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Pathology > H - Pancreas And Gallbladder > Flashcards

H - Pancreas And Gallbladder Flashcards

1
Q

Which pancreas cells secrete enzymes

A

Acinar

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2
Q

Name another type of cell in the pancreas

A

Islets of langerhan
Ducts

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3
Q

Define pancreatitis

A

Inflammation due to aberrant release of pancreatic enzymes

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4
Q

5 groups of Causes of pancreatitis

A

Duct obstruction
Metabolic / toxic
Poor blood supply
Infection / inflammation
Autoimmune / idiopathic

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5
Q

Duct obstruction causes of pancreatitis

A

Gallstones
Trauma
Tumours

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6
Q

Metabolic causes of pancreatitis

A

Alcohol
Drugs eg thiazides
High calcium
Hyperlipidaemia

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7
Q

Poor blood supply causes of pancreatitis

A

Shock
Hypothermia

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8
Q

Infectious cause of pancreatitis

A

Mumps

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9
Q

2 main causes of pancreatitis

A

Gallstones 50%
Alcohol 33%

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10
Q

Pathogenesis of gallstones causing pancreatitis

A

Gallstone distal to CBD and PD join
Leads to bile reflux into PD - damage to acini
Proenzymes released which are activated

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11
Q

Pathogenesis of alcohol causing pancreatitis

A

Spasm / oedema of sphincter of oddi
Formation of protein rich pancreatic fluid - obstructs PD

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12
Q

3 patterns of injury of acute pancreatitis (location) & what causes each

A

Periductal - necrosis of acinar near ducts post obstruction
Perilobular - necrosis at edge of lobules due to poor blood supply
Panlobular - after the above 2

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13
Q

What is the real problem with pancreatitis in terms of doing the damage

A

Activated enzymes cause acinar necrosis and enzyme release
Ranges from Stromal oedema to haemorrhagic necrosis

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14
Q

What do yellow - white foci on pancreas indicate and why

A

Fat necrosis
Lipases necrose fat causing Ca to bind FFA forming white soaps

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15
Q

Complications of pancreatitis

A

Pseudocyst
Abscess
Shock
Hypoglycaemia
Low Ca

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16
Q

Mortality in haemorrhagic pancreatitis

A

50%

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17
Q

What can you see on histology of acute pancreatitis

A

White deposits that stain blue under scope / stain

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18
Q

Define chronic pancreatitis

A

Relapsing / persistent pancreatitis
Associated w acute in half cases

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19
Q

Causes of chronic pancreatitis inc most common cause

A

Alcohol 80%
Hameochromotosis
Gallstones (rare)
Abnormal PD anatomy
CF
Tumours
Autoimmune / idiopathic

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20
Q

Describe pattern of injury of chronic pancreatitis

A

Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones & secondary dilatation

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21
Q

Complications of chronic panc

A

Malabsorption
DM
Pseudocysts
Carcinoma of panc (?unproven)

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22
Q

Order of loss of function of pancreas once blood supply cut off

A

Fibrosis
Loss of acini func
Loss of endocrine func

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23
Q

Describe structure of pancreatic pseudocyst

A

Lined by fibrous tissue - NO EPITHELIAL LINING
Fluid inside w pancreatic enzymes / necrotic material

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24
Q

Where do pseudocysts connect to

A

PD

25
Q

Fate of pseudocysts (4)

A

Resolve
Compress adjacent structures
Infected
Perforate

26
Q

What Ig is AI pancreatitis associated with

A

IgG4

27
Q

What is AI pancreatitis characterised by

A

IgG4+ plasma cells

28
Q

How does AI pancreatitis stain and why

A

Brown - IgG4

29
Q

Tx for AI pancreatitis

A

Steroids

30
Q

3 Types and 2 subtypes of each for pancreatic cancer

A

Carcinomas - ductal / acinar
Cystic neoplasm - serous / mucinous cystadenoma
Neuro endocrine -islet cell tumours or insulinomas

31
Q

Most common type of pancreatic cancer

A

Ductal carcinoma 85%

32
Q

Where are ductal carcinomas of pancreas mainly found

A

Head 60%
Tail

33
Q

Prognosis of ductal carcinoma of pancreas

A

5% 5 year survival

34
Q

Macroscopic appearance of ductal carcinoma of pancreas

A

Gritty and grey

35
Q

Microscopic appearance of ductal carcinoma of pancreas

A

Mucin secreting glands set in desmoplastic stroma

36
Q

2 types of precancerous ductal carcinoma of pancreas

A

PanIM - pancreatic introductal neoplasm
IMPN - intraductal mucinous papillary neoplasm

37
Q

What is raised in 95% of precancerous ductal carcinoma of pancreas

A

K RAS

38
Q

RFs for ductal carcinoma of pancreas

A

Older
Male
Smoking
Chronic pancreatitis
High BMI and poor diet
DM

39
Q

How and to where do ductal carcinoma of pancreas spread

A

Blood and lymphatics
Duodenum, liver, peritoneum

40
Q

Complications of spread of ductal carcinoma of pancreas

A

Chronic pancreatitis
Venous thrombosis (migratory thrombophlebitis)

41
Q

What other organs has cystic neoplasms & why

A

Ovary - also contains serous / mucinous epithelium

42
Q

Neuroendocrine marker of islet cell tumour

A

Chromogranin

43
Q

Are neuroendocrine tumours secretory

A

No not usually but they can be (insulinoma)

44
Q

What syndrome can neuroendocrine pancreatic tumours be associated with

A

MEN1

45
Q

Where do insulinomas come from and what do they do

A

From b cells
Secrete insulin

46
Q

Prevalence of gall stones in the west

A

20% of adults have them

47
Q

RFs for gallstones

A

Women
Older
Native Americans
COCP
Rapid weight loss
Disorders of bile metabolism

48
Q

2 types of gall stones

A

Cholesterol
Pigmented

49
Q

Which type of gallstones occur singularly vs multiples

A

Single = cholesterol
Multiple = pigment

50
Q

Which type of gallstones are radio opaque / radiolucent

A

Opaque = pigment
Lucent = cholesterol

51
Q

Components of each type of gallstone

A

Pigment = calcium salts of unconj BR
Cholesterol = >50% cholesterol

52
Q

Complications of gallstones

A

Obstruction of bile duct
Acute / chronic cholecystitis
Gall bladder cancer
Pancreatitis

53
Q

90% of acute cholecystitis is associated with what ?

A

Gallstones

54
Q

What are 10% of acute cholecystitis cases associated with

A

Infections like Typhoid etc

55
Q

Hallmark of chronic cystitis

A

Fibrosis leading to very thickened gallbladder wall

56
Q

What are gall bladder diverticula called

A

Rokitanksy Aschoff sinuses

57
Q

What do Rokitanksy Aschoff sinuses look like

A

Black circles
Outpouching into walls

58
Q

90% of adenocarcinomas of the gall bladder are associated with what

A

Gallstones

59
Q

90% of chronic cholecystitis cases are associated with what

A

Gallstones

Pathology (87 decks)

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