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NYCC Visceral Pathology > Gallbladder & Pancreas Pathology > Flashcards

Gallbladder & Pancreas Pathology Flashcards

1
Q

What is a cholelithiasis?

A

Gall stone

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2
Q

In industrialized nations, 75% of gallstones are ____

A

Cholesterol based/unpigmented

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3
Q

Cholesterol based gall stones are ____

A

Unpigmented

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4
Q

Bile-salt based gall stones are ____

A

Pigmented

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5
Q

Pigmented or bile-salt gall stones are more common in what region?

A

Tropics

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6
Q

What is biliary colic?

A
  • waxing and waning right upper quadrant pain (Murphy’s point)
  • due to stone lodged in cystic duct
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7
Q

What point is associated with a gall stone and where is it located?

A

Murphy’s point in the RUQ of the abdomen

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8
Q

What are the four Fs of a cholelithiasis?

A

Female
Forty
Fat
Fertile

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9
Q

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?

A

Cholelithiasis

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10
Q

What is a choledocholithiasis?

A

Gallstone in the common bile duct

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11
Q

What is acute cholecystitis?

A

Acute inflammation of the gall bladder wall

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12
Q

What is the pathogenesis of acute cholecystitis?

A

Impacted stone in the cystic duct results in dilation with pressure ischemia

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13
Q

What are the clinical features of acute cholecystitis?

A
  • RUQ pain, often radiating to R scap
  • fever
  • ^WBC
  • nausea, vomiting
  • risk of rupture if untreated
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14
Q

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?

A

Acute cholecystitis

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15
Q

Porcelain gallbladder is a late complication of what pathology?

A

Chronic cholecystitis

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16
Q

What is porcelain gallbladder and what can it lead to?

A
  • shrunken, hard gallbladder due to chronic inflammation, fibrosis, & dystrophic Ca.
  • may lead to cholangio adenocarcinoma (cancer of gallbladder)
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17
Q

What are the clinical features of chronic cholecystitis?

A
  • Hx of longstanding cholelithiasis w/ or w/out superimposed bouts of acute cholecystitis
  • vague RUQ pain, especially after eating
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18
Q

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?

A

Chronic cholecystitis

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19
Q

What are the etiologies of acute pancreatitis?

A

Ethanol and duct obstruction

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20
Q

How does duct obstruction cause acute pancreatitis?

A

Reflux of enzymes into the pancreas from the major duodenal papilla being obstructed

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21
Q

What are the clinical features of acute pancreatitis?

A
  • 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
22
Q

What type of jaundice is associated with acute pancreatitis?

A

Post-hepatic jaundice

23
Q

What pattern of necrosis is present in pancreatitis?

A

Enzymatic fat necrosis

24
Q

What are the histological findings in a patient with acute pancreatitis?

A

Enzymatic fat necrosis and suponification with dystrophic calcification

25
Q

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?

A

Acute pancreatitis

26
Q

The main etiology of chronic pancreatitis is ____

A

Chronic alcoholism

27
Q

What pathologies is chronic pancreatitis associated with?

A

Progressive systemic sclerosis (scleroderma) and cystic fibrosis

28
Q

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?

A

Chronic pancreatitis is causing the pain and it is caused by cystic fibrosis

29
Q

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?

A

Chronic pancreatitis is causing the pain and it is caused by progressive systemic sclerosis (scleroderma)

30
Q

The islets of langerhan are associated with what organ?

A

Pancreas

31
Q

A ductal adenocarcinoma is an (Exocrine/Endocrine) pancreatic carcinoma?

A

Exocrine

32
Q

Putz-Jeghers syndrome can predispose a person to what pathology?

A

Pancreatic adenocarcinoma
(^polyps everywhere)

33
Q

What part of the pancreas are ductal carcinomas most common?

A

Head

34
Q

What are the clinical features of a pancreatic adenocarcinoma?

A
  • anorexia
  • wt loss & cachexia
  • jaundice (due to duct obstruction)
35
Q

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?

A

Pancreatic adenocarcinoma

36
Q

Endocrine neoplasias of the pancreas are derived from what cells?

A

Islet cells

37
Q

What will be evident in the blood of a patient with a glucagonoma?

A

Hyperglycemia

38
Q

A glucagonoma is derived from what cells?

A

a-cells

39
Q

What will be evident in the blood of a patient with an insulinoma?

A

Hypoglycemia

40
Q

An insulinoma is derived from what cells?

A

beta-cells

41
Q

What are the signs and symptoms of an insulinoma?

A

hypoglycemia:
- confusion
- blurred vision
- sweating
- muscle weakness
- palpitations

42
Q

A VIPoma is derived from what cells?

A

ectopic cells

43
Q

What is a VIPoma and what will it cause?

A
  • 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
44
Q

A person with a gastrinoma will have what syndrome?

A

Zollinger-Ellison syndrome

45
Q

A gastrinoma is derived from what cells?

A

G-cells

46
Q

What do G-cells secrete?

A

Gastrin (tells stomach to ^HCl)

47
Q

What are the signs and symptoms of Zollinger-Ellison syndrome?

A

^HCl leading to peptic ulcer disease unresponsive to medication

48
Q

A somatostatinoma is derived from what cells?

A

delta-cells

49
Q

What do delta-cells secrete?

A

somatostatin

50
Q

somatostatin is a ____ antagonist

A

GH
(also shuts down other functions of ant. pit.)

51
Q

What are the signs and symptoms of a somatostatinoma?

A
  • achlorhydria (low HCl) –> ^gastric infections
  • cholelithiasis
  • diabetes
  • steatorrhea (bulky, fatty, foul-smelling stools)

NYCC Visceral Pathology (40 decks)

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