vomiting |
| Complications of acute pancreatitis | (1) shock (2) ARDS (3) Acute renal failure (4) abdominal bacterial infection (5) death (6) pancreatic pseudocysts |
| What is a pancreatic pseudocyst? | A pancreatic cyst containing blood products, pancreatic enzymes, and necrotic cell debris surrounded by a wall of fibrous connective tissue (no epithelial lining). |
| Complications of pancreatic pseudocyst | (1) pseudocysts can become infected and form abscesses (2) intestinal obstruction |
| What are the morphologic changes that occur due to chronic pancreatitis? | Majority of the pancreatic tissue is replaced by fibrous tissue and chronic inflammatory cells. The pancreatic tissue may be calcified in areas. Thick proteinaceous plugs, some of which are calcified are present in the duct system. |
| Clinical manifestation of chronic pancreatitis | (1) pain (2) steatorrhea and malabsorption (3) Vit K deficiency (4) Diabetes mellitus (5) weight loss (6) abdominal calcification seen on plain radiograph |
| What part of the pancreas do most pancreatic ductal carcinomas arise? | 60-70% of pancreatic carcinomas arise in the head of the pancreas |
| Clinical manifestations of carcinoma of pancreas | (1) weight loss (2) abdominal pain that radiates to the back (3) anorexia (4) obstructive jaundice (5) Migratory thrombophlebitis |
| Risk factors for pancreatic ductal carcinoma | There are no known strong risk factors. (1)Smoking (2)high-fat diet (3)Familial malignant melanoma (3)Familial breat cancer syndrome type 2 |
| (T or F) 90% of pancreatic carcinomas arise in the pancreatic parenchyma | False. 90% of pancreatic carcinomas arise in the pancreatic ducts. |
| Clinical manifestations of functional insulinoma | Insulin-induced hypoglycemia: sweating, nervousness, hunger |
| A tumor that is characterized by gastric hyperacidity and recurrent GI ulcerations. | Gastrinomas |
| Pancreatic tumor that manifests as watery diarrhea | VIPoma |
| A tumor that manifests with hyperglycemia, cholelithiasis, and steatorrhea | Somatostatinomas (delta cell tumor) |
| (T or F) Most insulinomas are benign. | True. 90%of insulinomas are benign. |
| Mucinous cystic neoplasms found in the pancreas characterized by cystic spaces lined by columnar epithelial cells that secrete mucin. | Mucnous cystic neoplasms |
| Pancreatic mass that is composed of numerous small cysts that contain a serous-like fluid. | Serous cystadenomas )microcystic cystadenomas) |
| (T or F) Mucinous cystic neoplasms do not require resection because majority of these neoplasms are benign. | False. All mucinous cystic lesions of the pancreas must be resected because of their potential malignancy. They are associate dwith focal areas of high grade dysplasia or carcinoma and after resection, they can recur with invasive carcinomas. |
| A pancreatic tumor that typically arises in young to middle-aged women with an excellent prognosis. The neoplasms have varyibng degrees of solid, pseudo-paillary and cystic growth. | Solid Pseudopapillary Tumors of the Pancreas |
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