H - Pancreas And Gallbladder Flashcards
Which pancreas cells secrete enzymes
Acinar
Name another type of cell in the pancreas
Islets of langerhan
Ducts
Define pancreatitis
Inflammation due to aberrant release of pancreatic enzymes
5 groups of Causes of pancreatitis
Duct obstruction
Metabolic / toxic
Poor blood supply
Infection / inflammation
Autoimmune / idiopathic
Duct obstruction causes of pancreatitis
Gallstones
Trauma
Tumours
Metabolic causes of pancreatitis
Alcohol
Drugs eg thiazides
High calcium
Hyperlipidaemia
Poor blood supply causes of pancreatitis
Shock
Hypothermia
Infectious cause of pancreatitis
Mumps
2 main causes of pancreatitis
Gallstones 50%
Alcohol 33%
Pathogenesis of gallstones causing pancreatitis
Gallstone distal to CBD and PD join
Leads to bile reflux into PD - damage to acini
Proenzymes released which are activated
Pathogenesis of alcohol causing pancreatitis
Spasm / oedema of sphincter of oddi
Formation of protein rich pancreatic fluid - obstructs PD
3 patterns of injury of acute pancreatitis (location) & what causes each
Periductal - necrosis of acinar near ducts post obstruction
Perilobular - necrosis at edge of lobules due to poor blood supply
Panlobular - after the above 2
What is the real problem with pancreatitis in terms of doing the damage
Activated enzymes cause acinar necrosis and enzyme release
Ranges from Stromal oedema to haemorrhagic necrosis
What do yellow - white foci on pancreas indicate and why
Fat necrosis
Lipases necrose fat causing Ca to bind FFA forming white soaps
Complications of pancreatitis
Pseudocyst
Abscess
Shock
Hypoglycaemia
Low Ca
Mortality in haemorrhagic pancreatitis
50%
What can you see on histology of acute pancreatitis
White deposits that stain blue under scope / stain
Define chronic pancreatitis
Relapsing / persistent pancreatitis
Associated w acute in half cases
Causes of chronic pancreatitis inc most common cause
Alcohol 80%
Hameochromotosis
Gallstones (rare)
Abnormal PD anatomy
CF
Tumours
Autoimmune / idiopathic
Describe pattern of injury of chronic pancreatitis
Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones & secondary dilatation
Complications of chronic panc
Malabsorption
DM
Pseudocysts
Carcinoma of panc (?unproven)
Order of loss of function of pancreas once blood supply cut off
Fibrosis
Loss of acini func
Loss of endocrine func
Describe structure of pancreatic pseudocyst
Lined by fibrous tissue - NO EPITHELIAL LINING
Fluid inside w pancreatic enzymes / necrotic material
Where do pseudocysts connect to
PD
Fate of pseudocysts (4)
Resolve
Compress adjacent structures
Infected
Perforate
What Ig is AI pancreatitis associated with
IgG4
What is AI pancreatitis characterised by
IgG4+ plasma cells
How does AI pancreatitis stain and why
Brown - IgG4
Tx for AI pancreatitis
Steroids
3 Types and 2 subtypes of each for pancreatic cancer
Carcinomas - ductal / acinar
Cystic neoplasm - serous / mucinous cystadenoma
Neuro endocrine -islet cell tumours or insulinomas
Most common type of pancreatic cancer
Ductal carcinoma 85%
Where are ductal carcinomas of pancreas mainly found
Head 60%
Tail
Prognosis of ductal carcinoma of pancreas
5% 5 year survival
Macroscopic appearance of ductal carcinoma of pancreas
Gritty and grey
Microscopic appearance of ductal carcinoma of pancreas
Mucin secreting glands set in desmoplastic stroma
2 types of precancerous ductal carcinoma of pancreas
PanIM - pancreatic introductal neoplasm
IMPN - intraductal mucinous papillary neoplasm
What is raised in 95% of precancerous ductal carcinoma of pancreas
K RAS
RFs for ductal carcinoma of pancreas
Older
Male
Smoking
Chronic pancreatitis
High BMI and poor diet
DM
How and to where do ductal carcinoma of pancreas spread
Blood and lymphatics
Duodenum, liver, peritoneum
Complications of spread of ductal carcinoma of pancreas
Chronic pancreatitis
Venous thrombosis (migratory thrombophlebitis)
What other organs has cystic neoplasms & why
Ovary - also contains serous / mucinous epithelium
Neuroendocrine marker of islet cell tumour
Chromogranin
Are neuroendocrine tumours secretory
No not usually but they can be (insulinoma)
What syndrome can neuroendocrine pancreatic tumours be associated with
MEN1
Where do insulinomas come from and what do they do
From b cells
Secrete insulin
Prevalence of gall stones in the west
20% of adults have them
RFs for gallstones
Women
Older
Native Americans
COCP
Rapid weight loss
Disorders of bile metabolism
2 types of gall stones
Cholesterol
Pigmented
Which type of gallstones occur singularly vs multiples
Single = cholesterol
Multiple = pigment
Which type of gallstones are radio opaque / radiolucent
Opaque = pigment
Lucent = cholesterol
Components of each type of gallstone
Pigment = calcium salts of unconj BR
Cholesterol = >50% cholesterol
Complications of gallstones
Obstruction of bile duct
Acute / chronic cholecystitis
Gall bladder cancer
Pancreatitis
90% of acute cholecystitis is associated with what ?
Gallstones
What are 10% of acute cholecystitis cases associated with
Infections like Typhoid etc
Hallmark of chronic cystitis
Fibrosis leading to very thickened gallbladder wall
What are gall bladder diverticula called
Rokitanksy Aschoff sinuses
What do Rokitanksy Aschoff sinuses look like
Black circles
Outpouching into walls
90% of adenocarcinomas of the gall bladder are associated with what
Gallstones
90% of chronic cholecystitis cases are associated with what
Gallstones
