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Disorders Of Hepatic, Bilary, And Pancreatic Function Notes

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Lecture 22 Disorders of hepatic, bilary and pancreatic function

Bilary disease o Gallstones
 Types

• Cholesterol/mixed 90-95%

• Pigment (break down haemoglobin) 5-10%
 Composition

• Cholesterol (crystallised cholesterol)

• Mixed (crystallised cholesterol & cholesterol with bile pigment)

• Pigment (calcium bilirubinate)
 Aetiology

• Cholesterol/mixed o Many theories o Relative saturation of cholesterol, phospholipid, bile salts

• Pigment o Deconjugation of bilirubin mono- and di-glucuronides
 Epidemiology

• Cholesterol/mixed o Female>male; pregnancy; OCP o Diabetes o Animal fat rich diet, rapid weight loss/gain

• Pigment o Haemolysis; Cirrhosis; Ileal resection
 Clinical presentation

• Silent- incidence 80%

• Bilary colic o Impaction of stone in GB neck or cystic duct o "Spasm" of contractions in GB wall as it tries to squeeze out stone o Usually lasts hours and radiates to back

• Acute cholecystitis o Prolonged impaction of stone in GB neck or cystic duct o Inflammation of gallbladder o Overgrowth of bacteria leading to infection

• Migration into common bile duct/bilary tree= jaundice/infection (COMMON)

• Migration through wall of GB into GI tract

• Murphy's sign (unable to breathe when RUQ palpated because of pain) o Bilary obstruction
 Pathophysiology

• Serum (haemoglobin>haem>biliverdin>bilirubin)

• Hepatocyte (bilirubin> bilirubin glucuronides)

• Bile>Intestine (deconjugated/reduced>oxidised)
 Aetiology

• Anatomical o Intraluminal- stones

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