pancreas and gallbladder pathology

Question 1

Clinical implications of gallstones

Answer 1

Major cause of acute cholecystitis. Also causes acute pancreatitis

Question 2

Are most gallstones symptomatic or asymptomatic

Answer 2

asymptomatic. Cholesterol are most common

Question 3

Risk factors for cholesterol vs pigment stones

Answer 3

Cholesterol: North american, age, estrogen, oral contraceptives, pregnancy, obesity, rapid weight loss. Pigment stones: Asian, chronic hemolytic syndromes, biliary infection, ileal dz

Question 4

What causes gallstone formation

Answer 4

increased cholesterol output and decreased bile acid synthesis lead to cholesterol supersaturation and crystallization. Hypomotility and excess mucin propagate crystallization

Question 5

Causes of acute cholecystitis

Answer 5

Most due to gallstone obstruction of neck/cystic duct. Also trauma, surgery, burns, postpartum

Question 6

pathophys of acute cholecystitis

Answer 6

gallstone blocks duct > accumulation of toxic products in lumen of gallbladder > disruption of mucus layer > distension > ischemia > more inflammation

Question 7

acute cholecystitis histology

Answer 7

acute inflammation, erosions, fibrinopurulent exudate

Question 8

Chronic cholecystitis histology

Answer 8

inflammation and fibrosis of gallbladder, herniations

Question 9

risk factors for gallbladder carcinoma

Answer 9

gallstones, chronic infection

Question 10

Most common carcinoma of gallbladder

Answer 10

adenocarcinoma

Question 11

Define choledocholithiasis

Answer 11

stones in biliary tree- major cause of ascending cholangitis. Can form in ducts or from gallblaadder

Question 12

what is a choledochal cyst

Answer 12

congenital dilation of common bile duct

Question 13

Risk factors for bile duct carcinoma

Answer 13

choledochal cyst in older adults - primary sclerosing cholangitis - infections (liver flukes)- Cholelithiasis

Question 14

Sequelae of pancreatitis

Answer 14

pseudocysts, abscesses, pancreatic insufficiency, secondary diabetes (destruction of endocrine component)

Question 15

Causes of acute pancreatitis

Answer 15

gallstones > alcohol > other

Question 16

Gallstone induced acute pancreatitis pathophys

Answer 16

gallstone in common bile duct leads to increased intraductal pressure in pancreas > leakage of enzyme rich fluids into parenchyma > tissue injury, inflammation, edema, ischemia > more injury

Question 17

Alcohol induced acute pancreatitis pathophys

Answer 17

Secretion stimulation (digestive enzymes), sphincter of Oddi contraction causes obstruction, defective packaging of enzymes, and some toxicity

Question 18

acute pancreatitis macroscopic features

Answer 18

necrosis, fat necrosis, pseudocysts,

Question 19

Characteristics of chronic pancreatitis

Answer 19

Irreversible parenchymal destruction and fibrosis

Question 20

Causes of chronic pancreatitis

Answer 20

alcohol abuse, long standing duct obstruction, hereditary, idiopathic

Question 21

Most common pancreatic neoplasia

Answer 21

ductal adenocarcinoma, followed by endocrine tumors then acinar cell carcinoma, solid-pseudopapillary neoplasm and pancreatoblastoma

Question 22

List pancreatic endocrine neoplasms

Answer 22

insulinoma, gastrinoma, glucagon tumor