Category Archives: Liver biliary tract and pancreatic diseases

Endocrine tumours

These turnours arise in the pancreas from APUD (amine precursor uptake and decarboxylation) cells and are sometimes called apudomas. Pancreatic endocrine tumours can occur in association with other endocrine turnours, particularly parathyroid adenoma and pituitary adenoma, as part of multiple endocrine neoplasias. Endocrine turnours predominantly secrete one hormone that produces its clinical effect, but ot

Carcinoma of the pancreas

The incidence of pancreatic carcinoma is steadily increasing in Western countries. This tumour is now the fourth commonest cause of cancer death in the UK and USA. The incidence increases with age and most patients are over 60 years of age. Males are affected more than females. There are no known aetiological factors, but the increasing incidence has been attributed to an increase in both smoking and the con

Cystic fibrosis

This is the commonest cause of pancreatic disease in childhood. It is inherited as an autosomal recessive condition and a specific gene deletion has been identified in 70% of cases. It has been suggested that the resultant protein defect produces an abnormality in the regulation of a J3-adrenergic-gated chloride channel in the cell membrane. This cystic fibrosis gene product has been named cystic fibrosis tr

Pancreatitis

Classification The classification of pancreatitis is difficult due to the inability to clearly separate acute and chronic pancreatitis. The original 1983 Marseilles classification was reviewed in 1984 and 1988 and simplified into acute and chronic forms. It was agreed that alcohol, which previously was classified as only causing chronic pancreatitis, can now cause the first episode acutely. By definition, acu

Investigation

Exocrine function The choice of individual tests is made on the clinical situation. SERUM AMYLASEMEASUREMENT is useful in acute disease but is of no value in chronic disease. SERUM LIPASE is raised in acute pancreatitis. MEASUREMENT OF DUODENAL ENZYMES, either after hormone stimulation or after food, is only sometimes helpful in the diagnosis of chronic pancreatitis because of the large reserve in enzyme capac

THE PANCREAS

Structure and function The pancreas extends retroperitoneally across the posterior abdominal wall from the second part of the duodenum to the spleen. The head is encircled by the duodenum; the body, which forms the main bulk of the organ, ends in a tail that lies in contact with the spleen. The main pancreatic duct usually joins the common bile duct to enter the duodenum as a single duct at the ampulla of Va

Turnours Of the biliary tract

Primary carcinoma of the gallbladder This adenocarcinoma represents <1% of all cancers. It occurs chiefly in those over 70 years of age and is commoner in females. Gallstones are usually present but a definite relationship is uncertain. The presenting features are of jaundice and occasionally right hypochondrial pain. A mass may be palpable in the right hypochondrium. The diagnosis is often made at operat

Miscellaneous conditions of the biliary tract

Primary sclerosing cholangitis Primary sclerosing cholangitis results from inflammation and fibrosis of the bile ducts leading to multiple areas of narrowing throughout the biliary system. The cause is unknown but immunological mechanisms have been implicated. HLA associations have been reported with HLA-B8, DR3; HLA-DR52a and HLA-DW2. DR4 marks for rapid disease progression. Fifty per cent or more of patient

Chronic cholecystitis

There are no symptoms or signs that can conclusively be shown to be due to chronic cholecystitis. Symptoms attributed to this condition are vague with abdominal discomfort or distension. There is no doubt that gallbladders studied histologically can show signs of chronic inflammation and occasionally a small, shrunken gallbladder is found either radiologically or on ultrasound examination. However these find

THE GALLBLADDER AND BILIARY SYSTEM

The main cause of disease of the gallbladder and biliary tract is gallstones. The structure, formation and function of bile. Gallstones Prevalence of gallstones Gallstones are present in 10-20% of the population in the Western Hemisphere, but the exact prevalence is unknown. There is a geographical variation. Gallstones are rare in the Far East and Africa and very common in native North Americans and in Chile