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YEAR 5: Histopathology AS > Histo: Diseases of the Pancreas and Gallbladder > Flashcards

Histo: Diseases of the Pancreas and Gallbladder Flashcards

1
Q

What are the main components of the exocrine part of the pancreas?

A

Acini (secrete enzymes) and ducts

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2
Q

Define acute pancreatitis.

A

Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes

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3
Q

List some causes of acute pancreatitis.

A
  • Duct obstruction (gallstones 50%, tumour, trauma)
  • Metabolic/toxic (alcohol 33%, drugs, hypercalcaemia, hyperlipidaemia)
  • Poor blood supply (shock, hypothermia)
  • Infection/inflammation (viruses e.g. mumps)
  • Autoimmune (IgG4)
  • Idiopathic
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4
Q

Which drug to ask about in acute pancreatitis?

A

thiazide- very common

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5
Q

Describe how alcohol can cause acute pancreatitis.

A

It leads to spasm/oedema of the sphincter of Oddi and the formation of protein-rich pancreatic fluid which is thick and causes an obstruction

NOTE: most other causes of acute pancreatitis will do so via direct acinar injury

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6
Q

Patterns of injury and their causes

A

periductal: necrosis near duct- obstruction
perilobular: near edge of lobules- blood supply
panlobula: severe

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7
Q

How does gallstone obstruction cause pancreatitis?

A

obstruction of the common bile duct, reflux into the acini causing damage

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8
Q

Describe the three main patterns of injury in acute pancreatitis and describe what they result from.

A
  • Periductal - necrosis of acinar cells near ducts (usually secondary to obstruction)
  • Perilobular - necrosis at the edges of the lobules (usually due to poor blood supply)
  • Panlobular - results from worsening periductal or perilobular inflammation
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9
Q

Outline the pathway of inflammation in acute pancreatitis.

A

Activated enzymes → acinar necrosis → release of more enzymes

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10
Q

What is saponification?

A
  • Lipases break down fats to release free fatty acids
  • Calcium binds to the free fatty acids forming soaps (yellow-white foci)- fat necrosis
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11
Q

List some complications of acute pancreatitis.

A
  • Pseudocyst formation, abscesses
  • Shock
  • Hypoglycaemia
  • Hypocalcaemia

prognosis mortality up to 50% for haemorrhagic panc

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12
Q

Define pseudocyst.

A
  • A collection of fluid without an epithelial lining
  • They are rich in pancreatic enzymes and necrotic material
  • They are lined by fibrous tissue
  • connect with pancreatic ducts

NOTE: they may resolve, compress adjacent structures, become infected or perforate

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13
Q

List some causes of chronic pancreatitis.

A
  • Metabolic/Toxic: alcohol (80%), haemochromatosis
  • Duct obstruction: gallstones, abnormal anatomy, cystic fibrosis (mucoviscoidosis)
  • Tumours
  • Idiopathic
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14
Q

Outline the pattern of injury in chronic pancreatitis.

A
  • Chronic inflammation with parenchymal fibrosis and loss of parenchyma
  • There will be duct strictures with calcified stones with secondary dilatations
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15
Q

List some complications of chronic pancreatitis.

A
  • Malabsorption
  • Diabetes mellitus
  • Pseudocysts
  • Pancreatic carcinoma
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16
Q

What is the characteristic feature of autoimmune pancreatitis?

A

Large numbers of IgG4 positive plasma cells typically found around the ducts

17
Q

How is autoimmune pancreatitis treated?

A

Steroids - usually responds well

18
Q

What are the two types of pancreatic cancer and which is more common?

A
  • Ductal (85%), 5% cancer deaths, 2M: 1F, 5% 5 year survival
  • Acinar (15%)

NOTE: many ductal carcinomas may actually arise from acini after a process called acini-ductal metaplasia (these ductal carcinomas have a different natural history to truly ductal carcinomas)

also cystic neoplasms and pancreatic neuroendocrine tumours

19
Q

Name two types of cystic neoplasm of the pancreas.

A
  • Serous cystadenoma
  • Mucinous cystadenoma
20
Q

List some risk factors for pancreatic cancer.

A
  • Smoking
  • BMI and dietary factors
  • Chronic pancreatitis
  • Diabetes mellitus
21
Q

Name two types of dysplastic precursor lesion that ductal carcinoma can arise from.

A
  • Pancreatic intraductal neoplasia (PanIN)
  • Intraductal mucinous papillary neoplasm
22
Q

Which mutation is very common in pancreatic cancer?

A

K-ras (95%)

23
Q

Describe the macroscopic appearance of ductal carcinoma?

A

Gritty and grey

Invades adjacent structures

NOTE: tumours in the head of the pancreas present earlier

24
Q

Describe the microscopic appearance of ductal carcinoma.

A
  • Adenocarcinomas (secrete mucin and form glands)
  • Mucin-secreting glands are set in desmoplastic stroma
25
Q

What is the most common site of ductal carcinoma?

A

Head (60%)

NOTE: neuroendocrine tumours are more common in the tail

body, tail, diffuse - other sites

26
Q

How do ductal carcinomas spread?

A

lots of ways but perineural also an option

27
Q

What are the usual sites of metastasis of ductal carcinoma?

A
  • Direct: bile ducts, duodenum
  • Lymph nodes
  • Blood: liver
  • Serosa: peritoneum
28
Q

List some complications of ductal carcinoma.

A
  • Metastasis
  • Chronic pancreatitis
  • Venous thrombosis (migratory thrombophlebitis)
29
Q

By what mechanism does pancreatic cancer cause migratory thrombophlebitis?

A
  • Circulating pancreatic cancer cells release mucous which activates the clotting cascade
30
Q

List some key features of pancreatic neuroendocrine neoplasms.

A
  • Usually non-secretory
  • Contains neuroendocrine markers (e.g. chromogranin - can be measured as a screening test for neuroendocrine tumours)
  • May be associated with MEN1
31
Q

What is the most common type of functional neuroendocrine tumour?

A

Insulinoma
commonest type of secretory tumour

32
Q

List some factors that increase the likelihood of developing gallstones.

A
  • Age- older
  • Gender (females)
  • Ethnic factors- native americans
  • Hereditary- disorder of bile metabolism
  • Drugs (e.g. oral contraceptive)
  • acquired disorders- rapid weight loss
33
Q

What are the two types of gallstone and what are their distinguishing features?

A
  • Cholesterol
    • May be single
    • Mostly radiolucent (NOT seen on AXR)
    • More than 50% cholesterol
  • Pigment
    • Often multiple
    • Contain calcium salts of unconjugated bilirubin
    • Mostly radio-opaque
34
Q

List some complications of gallstones.

A
  • Most are asymptomatic
  • Bile duct obstruction
  • Acute and chronic cholecystitis
  • Gallbladder cancer
  • Pancreatitis
35
Q

Acute cholecystitis

A

90% gallstones,
acalculous: salmonella

36
Q

chronic cholecystitis causes

A

chronic inflammation
fibrosis
diverticula
90% have gallstones

37
Q

What is the term used to describe diverticula of the gallbladder? How do they form?

A
  • Rokitansky-Aschoff sinuses - form as a result of the gallbladder contracting against an obstruction
  • mucosa been pushed out due to raised pressure
38
Q

Which type of cancer is gallbladder cancer?

A

Adenocarcinoma
90% associated with gallstones

NOTE: it is technically a type of cholangiocarcinoma

YEAR 5: Histopathology AS (20 decks)

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