L74

Question 1

What is biliary atresia?

• Pt pop
• Dx

Answer 1

Narrowing of biliary tract
NEWBORNS: most common cause of liver disease in infants
Treat
1. Kasai procedure
- Act quickly b/c cirrhosis faster in infants
2. Transplant

Question 2

Biliary atresia histo

Answer 2

See proliferation of ducts around the native duct -> liver trying to find a way out for excess bile

Question 3

What is a choledochal cyst?

Treat

Answer 3

Cystic dilation of bile duct
Present early in life - obstructive jaundice
Treat = resection

Question 4

2 complications of bile stones?

Answer 4

Choledocholithiasis = stones in common bile duct
Cholangitis = bacterial infection of bile ducts
- Can ascend from pt of obstruction

Question 5

Cholangitis histo

Answer 5

Seen in liver biopsy (don’t biopsy the bile duct itself)

• Obstruction
• Pus = PMNs in lumen
• Liver parenchyma might be inflammed

Question 6

Symptoms of cholangitis

Answer 6

Jaundice due to obstruction

Maybe ↑AST/ALT

Question 7

Acute cholecystitis usually due to stones. What is the other rare cause?

Answer 7

Acalculous cholecystitis
Aka hosp pts who have systemic issues
Tree doesn’t move bile correctly
Stagnant bile in GB = inflammation

Question 8

How does the GB change with chronic cholecystitis?

Answer 8

Thick
Fibrotic
Healing response due to repeated injury

Question 9

Main GB cancer

Answer 9

GB adenocarcinoma
- Gland formation
Thickened GB wall around mass
May migrate w/ nerves

Question 10

GB carcinoma

• Pt pop
• Prognosis
• Symptoms

Answer 10

Old women
Bad prognosis b/c detected late
Asymptomatic or pain (behaves like cholecystitis)

Question 11

Carcinoma of extrahepatic bile ducts

• 3 risk factors
• Looks like

Answer 11

1. PSC - primary sclerosing cholangitis
2. Choledochal cyst
3. Inflammatory states - parasites

Question 12

What is pancreas divisum

Answer 12

Ducts don’t form to primarily drain out the papilla of Vater
Instead, most drains via minor papilla
↑risk chronic pancreatitis

Question 13

What is pancreatic heteropia?

Answer 13

Normal pancreatic tissue elsewhere in GI
Clinically irrelevant to pts life
Slight ↑risk -> tumor

Question 14

What is annular pancreas?

Answer 14

Pancreas forms as a ring around duodenum

↑risk pancreatitis

Question 15

3 main outcomes of acute pancreatitis

Answer 15

Inflam
Fat necrosis (as inflam damages acinar cells so they release enzymatic contents)
Hemorrhage

Question 16

Are exocrine or endocrine pancreatic fxns lost first in chronic pancreatitis?

Answer 16

Exocrine goes 1st

Question 17

Histo of chronic pancreatitis

Answer 17

Fibrosis
Maybe loss of acini
Duct dilation
Pseudocysts

Question 18

What are serous pancreatic cysts?

Answer 18

Benign - sponge like and can get big but won’t kill

Question 19

What type of cells line serous cysts?

Answer 19

Cleared out cells (glycogen)

Question 20

What pancreatic cyst has malignant potential? Name 2 subtypes.

Answer 20

Mucinous cysts
1. Mucinous cystic neoplasms
2. Intraductal papillary mucinous neoplasms
**On a spectrum:
Benign –> borderline –> malignant parts within 1 tumor

Question 21

Pt pop + describe mucinous cystic neoplasms

Answer 21

Young women
Ovarian type cyst @ body or tail of pancreas
Mucinous lining epithelium

Question 22

Describe intraductal papillary mucinous neoplasms

Answer 22

Pancreatic HEAD
Interfere w/ main duct
Look like have papillae
See mucin oozing out ampulla from camera in duodenum

Question 23

Solid pseudo-papillary tumor
Pt pop
Solid or cystic?
Mutation
Malignant or benign

Answer 23

MALIGNANT but more likely to die from treatment complications
Mutation to beta-catenin / APC pathway
Solid AND cystic regions
Strongly young female

Question 24

What type of cancer is traditional pancreatic cancer?

Answer 24

Ductal adenocarcinoma

Question 25

Describe development of pancreatic cancer

Answer 25

Cyst that might progress to cancer Benign -> low grade -> high grade -> invasion More likely to be ductal

Question 26

``` Ductal adenocarcinoma Pt pop Presentation Location in pancreas Prognosis ```

Answer 26

Older pts - associated w/ SMOKING Most = head = jaundice - If body/tail -> pain due to neural invasion High MORTALITY b/c present at high stage

Question 27

Ductal adenocarcinoma histo

Answer 27

Looks like cholangiocarcinoma - won't need to tell difference

Question 28

Treat pancreatic adenocarcinoma

Answer 28

Surg - Head - take out some SI (Whipple) - Body/take - take out spleen + Adj chemo/radiation

Question 29

3 types of pancreatic endocrine neoplasms (fxnal classification)

Answer 29

Insulinomas (benign) will present as hypoglycemia Gastinomas (malignant) Glucagonomas (malignant)

Question 30

Stain for pancreatic endocrine neoplasms

Answer 30

Chromogranin // synapthophysin

Question 31

What do you need to know about acinar cell carcinoma?

Answer 31

It's rare

Question 32

What is pancreatoblastoma

Answer 32

Kids pancreatic tumor | Look for undifferentiated cells w/ squamoid nests