Lecture 24 - Pancreatic and Gallblader Pathology

Question 1

Acute pancreatitis?

Answer 1

Inflammation of the pancreas associated w acinar cell injury

Question 2

Etiology of pancreas and their triggers?

Answer 2

Metabolic (alcohol), mechanical (gallstones, trauma), vascular (shock, vasculitis) , infection (mumps)

Question 3

Pathology of pancreatitis?

Answer 3

Cell injury causing autodigestion by pancreatic enzymes and inflammation response by cytokines

Question 4

Protease consequence?

Answer 4

digestion of acini, ducts and islets

Question 5

Lipase consequence?

Answer 5

fat necrosis agt pancreas and other sites

Question 6

Elastase consequence?

Answer 6

blood vessel destruction leading to intestinal haemorrhage

Question 7

What triggers acute event?

Answer 7

obstruction of pancreatic duct and direct injury to acinar cells

Question 8

Clinical features of acute pancreatitis?

Answer 8

epigastric pain, nausea and vomiting, fever and tahcycardia, marked abdominal tenderness

Question 9

managing acute pancreatitis?

Answer 9

IV fluids, nasogastric suction, analgesia - ultimately rest the pancreas

Question 10

Chronic pancreatitis?

Answer 10

repeated bouts of pancreatic inflammation with pancreatic parenchyma replaced with fibrous tissue - alcohol main cause

Question 11

Pathology of Chronic Pancreatitis?

Answer 11

Fibrotic (rock hard), atrophy of exocrine compartment (w spared islets), mild chronic inflammatory infiltrate, calcification

Question 12

Clinical presentations of chronic pancreatitis?

Answer 12

repeated episodes of abdominal pain, loss of exocrin function (malabsorption), pseudocysts, diabetes (rare)

Question 13

Risk factors of pancreatic carcinoma?

Answer 13

tobacco smoking, heavy alcohol, high BMI

Question 14

Adenocarcinoma of pancreatic head?

Answer 14

invade ampulla, biliary obstruction

Question 15

Adenocarcinoma of body and tail?

Answer 15

silent, large at presentation, spread to nodes, adjacent organs, bones etc.

Question 16

Clinical features of pancreatic cancer?

Answer 16

jaundice, pain, pancreatitis, venous thrombosis

Question 17

Gallstone types?

Answer 17

Cholesterol stones: crystalline cholesterol monohydrate; Pigement stones: bilirubin and calcium salts

Question 18

Gallstone risk factors?

Answer 18

estrogen influence, obesity, rapid weight loss, family history

Question 19

Symptomatic consequences of gall stones?

Answer 19

Cholecystitis (acute/chronic), biliary colic due to choledocholithiasis

Question 20

Acute Cholecytitis cause and presentation?

Answer 20

Gallstones causing obstruction of neck or cystic duct; chemical irritation w bacterial infection later

Question 21

Management of gallbladder inflammation?

Answer 21

iv fluids, pain relief, surgical intervention - eventually cholecystectomy

Question 22

Condition when gallstones are in the biliary tree?

Answer 22

Choledocholithiasis