pancreas and gallbladder pathology Flashcards
the exocrine pancreas is composed of?
Ductal and Acinar components
where in the pancreas are enzymes made?
Acini
what is a cholangiocarcinoma?
prognosis vs pancreatic cancer?
Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile duct
better prognosis than pancreatic cancer
what are the types of cancers you can get from the pancreas?
ENDOCRINE
- cancer of the ductal epithelium
- variations of this name may add “invasive” and “ductal”
NEUROENDOCRINE
- cancer of the neuroendocrine cells
- sometimes called “islet cell cancers” - not from there
- functioning types ; secrete hormones such as insulin, gastrin, and glucagon
- non-functioning types; dont secrete
descriibe structure of islet of langerhans?
grouped, surrounding a capillary
descrihbe structure of pancreatric acinus?
Pancreatic acinar cells most distal
- contain zymogen granules
- secrete into;
Intercellular canaliculi
Centro-acinar cells line the Intercalated duct
- this is connected to the;
Intralobular duct, which is connected to the
Main pancreatic duct
source of hormones in pancreas?
islet cells
source of digestive enxymes in pancreas?
acinar cells;
storage organelles in the exocrine pancreas
allow the sorting, packaging and regulated
APICAL secretion of digestive enzymes
Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes is ____?
acute pancreatitis
-> auto digestion process
List the most common causes of acute pancreatitis in order?
Gall stones 50%
Alcohol 33%
Idiopathic 15%
list some obstructive cuases of acute pancreatitis?
Gall stones (50%)
Trauma
Tumours
alcohol can be as well
list some metabolic/toxic cuases of acute pancreatitis?
Alcohol 33%
Drugs (e.g. thiazide diuretics)
Hypercalcaemia
Hyperlipidaemia
list some haematological cuases of acute pancreatitis?
Poor blood supply due to:
- Shock
- Hypothermia
list some infectious causes of acute pancreatitis?
Viruses (e.g. mumps)
how does alcohol causes obstructive acute pancreatitis?
Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts
what is the mecahnsim of obstructive acute pancreatitis by gallstone?
Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to:
reflux of bile up the pancreatic duct followed by damage to acini (NECROSIS) causing ->
release of proenzymes which then become activated
what is the relationship of hyper and hypo calcaemia to acute pancreatitis?
HYPER calcaemia can cause acute pancreatitis
which can cause HYPO calcaemia
(remember -> hyper comes first)
summarise the pathogenesis of acute pancreatitis?
- DUCT OBSTRUCTION
2. DIRECT ACINAR INJURY
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.
what happens when lipases are released from the acinar in a pancreatitis?
become activated.
This will lead to fat necrosis.
§ Then, calcium will bind to the free fatty acids forming soaps (saponification) which are seen as yellow-white foci
why can patients with AP present as normo calceamic?
Hypercal causes ap which causes hypocal
DEFINITION of pseudocyst?
a collection of fluid rich in pancreatic enzymes or necrotic material without an epithelial lining
lined with fibrous tissue
§ Pseudocysts can become infected leading to abscess formation
LIST some importsnt causes of chronic pancreatitis?
Alcohol (80%) Haemochromatosis Gallstones Abnormal pancreatic duct anatomy Cystic fibrosis (“mucoviscoidosis”) idiopathic autoimmune
pattern of injury in chronic P?
Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones with secondary dilatations
simplified;
fibrosis and scarring will be present
Strictures caused by fibrosis
which cells will be seen in AP vs CP?
Acute inflammation – neutrophils present
Chronic inflam – lymphocytes
complications and prognosis of AP?
ComplicationsAP
Pancreatic : pseudocyst, abscess
Systemic: shock, hypoglycaemia, hypocalcaemia
Prognosis AP
Overall mortality up to 50% for haemorrhagic pancreatitis
Autoimmune pancreatitis is aka?
aetiology?
IgG4 Related Disease
large numbers of IgG4 positive plasma cells
deposited in various tissue around body
causing fibrosis
list tumours of the types of tumours in pancreas?
Carcinomas
Ductal (85% of all neoplasms)
Acinar
Cystic neoplasms
Serous cystadenoma
Mucinous cystic neoplasm
Pancreatic neuroendocrine tumours (Islet cell tumours)
what are RFs for P Carcinoma?
Smoking
BMI and dietary factors
Chronic pancreatitis
Diabetes
K-Ras mutations occur in 95% of what?
Intraducal Mucinous Papillary Neoplasm -> ductal carcinoma
Ductal carcinoma arise from?
dysplasia;
dysplastic ductal lesions:
1. Pancreatic Intraductal Neoplasia (PanIN)
2. Intraducal Mucinous Papillary Neoplasm
K-Ras mutations
what is the micro & macroscopic appearance of ductal carcinoma?
Macroscopic Appearance :
Gritty and grey
Invades adjacent structures
Tumours in the head present earlier
Micro:
Adenocarcinomas:
mucin secreting glands set in desmoplastic stroma
most common area in pancreas for ductal carcinoma?
Head (60%) of pancreas
how and where does a ductal carcinoma spread?
Direct: Bile ducts, duodenum
Lymphatic: Lymph nodes
Blood: Liver
Serosa: Peritoneum
complications of ductal carcinoma?
Due to spread
Chronic pancreatitis
Venous thrombosis (“migratory thrombophlebitis”)
which tumour is describd as follows;
Contain serous or mucin secreting epithelium
cf. ovarian tumours
Usually benign
cystic tumours
most common area in pancreas for neuroendocrine tumours?
in tail of pancreas as there are more neuroendocrine cells there
the commonest type of secretory tumour in pancreas?
Insulinomas (derived from beta cells)
cholelithiasis is?
gall stones
RFs for cholelithiasis?
5Fs
Fair Female fat- BMI >30 kg/m2 and hyperlipidaemia fertile - 1+ kids forty
RFs for cholelithiasis according to lecture slides?
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
name the 2 types of gallstones and how to identify them?
Cholesterol
(more than 50% cholesterol)
May be single, mostly radiolucent
Pigment
(contain calcium salts of unconjugated bilirubin)
Multiple, mostly radio-opaque
complications of gall stones ?
Bile duct obstruction*
Acute and chronic cholecystitis
Gall bladder cancer
Pancreatitis
most common cause of Acute cholecystitis?
90% gallstones
what can be measured in the blood as a screening test for neuroendocrine tumours?
chromogranin
what features are seen in CPancreatitis?
Chronic inflammation
Fibrosis
Diverticula – Rokitansky-Aschoff sinuses created
90% contain gall stones
Gall bladder cancer is of what type?
most common cause?
Adenocarcinoma
90% associated with gall stones
UNCOMMON
