Histopathology 10 - Pancreas and gall bladder Flashcards by Leila Aval

What is the exocrine pancreas composed of?

Ducts and acini

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What do the acini do?

Secrete enzymes

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What hormones secreted by the endocrine component?

Insulin and glucagon, somatostatin

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Acute pancreatitis pathophysiology

Acute inflammation of pancreas caused by aberrant release of pancreatic enzymes

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Most common cause of acute pancreatitis

Gallstones (50%)

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I GETSMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs

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What effect on calcium can acute pancreatitis have?

Can cause HYPOcalcaemia so if hypercalcaemia is the cause of someone’s pancreatitis, in the acute phase their calcium may be normal

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Pathogenesis of acute pancreatitis (Two main mechanisms)

Duct obstruction

Stone distal to where common bile duct and pancreatic duct meet results in reflux of bile up the pancreatic duct followed by acinar injury and release of proenzymes
Alcohol causes spasm/oedema of sphincter of oddi + the production of protein rich pancreatic fluid which obstructs the pancreatic ducts

Direct acinar injury (all other causes)

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3 patterns of injury in acute pancreatiits

Periductal
Perilobular
Panlobular

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Casue of periductal

Usually obstruction of the ducts

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Cause of perilobular

Poor blood supply

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Panlobular cause

Worsening of either periductal or perilobular

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Why can pancreatitis cause hypocalcaemia?

Lipases are released from the inflamed pancreas and become activated, leading to fat necrosis. These free fatty acids will bind to calcium –> saponification which are seen as yellow-white foci

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Pancreatic complication of acute AND chronic pancreatitis

Pancreatic pseudocyst formation

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What is a pancreatic pseudocyst?

Collection of fluid WITHOUT an epithelial lining, only lined by fibrous tissue

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Mortality rate for haemorrhagic pancreatitis

50%

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Main cause of chronic pancreatitis

ETHANOL (80%)

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Another common cause of chronic pancreatitis

50% cases associated with acute pancreatitis

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Causes other than GETSMASHED for chronic panc?

Haemochromatosis, Cystic fibrosis (mucoviscocity)

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Pattern of injury in chronic pancreatitis

Chronic inflammation with parencyhmal fibrosis and loss of parenchyma
Duct strictures with calcified stones
FIBROSIS AND SCARRING

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What feature is pathognomic of chronic panc?

Pancreatic calcifications

Complications of chronic pancreatitis

Pancreatic pseudocysts
Malabsorption (Early)
Diabetes mellitus
Pancreatic cancer

What is Pancreatic autoimmune disease characterised by/ what is it now called?

IgG4 Related disease thus lots of igG4 plasma cells

Treatment of IgG4 related disease

Steroid responsive

3 types of pancreatic cancer

Carcinomas, neuroendocrine tumours and cystic neoplasms

2 types of pancreatic carcinoma and whcih one is most common?

Ductal and acinar, DUCTAL most common

What % of cancer deaths is due to pancreatic ductal carcinoma?

Which mutation seen in pancreatic ductal carcinoma?

k-RAS

Which cells give rise to pancreatic NETs?

Islet cell tumours

Risk factors for pancreatic cancer

Smoking, raised BMI, chronic panc, DM

Ductal carcinoma arises from 2 types of dysplastic ductal lesions (pre-cancerous i.e. do not invade through BM)

1) Pancreatic Intraductal Neoplasia (PanIN) | 2) Intraductal mucinous papillary neoplasm

Microscopic appearance of ductal carcinomas

They are adenocarcinomas i.e. mucin secreting, form glands, set in desmoplastic stroma

Common sites of ductal carcinoma

HEAD (60%) >body >tail

Common sites of NETs

Tail>body>head

Most common site of blood metastasis of panc Ca

Liver

Complications of ductal carcinoma

Spread, chronic pancreatitis, venous thrombosis (migratory thrombophlebitis)

What is venous thrombosis/migratory thrombophlebitis?

Circulating pacnreatic cells release mucous which activates the coagulation cascade and leads to thrombosis in the venous system

Why are pancreatic NETs mainly found in the tail?

That is where most of the neuroendocrine cells reside

Are pancreatic NETs usually secreotry or non-secretory?

NON-SECRETORY

Stain for NETs

Chromogranin

Most common type of pancreatic NET

Insulinoma (causes hypoglycaemia)

What syndrome is pancreatic NETs associated with?

MEN1 (pituitary adenoma, parathyhroid hyperplasia and pancreatic tumours)

Risk factors for gall stones

Fat, female, forty, fertile, fair

Types of gallstone

Cholesterol (usually single), pigment (multiple) and mixed

Imaging for cholesterol and pigment stones

Cholesterol stones are mainly radiolucent so will not be seen on plain abdominal X-ray, USS required Pigment stones mainly radioopaque

Main cause of acute cholecystitis?

90% associated with gallstones

Features of chronic cholecystitis

chronic inflammation, Fibrosis and scarring, ROKITANSKY ASCHOFF SINUSES

What are rokitansky aschoff sinuses?

Diverticula caused by gall bladder contracting against obstruction

What type of cancer is GB cancer?

Adenocarcinoma

GB cancer associations

90% due to gall stones, v rare

What do alpha, beta and delta cells of the pancreas produce?

Alpha: glucagon Beta: insulin Delta: somatostatin

Pancreatic cancer tumour marker

Ca 19-9