Gallbladder & Pancreas Pathology Flashcards
What is a cholelithiasis?
Gall stone
In industrialized nations, 75% of gallstones are ____
Cholesterol based/unpigmented
Cholesterol based gall stones are ____
Unpigmented
Bile-salt based gall stones are ____
Pigmented
Pigmented or bile-salt gall stones are more common in what region?
Tropics
What is biliary colic?
- waxing and waning right upper quadrant pain (Murphy’s point)
- due to stone lodged in cystic duct
What point is associated with a gall stone and where is it located?
Murphy’s point in the RUQ of the abdomen
What are the four Fs of a cholelithiasis?
Female
Forty
Fat
Fertile
A 40 year old female patient named Samantha presents to your office complaining of right upper quadrant pain. She has 7 kids. She is 5’2 and weights 190 pounds which she blames on children number 4-7. A radiograph of the thoracolumbar region shows a bag of jewels in the right upper quadrant. What is the likely diagnosis?
Cholelithiasis
What is a choledocholithiasis?
Gallstone in the common bile duct
What is acute cholecystitis?
Acute inflammation of the gall bladder wall
What is the pathogenesis of acute cholecystitis?
Impacted stone in the cystic duct results in dilation with pressure ischemia
What are the clinical features of acute cholecystitis?
- RUQ pain, often radiating to R scap
- fever
- ^WBC
- nausea, vomiting
- risk of rupture if untreated
35 year old female patient presents to your office with upper right quadrant pain and right shoulder pain on the back of her right scapula. She is febrile and nauseous. A CBC shows 82% neutrophils and 14,000 WBCs. What is the likely diagnosis?
Acute cholecystitis
Porcelain gallbladder is a late complication of what pathology?
Chronic cholecystitis
What is porcelain gallbladder and what can it lead to?
- shrunken, hard gallbladder due to chronic inflammation, fibrosis, & dystrophic Ca.
- may lead to cholangio adenocarcinoma (cancer of gallbladder)
What are the clinical features of chronic cholecystitis?
- Hx of longstanding cholelithiasis w/ or w/out superimposed bouts of acute cholecystitis
- vague RUQ pain, especially after eating
56 year old female patient presents to your office complaining of diffuse upper right quadrant pain that comes and goes. When asked what bring on the pain she is not positive but notes that it does get worse after she eats. Radiograph of the thoracolumbar region reveals fibrosis and dystrophic calcification present on the quadrate lobe (inferior surface) of the liver. What is the likely diagnosis?
Chronic cholecystitis
What are the etiologies of acute pancreatitis?
Ethanol and duct obstruction
How does duct obstruction cause acute pancreatitis?
Reflux of enzymes into the pancreas from the major duodenal papilla being obstructed
What are the clinical features of acute pancreatitis?
- severe lancinating epigastric pain that refers to the back
- nausea, vomiting
- ^serum amylase & lipase
- if pt has gallstones w/ duct obstruction, will have post-hepatic jaundice & ^risk of acute pancreatitis
What type of jaundice is associated with acute pancreatitis?
Post-hepatic jaundice
What pattern of necrosis is present in pancreatitis?
Enzymatic fat necrosis
What are the histological findings in a patient with acute pancreatitis?
Enzymatic fat necrosis and suponification with dystrophic calcification
25 year old male patient presents to your office complaining of pain that feels stabby in the middle of his stomach just below his xiphoid process. The patient has been on a drinking bender for a 3 day bachelor party and just couldn’t take the pain anymore. He was vomiting all morning and had to come in for treatment today. Blood test shows elevated serum amylase and lipase levels. Biopsy of the pancreas reveals a “soap-like” presentation with enzymatic fat necrosis present. What is the likely diagnosis?
Acute pancreatitis
The main etiology of chronic pancreatitis is ____
Chronic alcoholism
What pathologies is chronic pancreatitis associated with?
Progressive systemic sclerosis (scleroderma) and cystic fibrosis
7 year old male patient presents to your office with frequent attacks of epigastric pain. The patient has a history of defective chloride channels and thus has viscous secretions of sweat and other fluids. He was diagnosed with COPD by the time he was 2 years old. What is the cause of this patients epigastric pain and what is causing the pain?
Chronic pancreatitis is causing the pain and it is caused by cystic fibrosis
37 year old male patient presents to your office with frequent attacks of epigastric pain. Upon physical screening you notice the patient has decreased ROM in their hands as they are stuck in a claws like position. The patient also reports difficulty swallowing. You notice on their skin that parts of it are shiny and cold to the touch. What is the likely cause of this patients epigastric pain and what is causing the epigastric pain?
Chronic pancreatitis is causing the pain and it is caused by progressive systemic sclerosis (scleroderma)
The islets of langerhan are associated with what organ?
Pancreas
A ductal adenocarcinoma is an (Exocrine/Endocrine) pancreatic carcinoma?
Exocrine
Putz-Jeghers syndrome can predispose a person to what pathology?
Pancreatic adenocarcinoma
(^polyps everywhere)
What part of the pancreas are ductal carcinomas most common?
Head
What are the clinical features of a pancreatic adenocarcinoma?
- anorexia
- wt loss & cachexia
- jaundice (due to duct obstruction)
47 year old male patient presents to your office complaining of epigastric pain. He is extremely gaunt and yellow. He reports that he has lost 30 pounds in the last two months without really doing anything different from his normal routine. A needle aspiration of the pancreas shows poorly differentiated glands with a fern-leaf pattern. What is the likely diagnosis?
Pancreatic adenocarcinoma
Endocrine neoplasias of the pancreas are derived from what cells?
Islet cells
What will be evident in the blood of a patient with a glucagonoma?
Hyperglycemia
A glucagonoma is derived from what cells?
a-cells
What will be evident in the blood of a patient with an insulinoma?
Hypoglycemia
An insulinoma is derived from what cells?
beta-cells
What are the signs and symptoms of an insulinoma?
hypoglycemia:
- confusion
- blurred vision
- sweating
- muscle weakness
- palpitations
A VIPoma is derived from what cells?
ectopic cells
What is a VIPoma and what will it cause?
- Vascular intestinal peptide tumor in endocrine pancreas
- ^VIP secretion –> ^vasodilation of gut –> ^leaky gut (fluid & electrolytes lost in stool)
- “Pancreatic cholera” or severe life-threatening diarrhea
A person with a gastrinoma will have what syndrome?
Zollinger-Ellison syndrome
A gastrinoma is derived from what cells?
G-cells
What do G-cells secrete?
Gastrin (tells stomach to ^HCl)
What are the signs and symptoms of Zollinger-Ellison syndrome?
^HCl leading to peptic ulcer disease unresponsive to medication
A somatostatinoma is derived from what cells?
delta-cells
What do delta-cells secrete?
somatostatin
somatostatin is a ____ antagonist
GH
(also shuts down other functions of ant. pit.)
What are the signs and symptoms of a somatostatinoma?
- achlorhydria (low HCl) –> ^gastric infections
- cholelithiasis
- diabetes
- steatorrhea (bulky, fatty, foul-smelling stools)
