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Kat's Pathology > Diseases and the Pancreas and Gallbladder > Flashcards

Diseases and the Pancreas and Gallbladder Flashcards

1
Q

What are the cells of the pancreas

A

Pancreatic acinar cell

Centroacinar cell

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2
Q

What is the basic structure of the pancrease

A

Pancreatic acinus stemming from intercalated ducts

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3
Q

What are the two components of the pancreas

A

Exocrine component

Endocrine component

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4
Q

Acute pancreatitis

A

Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes
Relatively common, increasing incidence

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5
Q

Causes of acute pancreatitis

A

Duct obstruction: gallstones, trauma, tumours.
Metabolic/toxic: alcohol, drugs (thiazides), hypercalcaemia, hyuperlipidaemia
Poor blood supply: shock, hypothermia
Infection/inflammation: viruses (mumps)
Autoimmune
Idiopathic

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6
Q

What proportion of alcoholics develop acute pancreatitis

A

5%

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7
Q

Pathogenesis of acute pancreatitis due to ductal obstruction

A

Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to:
reflux of bile up the pancreatic duct followed by damage to acini with release of proenzymes which then become activated

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8
Q

Pathogenesis of acute pancreatitis due to alcohol

A

Alcohol leads to spasm/oedema of sphincter of oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts

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9
Q

Pattern of injury in acute pancreatitis

A

Periductal: necrosis of acinar cells near ducts (usually secondary to obstruction)
Perilobular: necrosis at the edges of the lobules (usually due to poor blood supply)
Panlobular - develops from periductal and perilobular damage

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10
Q

Pattern of injury in acute pancreatitis

A

Activated enzymes –> acinar necrosis –> enzyme release, etc…
Ranges from stromal oedema, to haemorrhagic necrosis

E.g. lipases –> fat necrosis (calcium ions bind to free fatty acids forming soaps which are seen as yellow-white foci)

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11
Q

Complications of acute pancreatitis

A

Pancreatic: pseudocyst, abscess
Systemic: shock, hypoglycaemia, hypocalcaemia

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12
Q

Prognosis of acute pancreatitis

A

Overall mortality up to 50% for hemorrhagic pancreatitis

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13
Q

Chronic pancreatitis

A

Relapsing or persistent, associated with acute pancreatitis in half of cases
Relatively uncommon

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14
Q

Mortality from chronic pancreatitis

A

3% per year

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15
Q

Causes of chronic pancreatitis

A

Metabolic/toxic: alcohol (80%), haemochromatosis
Duct obstruction: gallstones, abnormal pancreatic duct anatomy, cystic fibrosis (mucoviscoidosis)
Tumours
Idiopathic: autoimmune

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16
Q

Pattern of injury for chronic pancreatitis

A

Pathogenesis of the same as for acute pancreatitis
Chrnoci inflammation with parenchymal finbrosis and loss of parenchyma
Duct strictures with calcified stones with secondary dilations

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17
Q

Complications of chronic pancreatitis

A

Malabsorption
Diabetes mellitus
Pseudocyts
Carcinoma of the pancreas

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18
Q

What is diagnostic of chronic pancreatitis

A

Abdominal radiograph with pancreatic calcifications

19
Q

Pancreatic pseudocysts

A

Associated with acute and/ or chronic pancreatitis
Lined by fibrous tissue (no epithelial lining), contain fluid rich in pancreatic enzymes) or necrotic material
Connect with pancreatic ducts
May resolve, compress adjacent structures, become infected or perforate

20
Q

Histology of pancreatic pseudocyst

A

The cyst lining is composed of granulation tissue & infiltrating cells without a discrete epithelial lining. A thickened fibrotic wall with prominent vascualrity is present

21
Q

Autoimmune pancreatitis

A

Characterised by large numbers of IgG4 positive plasma cells.
May involve the pancreas, bile ducts and almost any other part of the body.
Often called “IgG4 Disease”.

22
Q

Histology of autoimmune pancreatitis

A

IgG4 positive plasma cells

23
Q

Tumours of the pancreas

A

Carcinomas: ductal (85%), acinar
Cystic neoplasma: serous cystadenoma, mucinous cystic neoplasm
Pancreatic neuroendocrine tumours (islet cell tumour)

24
Q

Ductal pancreatic carcinoma

A

5% of cancer deaths
Increasingly common with age. 2M:F
5 year survival is 5%

25
Q

Risk factors for pancreatic carcinoma

A

Smoking
BMI and dietary factors
Chronic pancreatitis
Diabetes

26
Q

Ductal pancreatic carcinoma

A

Arise from dysplastic ductal lesions: pancreatic intraductal neoplasia (PanIN)
K-Ras mutations in 95% of cases

27
Q

Ductal carcinoma of the pancreas macroscopic appearance

A

Gritty and grey
Invades adjacent structure
Tumours in the head present earlier

28
Q

Ductal carcinoma of the pancreas microscopic appearance

A

Adenocarcinomas: mucin secreting glands set in desmoplastic strome

29
Q

Sites of ductal carcinoma of pancreas

A

Head 60%
Body
Tail
Diffuse

30
Q

How does a ductal carcinoma of the pancreas typically spread

A

Direct: bile ducts, duodenum
Lymphatic: lymph nodes
Blood: liver
Serosa: peritoneum

31
Q

Complications of ductal carcinoma of the pancreas

A

Due to spread
Chronic pancreatitis
Venous thrombosis (migratory thrombophlebitis)

32
Q

Histology of ductal adenocarcinoma of the pancreas

A

Findings diagnostic of ductal adenoCa. Perineural invasion is virtually diagnostic of invasive Ca provided the epithelial structures are gland forming.

33
Q

Cystic tumours of the pancreas

A

Usually multilocular
Contain serious or mucin secreting epithelium (CF ovarian tumours)
Usually benign

34
Q

Pancreatic endocrine neoplasms

A

Usually non-secretory
Contain neuroendocrine markers e.g. chromogranin
Behaviour difficult to predict,
May be associated with the Multiple Endocrine Neoplasia (MEN) 1 syndrome

35
Q

Insulinomas

A

Derived from beta cells in the pancreas

The commonest type of secretory tumour

36
Q

Histological pattern of insulinoma

A

Nested pattern

37
Q

Gallbladder pathology

A

Gallstones
Inflammation
Cancer

38
Q

Gallstones (i.e. cholelithiasis) prevalence

A

20% of adults in the West are affected

39
Q

Risk factors for gallstones

A

Age and gender: increasing age, F>M
Ethnic and geographic: e.g. Native Americans
Hereditary: e.g. disorders of bile metabolism
Drugs e.g. oral contraceptive
Acquired disorders e.g. rapid weight loss

FAT, FOURTY, FEMALE

40
Q

Types of gallstones

A

Cholesterol (more than 50% cholesterol), may be single, mostly radiolucent

Pigment (contain calcium salts of unconjugated bilirubin), multiple, mostly radio-opaque

41
Q

Complications of gallstones

A

Bile duct obstruction
Acute and chronic cholecystitis
Gall bladder cancer
Pancreatitis

42
Q

Acute cholecytitis

A

Acute inflammation of the gallbladder

90% associated with gallstones

43
Q

Chronic cholecystitis

A

Chronic inflammation of the gallbladder
Fibrosis
Diverticula - Rokitansky-Aschoff sinuses
90% contain gallstones

44
Q

Gallbladder cancer

A

Adenocarcinomas

90% are associated with gallstones

Kat's Pathology (105 decks)

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