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mog
10-14-2005, 12:32 PM
Why when a person gets a pancreatic cancer and then bile duct gets obstructed, and then gets jaundice? I cannot figure out the mechanism... Anybody could help me?

neilc
10-14-2005, 01:13 PM
pancreatic head cancer can obstruct the bile ducts. remember your anatomy! so, with an obstructed duct, bile has nowhere to go (ie cannot be excreted into GI trac) and backs up into liver/bloodstream, you get a conjugated hyperbilirubinemia, and jaundice.

Nimmuk
10-14-2005, 02:47 PM
pancreatic head cancer can obstruct the bile ducts. remember your anatomy! so, with an obstructed duct, bile has nowhere to go (ie cannot be excreted into GI trac) and backs up into liver/bloodstream, you get a conjugated hyperbilirubinemia, and jaundice.

Hey Neilc, thanks for the help...Mog is still in anatomy, thus, the question.

mog
10-14-2005, 03:34 PM
Thanks!

So when the bile (in this case, bilirubin) has nowhere to go, it basically goes back to the liver, and then back into the blood stream, and thus jaundice. So do they get into the venous drainage (from the liver) into the systemic circulation?

neilc
10-14-2005, 03:54 PM
bile is excreted by the liver into the bile ducts and then to the GI tract for excretion with stool (for the most part). with a non functioning duct (ie obstruction in the pancreatic head), the conjugated bilirubin is unable to make it to the GI tract. you get dilatated bile ducts, and increased permeability. more bilirubin makes it to the blood stream, which results in jaundice.

question for you: what else besides conjugated bilirubin will be elevated with bile duct obstruction and can have clinical findings/consequences? (hint: what else is in bile, and what does bile do?)

Crazytrain-Rider
10-14-2005, 09:17 PM
Wouldn't the patient have fatty pale colored stools like seen in CF patients?

neilc
10-14-2005, 09:36 PM
Wouldn't the patient have fatty pale colored stools like seen in CF patients?
yes, partly. the stools would be light colored...but, that is a direct consequence of less stercobilinogen in the stool (which gives it the brown color), which is due to the decreased bile excretion. but, bile has a purpose biochemically (another hint, it helps get rid of something in the bloodstream) and has a component that causes symptoms when it is built up (another hint, this component is what helps get rid of the compound i am refering too above). but, would the stools be fatty? i guess with a pancreatic CA, yes, as you would be missing enzymes just like in CF. but, with obstructive jaundice further up the biliary tree, not neccesarily...fatty...hmmm. if you think about bile and fat you will be able to answer my questions (now that is a HUGE hint...).

so, to answer my question, just ask yourself what does bile help the body get rid of, and what is the component of bile that does this?

teratos
10-15-2005, 06:32 AM
Remember, in pancreatic cancer, the jaundice is often PAINLESS...that is a clue. G

mog
10-15-2005, 11:23 AM
Gash I have no clue.... but it's very interesting to see how the things work and are all related to each other. I'm waiting for somebody else to be able to answer this...

neilc
10-15-2005, 03:10 PM
well, a component of bile is bile salts. and, bile has the job of helping eliminate extra cholesterol....so, if you can't get rid of the bile, the bile salts also get backed up (just like the bilirubin) and can make it into the skin, causing itchiness. and, since the cholesterol is not getting removed as well, you can get chol deposits, and elevated cholesterol....

microphage
10-15-2005, 11:47 PM
Remember, in pancreatic cancer, the jaundice is often PAINLESS...that is a clue. G

To go along with a topic for once in my life...


painless palpable gallbladder...= what sign?

And what is a Sister Mary ******'s Node?

neilc
10-16-2005, 03:35 AM
is that courvasier's sign? spelling?

sister mary josep=periumbilical node secondary to metastatic GI ca, i think.

been drinking, so i am not positive on this...so, forgive me if i am wrong.







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