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GI 2 Exam 1 > Gallbladder/Pancreas Key Concepts > Flashcards

Gallbladder/Pancreas Key Concepts Flashcards

1
Q

these stones arise exclusively in the gallbladder, and range from 100% pure (rare) to around 50% cholesterol

  • pale yellow, round to ovoid, have a finely granular, hard external surface, which on transection reveals a glistening radiating crystalline palisade (looks like fence posts in a line)
  • multiple stones usually present, that range up to several cm in diameter
  • stones are radiolucent
A

cholesterol stones

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2
Q

these stones are brown to black

  • black stones found in sterile gallbladder (50-75% are radiopaque due to calcium salts)
  • brown stones found in infected large bile ducts, tend to be laminated and soft (may have soap-like or greasy consistency), are radiolucent
A

pigment stones

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3
Q

gallbladder usually enlarged and tense, may assume a bright red or violet, blotchy to green-black discoloration
- serosa frequently covered by fibrinous exudate that may be fibrinopurulent

A

acute cholecystitis

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4
Q

an obstructing stone is usually present in the neck of the gallbladder or cystic duct
- gallbladder lumen may contain one or more stones and is filled with a cloudy or turbid bile that may contain large amounts of fibrin, pus, and hemorrhage

A

calculous cholecystitis

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5
Q

what is it called when gallbladder exudate is virtually pure pus?

  • in mild cases, the gallbladder wall is thickened, edematous, and hyperemic
  • in more severe cases, is transformed into green-black necrotic organ (gangrenous cholecystitis)
A

gallbladder empyema

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6
Q

what causes acute “emphysematous” cholecystitis?

A

the invasion of gas-forming organisms, notable clostridia and colioforms

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7
Q

in this condition, the serosa is usually smooth and glistening, but may be dulled by subserosal fibrosis

  • dense fibrous adhesions may remain as sequelae or preexistant acute inflammation
  • wall is variably thickened, ad has opaque gray-white appearance
  • mucosa itself is generally preserved
  • in mild cases: only scattered lymphocytes, plasma cells, and macrophages in the mucosa and subserosal fibrous tissue
  • in more severe cases: marked subepithelial and subserosal fibrosis, with mononuclear cell infiltration
A

subserosal fibrosis

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8
Q

what are Rokitansky-Aschoff sinuses?

A

buried crypts of epithelium within the gallbladder wall with outpouchings of mucosal epithelium through the wall

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9
Q

extensive calcification within the gallbladder wall, notable for a marked increase

A

porcelain gallbladder

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10
Q

in this condition, the gallbladder has a massively thickened wall and is shrunken, nodular, and chronically inflamed with foci of necrosis and hemorrhage
- is triggered by rupture of Rokitasky-Aschoff sinuses into the wall of the gallbladder, followed by an accumulation of macrophages that have ingested biliary phospholipids

A

thogranulomatous cholecystitis

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11
Q

lipid-containing cells with foamy cytoplasm

A

xanthoma cells

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12
Q

atrophic, chronically dilated gallbladder, may contain only clear secretions

A

hydrops of the gallbladder

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13
Q

what are the two patterns of growth seen in carcinomas of the gallbladder?

A

infiltrating and exophytic

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14
Q

this pattern of gallbladder carcinoma is more common and usually appears as a poorly defined area of diffuse mural thickening and induration

  • deep ulceration can cause direct penetration into the liver or fistula fistulation to adjacent viscera into which the neoplasm has grown
  • scirrhous (slow-growing malignant tumor with very firm consistency)
A

infiltrating carcinoma

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15
Q

this pattern of carcinoma grows into the lumen as an irregular, cauliflower mass, but at the same time invades the underlying wall

A

exophytic carcinoma

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16
Q

most carcinomas of the gallbladder are what?

A

adenocarcinomas

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17
Q

what type of carcinoma generally has a better prognosis than the others?

A

papillary tumors

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18
Q

what are common sites of metastasis of gallbladder carcinomas?

A

peritoneum, GI tract, and lungs

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19
Q

it is common to find what, in the epithelium adjacent to invasive cancer, or in gallbladders with long-standing cholelithiasis
- these are nearly always flat dysplasias, with varying grades of cellular atypia, including carcinoma-in-situ

A

preneoplastic (dysplastic) lesions

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20
Q

what are risk factors for the development of cholesterol stones?

A

advancing age, female gender, estrogen use, obesity, and heredity

21
Q

what almost always occurs in association with cholelithiasis?

A

cholecystitis

- although in about `0% of cases, it occurs in the absence of gallstones

22
Q

what is a risk factor for gallbladder cancer?

A

gallstones

NOTE: typically gallbladder cancers are detected late because nonspecific symptoms and hence carry a poor prognosis

23
Q

what is the most common reason for emergency cholecystectomy?

A

acute calculous cholecystitis

24
Q

what is a reversible form of pancreatic parenchymal injury associated with inflammation?

A

acute pancreatitis

25
Q

what are the risk factors for acute pancreatitis?

A
  • excessive alcohol intake
  • pancreatic duct obstruction
  • genetic factors (PRSS1, SPINK1)
  • traumatic injuries
  • meds
  • infection
  • metabolic disorders -> hypercalcemia
  • ischemia
26
Q

fibrous, atrophy, dropout of acini, and variable dilation of pancreatic ducts

  • the gland is hard, sometimes with visibly dilated ducts containing calcified concretions
  • chronic inflammatory infiltrate around lobules and ducts
  • ductal epithelium may be atrophied or hyperplastic, or may show squamous metaplasia
  • acinar loss
  • usually a relative sparing of islets of Langerhans
  • when caused by alcohol abuse, ductal dilation and intraluminal protein plugs with calcifications are seen
A

chronic pancreatitis

27
Q

duct-centric mixed inflammatory cell infiltrate, venulitis, and increased numbers of IgG4-secreting plasma cells

A

autoimmune pancreatitis

28
Q

irreversible injury of the pancreas leading to fibrosis, loss of pancreatic parenchyma, loss of exocrine and endocrine function, and high risk of developing pseudocysts

A

chronic pancreatitis

29
Q

what are the most common causes of chronic pancreatitis?

A
  • repeated bouts of acute pancreatitis
  • chronic alcohol abuse
  • germline mutations in CFTR (CF!), especially when combined with environmental stressors
30
Q

usually solitary, may be situated within the pancreas, or more commonly in the lesser omental sac or in the retroperitoneum between the stomach and transverse colon or between the stomach and transverse colon, or between stomach and liver (can also be sub-diaphragmatic)
- form when areas of intra-pancreatic hemorrhagic fat necrosis are walled off by fibrous tissue and granulation tissue

A

pseudocytsts

31
Q

virtually all serous cystic pancreatic neoplasms are what?

A

benign

32
Q

curable noninvasive cystic neoplasms that can progress to incurable invasive carcinoma

A

intra-ductal papillary mucinous neoplasms

33
Q

where do approximately 60% of cancers of the pancreas arise?

A

in the head

  • 15% in the body
  • 5% in the tail
  • 20% diffusely involve the entire gland
34
Q

the vast majority of pancreatic carcinomas are what?

A

ductal adenocarcinomas that recapitulate to some degree normal ductal epithelium by forming glands and secreting mucin

35
Q

what are two characteristic features of pancreatic cancer?

A
  • they are highly invasive (even “early” cancers invade peripancreatic tissue)
  • elicits an intense host reaction in the form of dense fibrosis (desmoplastic response)
36
Q

what do most carcinomas of the head of the pancreas obstruct?

A

the distal common bile duct

37
Q

what is the consequence of a blocked common bile duct?

A

marked distention of the biliary tree in about 50% of patients
- most develop jaundice

38
Q

what is the difference between carcinoma of the head vs the body and tail of the pancreas?

A

carcinomas of the body and tail do not impinge on the biliary tract and hence remain silent for some time
- they may be quite large and most are widely disseminated by the time they are discovered

39
Q

where do pancreatic cancers often grow along and invade?

A

nerves, and invade into blood vessels and the retroperitoneum
- they can directly invade the spleen, adrenals, transverse colon, and stomach

40
Q

what lymph nodes are frequently involved in pancreatic cancer?

A

peripancreatic, gastric, mesenteric, omental, and portohepatic

41
Q

where does distant metastasis occur in pancreatic cancer?

A

liver and lungs

42
Q

moderately to poorly differentiated adenocarcinoma forming abortive tubular structures or cell clusters, show what kind of growth pattern?

A

aggressive, deeply infiltrative growth pattern

43
Q

malignant glands are poorly formed and are usually lined by pleomorphic cuboidal-columnar epithelial cells
- what type of pancreatic cancer is the exception to this?

A

well-differentiated carcinoma

44
Q

what is the leading preventable cause of pancreatic cancer?

A

cigarette smoking

45
Q

what is a pancreatic intraepithelial neoplasia?

A

well-defined precursor lesion that can give rise to pancreatic cancer

46
Q

what illicit an intense desmoplastic response?

A

ductal adenocarcinomas

47
Q

what are the genes most frequently mutated or otherwise altered in pancreatic cancer?

A

KRAS, p16/CDKN2A, TP53, SMAD4

48
Q

how to most patients with pancreatic cancer present clinically?

A

abdominal pain, weight loss

  • sometimes accompanied by jaundice and DVT
  • succumb to the disease within 1-2 years

GI 2 Exam 1 (22 decks)

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