Histopathology 7 - Diseases of the pancreas and gall bladder Flashcards

1
Q

Recall the mnemonic for the causes of acute pancreatitis

A

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidaemia/hypercalcaemia/hyperparathyroidism 
ERCP
Drugs
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2
Q

Recall two causes of pancreatitis via duct obstruction

A
Gallstones
Alcohol (via spasm/ oedema of Sphinter of Oddi)
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3
Q

Recall the pathophysiology of injury seen in acute pancreatitis

A
  1. Enzymes activated
  2. Acinar necrosis
  3. Enzyme release

Can cause anything from stromal oedema to haemorrhagic necrosis

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4
Q

Why are yellow/white foci seen in acute pancreatitis?

A

Lipases cause fat necrosis

Calcium ions bind to free fatty acids forming soaps (which are white yellow)

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5
Q

What is a pseudocyst?

A

Dilated space with no epithelial lining

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6
Q

What is a cyst?

A

Dilated space lined by epithelium

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7
Q

Recall 2 pancreatic and 3 systemic complications of acute pancreatitis

A

Pancreatic: pseudocyst + abscess
Systemic: shock, hypoglycaemia, hypocalcaemia

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8
Q

Recall 4 complications of chronic pancreatitis

A

Malabsorption
Diabetes mellitus
Pseudocysts
Carcinoma of the pancreas

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9
Q

What is contained within a pancreatic pseudocyst?

A

Pancreatic enzymes and necrotic material (which is why it’s so bad when they perforate - it causes peritonitis)

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10
Q

Which immunoglobin is implicated in autoimmune acute pancreatitis?

A

IgG4

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11
Q

What type of cancer makes up 85% of pancreatic neoplasms?

A

Ductal carcinoma

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12
Q

What mutation is very common in ductal carcinoma?

A

K-Ras

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13
Q

What are the 2 types of precancerous dysplastic ductal lesions in the pancreas?

A
  1. PanIn (pancreatic intraductal neoplasm)

2. Intraductal mucinous papillary neoplasm

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14
Q

Which type of tumour has a “gritty and grey” macroscopic appearance?

A

Ductal carcinoma

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15
Q

Define adenocarcinoma

A

Mucin-secreting glands set in desmoplastic stroma (means: strong stromal reaction)

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16
Q

Recall 3 complications of ductal carcinoma

A
  1. Liver metastasis
  2. Chronic pancreatitis
  3. Venous thrombosis (“migratory thrombophlebitis”/ Trousseau syndrome) = mucin activating coagulation in circulatory system causing thrombosis
17
Q

Which type of pancreatic tumours are usually benign?

A

Cystic tumours

18
Q

Which type of pancreatic tumour is likely to contain neuroendocrine markers?

A

Pancreatic endocrine neoplasms

19
Q

Recall a neuroendocrine marker in pancreatic endocrine neoplasms

A

Chromogranin

20
Q

Which type of pancreatic tumour is associated with MEN1?

A

Pancreatic endocrine neoplasms

21
Q

What is the most common type of secretory pancreatic tumour?

A

Insulinomas

22
Q

In which portion of the pancreas are neuroendocrine tumours most common?

23
Q

What are the 2 types of gallstone?

A

Cholesterol

Pigment

24
Q

What do pigment gallstones contain?

A

Calcium salts of unconjugated bilirubin

25
Which type of gallstones are radiolucent/radio opaque
Cholesterol: radiolucent Pigment: radio-opaque
26
Recall 4 potential complications of gallstones
Bile duct obstruction Cholecystitis Gall bladder cancer Pancreatitis
27
What is the most common cause of acute cholecystitis?
Gallstones (accounts for 90%)
28
What is a key histopathological finding in chronic cholecystitis?
Diverticula Rokitansky-Aschoff sinuses
29
What is the most common cause of gallbladder cancer?
Gallstones
30
What are the 3 patterns of injury that may be seen in acute pancreatitis?
Periductal (necrosis of acinar cells near ducts) Perilobular (necrosis at the edges of lobules) Panlobular (develops from either of the above)
31
What is IgG4 related disease?
A type of autoimmune disease that may affect the pancreas, surrounding structure or pretty much anywhere else in the body
32
What are the 4 different types of pancreatic tumour?
``` Carcinomas: 1. Ductal 2. Acinar Cystic neoplasms: 1. Serous cystadenomas 2. Mucinous cystic neoplasms ```
33
What is the typical microscopic appearance of ductal carcinoma of the pancreas?
Desmoplastic stroma