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Disorders Of Hepatic, Bilary, And Pancreatic Function Notes

Medicine Notes > Gastrointestinal (GI) System Notes

This is an extract of our Disorders Of Hepatic, Bilary, And Pancreatic Function document, which we sell as part of our Gastrointestinal (GI) System Notes collection written by the top tier of Bristol University students.

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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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