Nonneoplastic Conditions

Duodenum: duodenitis and DU have been previously discussed - gastric metaplasia, or nodular gastric heterotopia in D1 and Brunner's gland hyperplasia are also encountered in biopsies of the proximal duodenum. Biopsy for coeliac disease is considered under small intestine (page 53).

Ampulla of Vater: inflammatory polyps of the duodenal papilla are small, pedunculated and often ulcerated. Partly traumatic in origin due to passage of calculi from the biliary tree, distinction from neoplasia at OGD/ERCP can be difficult and biopsy is required.

Pancreas: the distal pancreatic duct forms a common channel with the terminal common bile duct in 50-60% of patients resulting in a strong association between pancreatitis and biliary tract disease.

Acute pancreatitis: with an overall mortality of 10-15% it is rarely biopsied or resected. The commonest causes are gall stones, sphincter spasm or incompetence with reflux of duodenal fluid and bile, alcohol, trauma and hypothermia. It is due to release of pancreatic enzymes comprising pancreatic haemorrhage, necrosis and inflammation with saponification and chalky calcification of abdominal fat. It is usually a self-limiting process but critical complications include sepsis, shock, bowel paralysis or perforation. Treatment is resuscitative and supportive - operative intervention can include removal of obstructing gall stones (by ERCP) or infected necrotic tissue (necrosectomy).

Chronic pancreatitis: commonly due to excess alcohol intake, there is correlation between radiological calcification, pancreatic endocrine and exocrine dysfunction and the severity of histological changes. Complications include abscess, systemic fat necrosis and pancreatic pseudocyst. Caused by distruption of the duct system due to obstruction by calculus or tumour, a pseudocyst has a thick fibrous wall lined by granulation tissue but no epithelium. It can rupture into the peritoneal cavity or splenic artery. Treatment is by endoscopic or transabdominal drainage either internally to stomach or duodenum, or externally to skin. Surgical excision is used if small and localised to the body or tail, or if the pseudocyst is thick-walled and not appropriately sited for drainage.

The commonest biopsy expression of chronic pancreatitis is that seen adjacent to a pancreatic tumour or secondary to an ampullary tumour due to duct obstruction. The acinar and stromal changes can mimic pancreatic carcinoma, making interpretation difficult especially on frozen section. Chronic pancreatitis tends to retain its lobular architecture, lacks malignant cytological changes and shows no invasion of nerve sheaths or peripancreatic fat.

Extrahepatic bile ducts: stricture of the common bile duct may be caused by passage of a calculus with or without ascending cholangitis and secondary infection, but is more usually after surgical trauma due to inadvertent injury to or ligation of the duct. Treatment aims to reestablish free drainage of bile to the bowel either by a bypass or stenting procedure (see below).

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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