pancreas and gallbladder pathology Flashcards
Clinical implications of gallstones
Major cause of acute cholecystitis. Also causes acute pancreatitis
Are most gallstones symptomatic or asymptomatic
asymptomatic. Cholesterol are most common
Risk factors for cholesterol vs pigment stones
Cholesterol: North american, age, estrogen, oral contraceptives, pregnancy, obesity, rapid weight loss. Pigment stones: Asian, chronic hemolytic syndromes, biliary infection, ileal dz
What causes gallstone formation
increased cholesterol output and decreased bile acid synthesis lead to cholesterol supersaturation and crystallization. Hypomotility and excess mucin propagate crystallization
Causes of acute cholecystitis
Most due to gallstone obstruction of neck/cystic duct. Also trauma, surgery, burns, postpartum
pathophys of acute cholecystitis
gallstone blocks duct > accumulation of toxic products in lumen of gallbladder > disruption of mucus layer > distension > ischemia > more inflammation
acute cholecystitis histology
acute inflammation, erosions, fibrinopurulent exudate
Chronic cholecystitis histology
inflammation and fibrosis of gallbladder, herniations
risk factors for gallbladder carcinoma
gallstones, chronic infection
Most common carcinoma of gallbladder
adenocarcinoma
Define choledocholithiasis
stones in biliary tree- major cause of ascending cholangitis. Can form in ducts or from gallblaadder
what is a choledochal cyst
congenital dilation of common bile duct
Risk factors for bile duct carcinoma
choledochal cyst in older adults - primary sclerosing cholangitis - infections (liver flukes)- Cholelithiasis
Sequelae of pancreatitis
pseudocysts, abscesses, pancreatic insufficiency, secondary diabetes (destruction of endocrine component)
Causes of acute pancreatitis
gallstones > alcohol > other
Gallstone induced acute pancreatitis pathophys
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
Alcohol induced acute pancreatitis pathophys
Secretion stimulation (digestive enzymes), sphincter of Oddi contraction causes obstruction, defective packaging of enzymes, and some toxicity
acute pancreatitis macroscopic features
necrosis, fat necrosis, pseudocysts,
Characteristics of chronic pancreatitis
Irreversible parenchymal destruction and fibrosis
Causes of chronic pancreatitis
alcohol abuse, long standing duct obstruction, hereditary, idiopathic
Most common pancreatic neoplasia
ductal adenocarcinoma, followed by endocrine tumors then acinar cell carcinoma, solid-pseudopapillary neoplasm and pancreatoblastoma
List pancreatic endocrine neoplasms
insulinoma, gastrinoma, glucagon tumor
