Gallbladder and Pancreas Path Flashcards
What is acute pancreatitis?
a group of reversible lesions characterized by inflammation of the pancreas ranging in severity from edema and fat necrosis to parenchymal necrosis with severe hemorrhage
What are the top two etiologies of acute pancreatitis?
Alcoholism
Hyperlipoproteinemia
What drugs can lead to acute pancreatitis?
Thiazide diuretics
What genetic mutations can lead to acute pancreatitis?
PRSS1 (trypsinogen) or SPINK1 (trypsin inhibitor
What are the three major mechanical causes of acute pancreatitis?
Gallstones
Trauma
iatrogenic injury
What are the three vascular etiologies of acute pancreatitis?
Shock
Atheroembolism
vasculitis
What are the three infectious etiologies of acute pancreatitis?
Mumps
Coxsackie virus
Mycoplasma pneumoniae
What is the cell in the pancreas that release trypsin? What does this cause when these cells are damaged?
Acinar cells
Premature activation of enzymes, causing pancreatitis
What enzyme in the pancreas produce hemorrhage?
elastase
What enzyme causes the fat necrosis of acute pancreatitis?
Lipase
What is the intrinsic cause of pancreatitis within acinar cells?
Defective transport failure to bring out enzymes
What are the two enzymes that are released with pancreatic acinar cell damage?
Lipase
Trypsin
What is the role that Ca plays in pancreatitis?
Ca activates enzymes–thus the hypocalcemia that can be seen in acute pancreatitis
What is the significant sequelae of acute pancreatitis?
Shock
What is the significant sequelae with the fat necrosis seen in acute pancreatitis?
Hypocalcemia
What is the time frame difference between lipase and amylase?
Amylase peaks first, then lipase
Increase in amylase that lasts >7 days, suggests what?
Pancreatic pseudocyst
What is the cause of renal failure with acute pancreatitis?
Enzyme activation hurts the tubules
What is the cause of ARDS with acute pancreatitis?
Elastase will degrade the lung BM
What is acute interstitial pancreatitis?
Inflammation and edema
What are the three morphologies of acute pancreatitis?
Interstitial
Necrotizing
Hemorrhagic
What is the cause of hemorrhagic pancreatitis?
Elastase degrades arteries
What are the systemic effects of acute pancreatitis?
Leukocytosis
DIC
Shock
What is the color of the Ca that builds up in acute pancreatitis with staining?
Blue
What is a pancreatic pseudocyst?
Collection of blood, enzymes, and debris
What is the difference between a pancreatic pseudocyst, and an abscess?
Abscess has an epithelial lining, and is filled with bacteria. Pseudocysts do not.
What is the definition of chronic pancreatitis?
Irreversible loss of exocrine pancreas
What are the main cytokines that are released with chronic pancreatitis? What does this cause?
TGF-b
PDGF
Fibrosis about the acinar cells
What is the main histological difference between acute and chronic pancreatitis?
Fibrosis
What is the most common cause of chronic pancreatitis?
Etoh
What are the two genetic mutations that can result in chronic pancreatitis?
PRSS1 (trypsinogen)
SPINK1 (Serine protease inhibitor)
What is the cause of chronic pancreatitis in CF?
Build up of thick pancreatic secretions, leading to fibrosis and causing blockage.
What are the three pathologies of chronic pancreatitis?
Fibrosis
Duct distortion
Altered pancreatic secretions
What is the MOA of EtOH causing pancreatitis?
EtOH induces protein secretions in the pancreas. which causes increased viscosity of secretions. These can later calcify
What happens to the acinar cells with chronic pancreatitis?
Acinar cell drop out
What are the three ssx of chronic pancreatitis, besides abdo pain?
DM
Steatorrhea
Calcifications
What are the gross characteristics of the pancreas with chronic pancreatitis?
Rosary beads secondary to areas of stenosis
What are the two types of non-neoplastic pancreatic cysts?
Congenital
Pseudocysts
What is von Hippel-Lindau disease? How does this relate to the pancreas?
Mutation in the VHL factor, causing angiomas and cysts in the pancreas.
What are pseudocysts seen in pancreatitis?
Localized collections of pancreatic secretions, that lack a true epithelial lining
What do pancreatic pseudocysts look like histologically?
fibrin and granulation tissue surrounding the cys
What are the three types of cystic tumors of the pancreas?
- Microcystic serous cystadenomas
- Mucinous cystic tumors
- Solid pseudopapillary tumors
What are the microcystic serous cystadenomas?
Usually benign collections of serous fluid in the pancrease
What are the mucinous cystic tumors?
a grouping of cystic neoplasms that arise from the pancreas. They may be benign, malignant or in between.
What are the solid pseudopapillary tumors?
a type of tumor (neoplasm) that grows within the pancreatic ducts (intraductal) and is characterized by the production of thick fluid by the tumor cells (mucinous).
What are the histological characteristics of Pancreatic serous cystadenomas? Pancreatic mucinous cystadenomas?
cuboid epithelial lined cyst-like structures, without cellular atypia
Columnar epithelium with fibrous tissue
What are the intraductal papillary mucinous neoplasms?
Benign, or borderline malignant neoplasms in the ductal apparatus
In whom does pancreatic cancer occur?
Elderly, black, diabetic men
Where does pancreatic cancer arise from in the pancreas?
Ducts
What causes the ssx of pancreatic cancer?
Painless jaundice caused by obstruction of the common bile duct
What are the antigens that are elevated in pancreatic cancer?
CEA and CA19-9
What is the most significant risk factor for pancreatic cancer? What does this cause?
Smoking causes KRAS mutations
What is the most common genetic mutation found in pancreatic cancers?
KRAS
What is the genetic cause of Peutz-Jegher syndrome? What are the ssx?
STK11
macules around the mouth, with associated increase in polyposis and chance of pancreatitis
What are the histological characteristics of pancreatic cancer?
Papillary epithelium with moderate architectural and cytological atypia
What is the sequence of genetic mutations that occur in pancreatic cancer?
KRAS2
p16/CDKN2A
p53
Where in the pancreas do most cancers occur? What type of cancer is this?
Head of the pancreas
Adenocarcinoma
What is Courvoisier’s Gallbladder?
An enlarged, often palpable gall bladder associated with carcinoma of the head of the pancreas.
What are the three common sites of mets from pancreatic cancer?
Lung
Liver
Peritoneum
Most gallstones are comprised of what?
Cholesterol
What are the three types of gallstones?
- Cholesterol
- Pigmented (from bili)
- Mixed
What is the drug used to treat cholesterol gallstones? How does this work?
Cholestyramine–sequesters bile and cholesterol in the duodenum
What are the four contributing factors for cholelithiasis?
- Supersaturation
- Gallbladder hypomotility
- Crystal nucleation
- Accretion within the gallbladder mucous layer
What causes pigmented gallstones?
Ca precipitations of bili
What are the ssx of cholelithiasis?
Spasmodic, colicky, RUQ pain after eating fatty meals
What is the cause of strawberry gallbladder?
Foam cells within the gallbladder
What is acute cholecystitis?
Calculi cause inflammation and PMN infiltration of the gallbladder
What is the cause of chronic cholecystitis?
Chronic, longstanding inflammation of the gallbladder, probably caused by accumulation of damage in acute attacks.
What are the gross characteristics of cholecystitis?
GB is thickened and fibrotic
What are the microscopic appearance of chronic cholecystitis?
Collagen in wall
Lymphocytic infiltration
Plasma cells
Macrophages
What are Rokitansky-Aschoff sinuses?
outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall.
What type of cancer is gallbladder cancer? Ssx?
Adenocarcinoma
Ssx indistinguishable from cholelithiasis
What are the two morphological characteristics of adenocarcinomas of the gallbladder?
Infiltrating
Exophytic