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YEAR 5: Histopathology - PK Edited > 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 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, tumour, trauma)
  • Metabolic/toxic (alcohol, drugs, hypercalcaemia, hyperlipidaemia)
  • Poor blood supply
  • Infection/inflammation (viruses e.g. mumps)
  • Autoimmune
  • Idiopathic
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4
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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5
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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6
Q

Outline the pathway of inflammation in acute pancreatitis.

A

Activated enzymes → acinar necrosis → release of more enzymes

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7
Q

What is saponification?

A
  • Lipases break down fats around the pancreas to release free fatty acids
  • Calcium binds to the free fatty acids forming soaps
  • this leaves white chalky deposits
  • this can eventually cause hypocalaemia

Complication of acute pancreatitis

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8
Q

List some complications of acute pancreatitis.

A
  • Pseudocyst formation, abscesses
  • Shock
  • Hypoglycaemia
  • Hypocalcaemia (from saponification)
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9
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

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

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10
Q

List some causes of chronic pancreatitis.

A
  • Metabolic/Toxic: alcohol (80%), haemochromatosis
  • Duct obstruction: gallstones, abnormal anatomy, cystic fibrosis (mucoviscoidosis)
  • Tumours
  • Idiopathic
  • autoimmune (IgG4 produced by plasma cells)
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11
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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12
Q

List some complications of chronic pancreatitis.

A
  • Malabsorption
  • Diabetes mellitus
  • Pseudocysts
  • Pancreatic carcinoma
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13
Q

What is the characteristic feature of autoimmune pancreatitis?

A

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

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14
Q

How is autoimmune pancreatitis treated?

A

Steroids - usually responds well

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15
Q

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

A
  • Ductal (85%)
  • 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)

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16
Q

Name two types of cystic neoplasm of the pancreas.

A
  • Serous cystadenoma
  • Mucinous cystadenoma
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17
Q

List some risk factors for pancreatic cancer.

A
  • Smoking
  • BMI and dietary factors
  • Chronic pancreatitis
  • Diabetes mellitus
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18
Q

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

A
  • Pancreatic intraductal neoplasia (PanIN)
  • Intraductal mucinous papillary neoplasm
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19
Q

Which mutation is very common in pancreatic cancer?

A

K-ras (95%)

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20
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

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21
Q

Describe the microscopic appearance of ductal carcinoma.

A
  • Adenocarcinomas (secrete mucin and form glands)
  • Mucin-secreting glands are set in desmoplastic stroma
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22
Q

What is the most common site of ductal carcinoma?

A

Head (60%)

NOTE: neuroendocrine tumours are more common in the tail

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23
Q

What are the usual sites of metastasis of ductal carcinoma?

A
  • Direct: bile ducts, duodenum
  • Lymph nodes
  • Blood: liver
  • Serosa: peritoneum
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24
Q

List some complications of ductal carcinoma.

A
  • Metastasis
  • Chronic pancreatitis
  • Venous thrombosis (migratory thrombophlebitis)
25
Q

By what mechanism does pancreatic cancer cause migratory thrombophlebitis?

A
  • Circulating pancreatic cancer cells release mucous which activates the clotting cascade
26
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 during CT/MRI scans)
  • May be associated with MEN1
  • is a tumour of the islet cells (as can be releasing endocrine material)

Is functional or nonfunctional
functional i.e. insulinoma

27
Q

What is the most common type of functional neuroendocrine tumour?

A

Insulinoma

28
Q

List some factors that increase the likelihood of developing gallstones.

A
  • Age
  • Gender (females)
  • Ethnic factors
  • Hereditary
  • Drugs (e.g. oral contraceptive)
29
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)
  • Pigment
    • Often multiple
    • Contain calcium salts of unconjugated bilirubin
    • Mostly radio-opaque
30
Q

List some complications of gallstones.

A
  • Most are asymptomatic
  • Bile duct obstruction
  • Acute and chronic cholecystitis
  • Gallbladder cancer
  • Pancreatitis
31
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
32
Q

Which type of cancer is gallbladder cancer?

A

Adenocarcinoma

NOTE: it is technically a type of cholangiocarcinoma

33
Q

Function of CCK and secretin?

A

CCK - causes gall bladder contraction so stimulates digestion of fat and protein

Secretin - controls gastric acid secretion and buffers it with HCO3- released from the pancreas

34
Q

Where are the endocrine hormones produced? And what cells produce what?

A

Islets of langerhans!

Alpha - glucagon (to increase blood glucose)
Beta cells - insulin
Delta cells - somatostatin (which inhibits the hormones above)

35
Q

Where are the exocrine materials made in the pancreas/

A

Acini

In the acinar cells - peptidases, lipases, amylase

36
Q

Microvascular complications of diabetes?

A

Retinopathy
Glomerulonephritis / nephropathy
Peripheral neuropathy

37
Q

Macrovascular complications of diabetes?

A

IHD
PVD
CVA

38
Q

Diagnosis of diabetes?

A

Fasting glucose >7mmol/L
Random plasma glucose >11.1 mmo/L
HbA1c >48mmol/L

39
Q

Pathophysiology of t1dm

A

autoimmune destruction of beta cells by cd4+ and cd8+ t lymphocytes

40
Q

Scoring for acute pancreatitis?

A

GLASGOW scale >=3 -> severe

41
Q

blood markers for acute pancreatitis

A

amylase (but only transient)
lipase is more sensitive

42
Q

histology of acute pancreatitis

A

coagulative necrosis

43
Q

complications of acute pancreatitis

A

saponification (15%) (+ thus hypocalcaemia)
hypoglycaemia

44
Q

what is a cholangiocarcinoma?

A

cancer of the bile ducts

45
Q

what are rokitansky aschoff sinuses?

A

diverticula in the gall bladder, can cause chronic cholecystitis

46
Q

procedure for pancreatic cancer

A

whipple’s

47
Q

Blood marker for pancreatic cancer

A

CA19.9

48
Q

clinical presentation of pancreatic cancer

A

weight loss, upper abdo and back pain
painless jaundice
steatorrhoea
DM
virchow’s node
Courvoisier’s sign (painless jaundice and enlarged gall bladder)
abdominal mass

49
Q

where are pancreatic cancers usually?

A

head

50
Q

what type of cancer is pancreatic carcinoma

A

ductal adenocarcinoma

51
Q

risk factors for pancreatic cancer

A

FAP, HNPCC, smoking, diet

52
Q

what is zollinger ellison syndrome

A

Gastrinoma causing recurrent ulceration

causes pancreas to secrete lots and lots of gastrin, a hormone that stimulates production of gastric acid, leading to severe gastrointestinal ulcers

53
Q

what is men1

A

PPP -
pit adenoma
parathyroid hyperplasia/adenoma
pancreatic endocrine tumour

54
Q

what is men2a

A

Parathyroid, medullary thyroid and phaeochromocytoma

55
Q

what is men 2b

A

mucosal neuromas, marfanoid body, medullary thyroid, phaeo

56
Q

what is the name of the marker for ct/mri scans of neuroendocrine tumours?

A

chromograffin

57
Q

what is a VIPoma

A

pancreatic neuroendocrine tumour, causes watery diarrhoea

58
Q
A

YEAR 5: Histopathology - PK Edited (29 decks)

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