GI Pathology 2

Question 1

cholelithiasis - pathogenesis

Answer 1

*precipitation of cholesterol or bilirubin
*decreased phospholipids/bile acids
*stasis

Question 2

acute cholecystitis

Answer 2

*inflamed gallbladder due to duct obstruction (gallbladder neck usually)
*RUQ pain, fever, nausea, vomiting
*acute chemical irritation/inflammation (thick hemorrhagic wall; fibrin, pus, gangrenous necrosis)

Question 3

chronic cholecystitis

Answer 3

*inflamed gallbladder due to chemical irritation (long-standing cholelithiasis)
*POSTPRAINDIAL RUQ pain to right shoulder
*chronic inflammation -> fibrosis & Rokitansky-Aschoff (RA) sinuses penetrate muscularis
*calcifications -> porcelain gallbladder

Question 4

acute pancreatitis

Answer 4

*reversible pancreatic parenchymal injury associated with inflammation & hemorrhage
*autodigestion due to release of pancreatic enzymes (trypsin)
*causes: gallstones, alcohol, etc

Question 5

acute pancreatitis - clinical presentation

Answer 5

*sudden calamitous onset - “acute abdomen”
*pain, nausea/vomiting
*flank hemorrhage

Question 6

acute pancreatitis - lab findings

Answer 6

*elevated serum lipase & amylase
*hypocalcemia - calcification of fat/saponification

Question 7

acute pancreatitis - pathology

Answer 7

*hemorrhage
*saponification (fat necrosis) - liquefactive necrosis of parenchyma

Question 8

acute pancreatitis - complications

Answer 8

*SHOCK, DIC/SIRS/ARDS
*pseudocyst formation
*chronic pancreatitis (repeated bouts)

Question 9

chronic pancreatitis

Answer 9

*irreversible destruction of exocrine parenchyma and fibrosis from prolonged inflammation
*causes = ALCHOL

Question 10

chronic pancreatitis - pathology

Answer 10

*FIBROSIS with maintenance of lobular growth
*atrophic exocrine glands
*dystrophic calcifications

Question 11

chronic pancreatitis - complications

Answer 11

*pseudocysts
*CARCINOMA

Question 12

pancreatic carcinoma

Answer 12

*malignancy of pancreatic duct epithelium

Question 13

pancreatic carcinoma - epidemiology

Answer 13

*4th leading cause of cancer deaths in US
*predominantly in the elderly
*risk factors = SMOKING, chronic pancreatitis, diets high in fats

Question 14

pancreatic carcinoma - pathogenesis

Answer 14

*stepwise evolution from precursor lesions
*multiple genes are somatically mutated or epigenetically silenced

Question 15

pancreatic carcinoma - clinical presentation

Answer 15

*silent until they invade into adjacent structures
*epigastric pain
*weight loss, anorexia
*jaundice
*pale stools
*diabetes mellitus

Question 16

pancreatic carcinoma - labs

Answer 16

elevated CA 19-9

Question 17

pancreatic carcinoma - pathology

Answer 17

*head > body > tail
*ill-defined, invasive ducts with fibrosis
*destruction of normal architecture
*metastatic to liver, lymph nodes

Question 18

Trousseau Sign of Malignancy

Answer 18

*visceral malignancy induces generalized HYPERcoagulable state - thrombosis occurs elsewhere in the body, e.g. extremities
*early sign of gastric and pancreatic carcinoma
*recurrent episodes of vessel inflammation from blood clot (thrombophlebitis)