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Medicine Notes Gastrointestinal (GI) System Notes

Disorders Of Hepatic, Bilary, And Pancreatic Function Notes

Updated Disorders Of Hepatic, Bilary, And Pancreatic Function Notes

Gastrointestinal (GI) System Notes

Gastrointestinal (GI) System

Approximately 57 pages

These notes helped me achieve a mark of 73% in my GI exam, which is the equivalent of a 1st. The notes are based on a series of lectures on the subject. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the GI tract (e.g. physiology or anatomy), would benefit greatly from these notes. There are lecture in the series on th...

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Lecture 22

Disorders of hepatic, bilary and pancreatic function

  • Bilary disease

    • 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

          • Many theories

          • Relative saturation of cholesterol, phospholipid, bile salts

        • Pigment

          • Deconjugation of bilirubin mono- and di-glucuronides

      • Epidemiology

        • Cholesterol/mixed

          • Female>male; pregnancy; OCP

          • Diabetes

          • Animal fat rich diet, rapid weight loss/gain

        • Pigment

          • Haemolysis; Cirrhosis; Ileal resection

      • Clinical presentation

        • Silent- incidence 80%

        • Bilary colic

          • Impaction of stone in GB neck or cystic duct

          • “Spasm” of contractions in GB wall as it tries to squeeze out stone

          • Usually lasts hours and radiates to back

        • Acute cholecystitis

          • Prolonged impaction of stone in GB neck or cystic duct

          • Inflammation of gallbladder

          • 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)

    • Bilary obstruction

      • Pathophysiology

        • Serum (haemoglobin>haem>biliverdin>bilirubin)

        • Hepatocyte (bilirubin> bilirubin glucuronides)

        • Bile>Intestine (deconjugated/reduced>oxidised)

      • Aetiology

        • Anatomical

          • Intraluminal- stones

          • Mural- tumour, stricture (may also itch because of bile salt)

          • Extramural- noses, pseudocyst

        • Disease

          • Benign

            • Stones

            • Pancreatitis (not common)

          • Malignant

            • Pancreatic adenocarcinoma

      • Clinical features

        • Icterus, jaundice

        • Pale stools, dark urine

        • Pruritis

      • Investigation

        • Ultrasound

          • Intrahepatic duct dilatation (GALL STONES= must have this)

          • Extrahepatic dilatation (could be OTHER reasons)

          • Duct stones; Gall stones; Mass

        • Cholangiography

        • CT; MRI

      • Therapy

        • Endoscopic

        • ...

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