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a path 3 > HISTO: Pancreas and gallbladder > Flashcards

HISTO: Pancreas and gallbladder Flashcards

1
Q

Pancreatic microanatomy

A
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2
Q

What are the two types of tissue seen on histology in the pancreas?

A

Excorine

Endocrine

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3
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes. Relatively common, incidence increasing.

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4
Q

What are the causes of acute pancreatitis? What are the two most common causes.

A

Duct obstruction = Gall stones (50%), Trauma, Tumours

Metabolic/toxic = Alcohol (33%) (5% of alcoholics develop acute pancreatitis); Drugs (e.g. thiazides); Hypercalcaemia, Hyperlipidaemia

Poor blood supply = Shock, Hypothermia

Infection/ inflammation - Viruses (e.g. mumps)

Autoimmune

Idiopathic (15%)

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5
Q

What are the two mechanisms of pathogenesis of acute pancreatitis?

A
  1. Duct obstruction- due to gallstones and alcohol
  2. Direct acinar injury - all other causes
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6
Q

What is the pathogenesis of duct obstruction causing acute pancreatitis?

A

Gallstone stuck distal to where the common bile duct and pancreatic ducts join

—> reflux of bile up the pancreatic duct —> damage to acini and release of proenzymes which then become activated

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7
Q

How does alcohol cause acute pancreatitis?

A

Alcohol –> spasm/oedema of Sphincter of Oddi + formation of a protein rich pancreatic fluid –> obstructs the pancreatic ducts

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8
Q

What are the 3 pattens of injury in acute pancreatitis?

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 – develops from 1. and 2.

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9
Q

How do activated enzymes e.g. lipases, cause these patterns of injury?

A

Activated enzymes –> acinar necrosis –> enzyme release etc.

Ranges from stromal oedema, to haemorrhagic necrosis

e.g. Lipases –> fat necrosis (calcium ions bind to free fatty acids forming soaps which are seen as yellow white foci)

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10
Q

What are the complications of acute pancreatitis?

A

Pancreatic : pseudocyst, abscess

Systemic: shock, hypoglycaemia, hypocalcaemia

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11
Q

What is the prognosis for acute pancreatitis?

A

Overall mortality up to 50% for haemorrhagic pancreatitis (due to association with systemic shock)

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12
Q

What is shown?

A

Yellow white foci when calcium ions bind to fatty acids forming soaps

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13
Q

What is chronic pancreatitis? How common is it?

A

Relapsing or persistent, associated with acute pancreatitis in half of cases

Relatively uncommon

Mortality 3% per year

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14
Q

What are the causes of chronic pancreatitis? What is the most common cause?

A

Metabolic/toxic = Alcohol (80%); Haemochromatosis

Duct obstruction = Gallstones; Abnormal pancreatic duct anatomy; Cystic fibrosis (“mucoviscoidosis”)

Tumours

Idiopathic Autoimmune

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15
Q

What is the pathogenesis of chronic pancreatitis?

A

Same as for acute pancreatitis

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16
Q

What is the pattern of injury seen in chronic pancreatitis?

A

Chronic inflammation with parenchymal fibrosis and loss of parenchyma

Duct strictures with calcified stones with secondary dilatations

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17
Q

What are the complications of chronic pancreatitis?

A
  • Malabsorption
  • Diabetes mellitus
  • Pseudocyts
  • Carcinoma of the pancreas - chronic pancreatitis may be a risk factor for this
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18
Q

What is shown?

A

Calcification - could be either acute or chronic

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19
Q

What are the cells in the middle in this slide of chronic pancreatitis?

A

Rounded areas are endocrine cells which survive well - although there is a risk of diabetes over time

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20
Q

What are pancreatic pseudocysts associated with?

A

Associated with acute and/ or chronic pancreatitis

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21
Q

What are the characteristics of pancreatis pseudocysts?

A

Lined by fibrous tissue (no epithelial lining), contain fluid rich in pancreatic enzymes or necrotic material

Connect with pancreatic ducts

May resolve, compress adjacent structures, become infected or perforate

22
Q

What is a characteristic of IgG4 related disease? What parts of the body may be affected?

A

Characterised by large numbers of IgG4 positive plasma cells.

May involve the pancreas, bile ducts and almost any other part of the body

23
Q

What disease is represented here?

A

IgG4 related disease

24
Q

What are 3 types of tumours of the pancreas?

A

Carcinomas

  • Ductal (85% of all neoplasms)
  • Acinar

Cystic neoplasms

  • Serous cystadenoma
  • Mucinous cystic neoplasm

Pancreatic neuroendocrine tumours (Islet cell tumours)

25
Q

What is the most common type of pancreatic tumour?

A

Ductal carcinomas (85% of all)

26
Q

What is the prognosis with ductal carcinoma in the pancreas?

A
  • 5% of cancer deaths
  • Increasingly common with age, 2M: 1F
  • 5 year survival: 5%
27
Q

What are 3 risk factors for pancreatic carcinomas?

A
  • Smoking
  • BMI and dietary factors
  • Chronic pancreatitis
  • Diabetes
28
Q

What mutations are common in pancreatic ductal carcinomas? How do these cancers arise?

A

Arise from dysplastic ductal lesions:

  • Pancreatic Intraductal Neoplasia (PanIN)
  • Intraducal Mucinous Papillary Neoplasm

K-Ras mutations in 95% of cases

29
Q

What is the macroscopic appearance of ductal carcinomas of the pancreas?

A
  • Gritty and grey
  • Invades adjacent structures
  • Tumours in the head present earlier
30
Q

What are the microscopic features of ductal carcinomas of the pancreas?

A

Adenocarcinomas: mucin secreting glands set in desmoplastic stroma

31
Q

Where do most ductal carcinomas of the pancreas arise?

A
  • Head (60%)
  • Body
  • Tail
  • Diffuse
32
Q

Where do pancreatic ductal carcinomas spread to?

A
  • Direct: Bile ducts, duodenum
  • Lymphatic: Lymph nodes
  • Blood: Liver
  • Serosa: Peritoneum

Perineural?

33
Q

What are the complications of pancreatic ductal carcinomas?

A

Complications are due to spread

  • Chronic pancreatitis
  • Venous thrombosis (“migratory thrombophlebitis”)
34
Q

What are the two types of cystic tumours of the pancreas? What are their features?

A

Are made of serous or mucinous secreting epithelium (cf. ovarian tumours)

Usually benign

35
Q

What are the features of this pancreatic cystic tumour?

A
  • Benign
  • Sharply demarcated
  • Does nt invade locally or distally
36
Q

Are most pancreatic endocrine neoplasms secretory or non-secretory?

A

Non-secretory in most cases except for insulinomas

37
Q

Give an example of a neuroendocrine marker which can be used to screen for pancreatic endocrine tumours?

A

Contain neuroendocrine markers e.g. chromogranin

38
Q

What is a genetic cause of pancreatic endocrine neoplasms?

A

may be associated with the Multiple Endocrine Neoplasia (MEN) 1 syndrome

39
Q

What is the problem with pancreatic endocrine tumours?

A

behaviour difficult to predict

40
Q

What is the most common secretory tumour of the pancreas?

A

Insulinoma - derived from beta cells

Commonest type of secretory tumour

41
Q

How common is cholelithiasis?

A

20% of adults in the West

42
Q

What are the risk factors for gall stones?

A
  • Age and gender: increasing age, F>M
  • Ethnic and geographic: e.g. Native Americans
  • Hereditary: e.g. disorders of bile metabolism
  • Drugs e.g. oral contraceptive
  • Acquired disorders e.g. rapid weight loss
43
Q

What are the types of gall stones? How do they appear on imaging?

A

Cholesterol (>50% cholesterol) = may be single, mostly radiolucent

Pigment (contain calcium salts of unconjugated bilirubin) = multiple, mostly radio-opaque

44
Q

What are the complications of gall stones?

A
  • Bile duct obstruction
  • Acute and chronic cholecystitis
  • Gall bladder cancer
  • Pancreatitis
45
Q

What is acute cholecytitis most associated with?

A

= acute inflammation

90% associated with gall stones

46
Q

What are the histopathological features of chronic cholecystitis?

A

= chronic inflammation

  1. Fibrosis
  2. Diverticula – Rokitansky-Aschoff sinuses
  3. 90% contain gall stones
47
Q

What is the thickness of a normal gall bladder wall?

A

2mm

48
Q

What is this feature of chornic cholecystitis?

A

Diverticula - Rokitansky-Aschoff sinsus

49
Q

What are the most common types of gall bladder cancer? What is this cancer most associated with?

A

Adenocarcinomas

90% associated with gall stones

50
Q
A

Ductal adenocarcinoma

51
Q
A

empty answer

52
Q
A

haemolytic anaemia

a path 3 (89 decks)

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