Histopathology 9: Pancreas & Gall Bladder Flashcards by D J

Which 2 mediators control enzyme and alkali release from the pancreas ?

Secretin - released by S cells in the duodenum causes pancreatic HCO3- secretion

Cholecystokinin (CCK) - released by I cells in the duodenum causes pancreatic release of digestive enzymes

How well did you know this?

Not at all

Perfectly

Which cells release glucagon ?

Alpha cells

How well did you know this?

Not at all

Perfectly

Which cells release somatostatin ?

Delta cells

How well did you know this?

Not at all

Perfectly

What type of hypersensitivity reaction is T1DM ?

Type 4 delayed T cell mediated

How well did you know this?

Not at all

Perfectly

List the causes of Acute pancreatitis ?

I GET SMASHED

Duct obstruction -> gallstones, trauma, tumours (MAIN SO REMEMBER)

Metabolic -> alcohol, drugs (thiazides), hypercalcaemia (COMES UP IN EXAMS), hyperlipidaemia

Poor blood supply -> Shock and hypothermia

Infection -> Mumps

Idiopathic

How well did you know this?

Not at all

Perfectly

Which blood test is most sensitive for Acute pancreatitis ?

Serum Lipase

How well did you know this?

Not at all

Perfectly

List 4 causes of chronic pancreatitis ?

Cystic fibrosis
Alcoholism
Pancreatic duct obstruction - stones /cancer
Auto-immune

How well did you know this?

Not at all

Perfectly

Describe the histology of chronic pancreatitis ?

Dilated ducts
Fibrosis
calcification
loss of exocrine tissue

How well did you know this?

Not at all

Perfectly

A patient presents with significant weight loss, abdominal pain, multifocal fat necrosis and polyarthralgia. Histopathology: Eosinophilic granular cytoplasm, immune reactivity for lipase

Most likely diagnosis ?

Acinar cell carcinoma

neoplasm that releases lots of lipase

How well did you know this?

Not at all

Perfectly

A patient presents with epigastric pain that radiates to the back, he’s jaundiced and appears cachectic. An abdominal mass is felt on examination.

Most likely diagnosis ?

Ductal adenocarcinoma of the pancreas

How well did you know this?

Not at all

Perfectly

Where in the pancreas do Ductal adenocarcinomas tend to occur ?

Head of the pancreas

How well did you know this?

Not at all

Perfectly

What is covosiers law ?

Presence of a palpable enlarged gallbladder, with painless jaundice means gallstones are unlikely.

How well did you know this?

Not at all

Perfectly

What is the tumour marker for pancreatic cancer ?

CA19-9

How well did you know this?

Not at all

Perfectly

Histopathology: Cells arranged in nests or trabecular with granular cytoplasm.

Most likely diagnosis ?

Characteristic feature?

Islet cell tumour- Insulinoma

Hypoglycaemic attacks.

How well did you know this?

Not at all

Perfectly

Which syndrome is associated with gastrinomas

Zollinger ellison syndrome

How well did you know this?

Not at all

Perfectly

What are Rokitansky-Aschoff sinuses ?

Cholecystitis causes fibrosis which means the gallbladder is contracting against an obstruction.

This pressure causes diverticula of the gallbladder to form which are known as Rokitansky-Aschoff sinuses.

How well did you know this?

Not at all

Perfectly

What is the endocrine /exocrine aspect of the pancreas?

What do they produce?

Endocrine - Islet of Langerhands:
Insulin
Glucagon
Somatostatin

Exocrine - Acini + ducts:
Protease
Lipase
Amylase

Define acute pancreatitis

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

How do alcohol, gallstones and other causes of acute pancreatitis cause it?

Note this is also how chronic pancreatitis works

Alcohol: (Duct obstruction)
Spasm/oedema of the sphincter of Oddi + formation of protein-rich pancreatic fluid which is thick and causes an obstruction

Gallstones: (Duct obstruction)
Get stuck distal to where CBD and pancreatic duct join
→ bile reflux up pancreatic duct → damage to acini → release of proenzymes which then become activated

All other causes:
Via direct acinar injury

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

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

Outline the pathway of inflammation in acute pancreatitis

Activated enzyme reflux 🡪 acinar necrosis 🡪 release of more enzymes

Release of lipases 🡪 fat necrosis 🡪 saponification w/ calcium (soaps formed when ca binds w/ free fatty acids)

Complications of acute pancreatitis v chronic pancreatitis? (4)

Acute:

Pseudocyst formation, abscesses
Shock
Hypoglycaemia
Hypocalcaemia (due to saponification)

Chronic:

Malabsorption
Diabetes mellitus
Pseudocysts
Pancreatic carcinoma

What are pseudocysts?

What happens to pseudocysts?

A collection of fluid in a dilated space without an epithelial lining (has fibrous 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 (if they perforate → necrotic material rich in activated enzymes leaks into peritoneal cavity = acute peritonitis)

What is the characteristic feature of autoimmune pancreatitis?

How is this treated?

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

Steroids - usually responds well

Different types of pancreatic tumours?

Carcinomas: Ductal (85%) Acinar (15%) Note: acinar-ductal metaplasia (most originate from acinar-> ductal carcinoma - true ductal looks different) Cystic neoplasms: Serous cystadenoma (assc w von-hipel-lindau) Mucinous cystic neoplasm Neuroendocrine islet cell tumours: Insulinoma (MOST COMMON) Gastrinoma VIPoma

DIfferent types of MEN?

Multiple Endocrine Neoplasia (MEN) A group of genetic syndromes where there are functioning hormone-producing tumours in multiple organs e.g; • MEN 1= ‘PPP’ - Parathyroid hyperplasia/adenoma, Pancreatic endocrine tumour (often phaeochromacytoma -adrenal), Pituitary adenoma. • MEN 2A- Parathyroid, Thyroid, phaeochromacytoma • MEN 2B- Meduallary Thyroid, Phaeo, Neuroma. Marfanoid phenotype

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

Cholesterol - May be single - Mostly radiolucent (NOT seen on AXR) Pigment - Often multiple - Contain calcium salts of unconjugated bilirubin - Mostly radio-opaque

Most common site of duct carcinoma? What happens in the other place?

Head (60%) NOTE: neuroendocrine tumours are more common in the tail

Which mutation is very common in pancreatic cancer?

K-ras (95%)

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

Pancreatic intraductal neoplasia (PanIN) Intraductal mucinous papillary neoplasm (IMPN)

Microscopic and macroscopic appearances of ductal carcinoma? Which cancers present earlier?

Microscopic: - Adenocarcinomas (secrete mucin and form glands) - Mucin-secreting glands are set in desmoplastic stroma Macroscopic: - Gritty and grey - Invades adjacent structures NOTE: tumours in the head of the pancreas present earlier

where are mucin-secreting glands in adenocarcinomas?

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

Recall a neuroendocrine marker in pancreatic endocrine neoplasms

Chromogranin

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

Tail

Cholecystitis causes?

Acute (MAIN ONE IN Qs) - Acute inflammation - Associated w/ gallstones Chronic: - Chronic inflammation - Fibrosis - Associated w/ gallstones

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

Gallstones, alcohol -> pseudocyst, abscess, chronic pancreatitis

Which cells are involved in autoimmune pancreatitis?

IgG4 plasma cells

What is the precursor lesion for a pancreatic ductal carcinoma?

PANin (pancreatic intraductal neoplasms)

Which genetic syndrome is most commonly associated with pancreatic endocrine neoplasms?

MEN1

What are gallstones most commonly composed of?

Cholesterol