Pancreas and Gallbladder Flashcards
Label this:
Which is the exocrine component and which is the endocrine component?
1= exocrine
2= endocrine
What is acute pancreatitis?
Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes.
Relatively common, incidence increasing.
What are the causes of acute pancreatitis?
Idiopathic (15%)
Gallstones (50%)
Ethanol (33%)
Trauma
Steroids/ shock
Mumps (viruses)/ malignancy
Autoimmune
Scorpion sting (Trinidad Scorpion)
Hypertriglyceridaemia/ hypercalcaemia/ hypothermia
ERCP
Drugs (like azathioprine and thiazides)
What is the pathogenesis of acute pancreatitis?
Duct obstruction
Bile reflux up the duct
Direct acinar injury
Release of proenzymes which become activated
How does alcohol cause duct obstruction?
Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts
What are the patterns of injury in acute pancreatitis?
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 – develops from 1. and 2.
How is acinar necrosis caused?
Activated enzymes -> acinar necrosis -> enzyme release etc.
Ranges from stromal oedema, to haemorrhagic necrosis
e.g. Lipases -> fat necrosis (calcium ions bind to free fatty acids forming soaps which are seen as yellow-white foci)
What are the complications of acute pancreatitis?
Pancreatic : pseudocyst, abscess
Systemic: shock, hypoglycaemia, hypocalcaemia
What is the prognosis of acute pancreatitis?
Up to 50% for haemorrhagic pancreatitis
What is chronic pancreatitis?
Relapsing or persistent, associated with acute pancreatitis in half of cases
Relatively uncommon
Mortality 3% per year
What are the causes of chronic pancreatitis?
Alcohol (80%)
Haemochromatosis
Gallstones
Abnormal pancreatic duct anatomy
Cystic fibrosis (mucoviscoidosis)
Tumours
Autoimmune
What is the pathogenesis and histopathological findings of chronic pancreatitis?
Pathogenesis of chronic pancreatitis
As for acute pancreatitis
Pattern of injury
Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones with secondary dilatations
What are the complications of chronic pancreatitis?
Malabsorption
Diabetes mellitus
Pseudocyts
Carcinoma of the pancreas
What is a pseudocyst?
Associated with acute and/ or chronic pancreatitis
Lined by fibrous tissue (no epithelial lining), contain fluid rich in pancreatic enzymes or necrotic material
Connect with pancreatic ducts
May resolve, compress adjacent structures, become infected or perforate
What is IgG4 disease (Autoimmune pancreatitis)?
Characterised by large numbers of IgG4 positive plasma cells.
May involve the pancreas, bile ducts and almost any other part of the body.
What are the tumours of the pancreas?
Carcinomas: Ductal (85%), Acinar
Cystic neoplasms: Serous cystadenomas, mucinous cystic neoplasm
Pancreatic neuroendocrine tumours (islet cell)
What is the epidemiology of a ductal cell pancreatic carcinoma?
5% of cancer deaths
Increasingly common with age, 2M: 1F
5 year survival: 5%
What are the RFs for pancreatic carcinoma?
Smoking
BMI and dietary factors
Chronic pancreatitis
Diabetes
Where do ductal carcinomas arise?
Arise from dysplastic ductal lesions:
Pancreatic Intraductal Neoplasia (PanIN)
Intraducal Mucinous Papillary Neoplasm
K-Ras mutations in 95% of cases
What is the pathological appearance of the pancreatic carcinoma?
Macroscopic Appearance
Gritty and grey
Invades adjacent structures
Tumours in the head present earlier
Microscopic Appearance
Adenocarcinomas:
mucin secreting glands set in desmoplastic stroma
What are the sites of the ductal carcinoma?
Head (60%)
Body
Tail
Diffuse
Where do ductal carcinomas spread?
Direct: Bile ducts, duodenum
Lymphatic: Lymph nodes
Blood: Liver
Serosa: Peritoneum
Also perineural
What are the complications of ductal carcinomas?
Due to spread
Chronic pancreatitis
Venous thrombosis (“migratory thrombophlebitis”)
What are cystic tumours?
Contain serous or mucin secreting epithelium
(cf. ovarian tumours)
Usually benign
What are pancreatic endocrine neoplasias?
usually non-secretory
contain neuroendocrine markers e.g. chromogranin
behaviour difficult to predict,
may be associated with the Multiple Endocrine Neoplasia (MEN) 1 syndrome
What are insulinomas?
Insulinomas (derived from beta cells)
the commonest type of secretory tumour
What bad things can happen to the gall bladder?
Gall stones
Inflammation
Cancer
Who gets cholelithiasis?
20% of adults in the West
What are the RFs for gall stones?
Age and gender: increasing age, F>M
Ethnic and geographic: e.g. Native Americans
Hereditary: e.g. disorders of bile metabolism
Drugs e.g. oral contraceptive
Acquired disorders e.g. rapid weight loss
What are the types of gallstones?
Cholesterol (more than 50% cholesterol)
May be single, mostly radiolucent
Pigment (contain calcium salts of unconjugated bilirubin)
Multiple, mostly radio-opaque
What are the complications of gall stones?
Bile duct obstruction
Acute and chronic cholecystitis
Gall bladder cancer
Pancreatitis
What is acute cholecystitis?
Acute inflammation
90% associated with gall stones
What is chronic cholecystitis?
Chronic inflammation
Fibrosis
Diverticula – Rokitansky-Aschoff sinuses
90% contain gall stones
What is gall bladder cancer?
Adenocarcinomas
90% associated with gall stones
What is this?
Acute Pancreatitis
What does this AXR show?
Pancreatic calcifications suggestive of chronic pancreatitis
Describe this pancreatic specimen and give a diagnosis.
Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones with secondary dilatations
What is this?
IgG4 disease
Characterised by large numbers of IgG4 positive plasma cells.
What is this?
Ductal Carcinoma
What is this?
Cystic tumour
What is this?
Insulinoma
What is this?
Chronic Cholecystitis
What is the name of this sign?
Rokitansky-Aschoff sinus
What is this?
Advanced Gallbladder cancer
What is this?
Acute pancreatitis with calcifications
