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Path - Histopath > pancreas and gallbladder pathology > Flashcards

pancreas and gallbladder pathology Flashcards

1
Q

the exocrine pancreas is composed of?

A

Ductal and Acinar components

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2
Q

where in the pancreas are enzymes made?

A

Acini

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3
Q

what is a cholangiocarcinoma?

prognosis vs pancreatic cancer?

A

Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile duct

better prognosis than pancreatic cancer

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4
Q

what are the types of cancers you can get from the pancreas?

A

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
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5
Q

descriibe structure of islet of langerhans?

A

grouped, surrounding a capillary

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6
Q

descrihbe structure of pancreatric acinus?

A

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

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7
Q

source of hormones in pancreas?

A

islet cells

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8
Q

source of digestive enxymes in pancreas?

A

acinar cells;

storage organelles in the exocrine pancreas

allow the sorting, packaging and regulated

APICAL secretion of digestive enzymes

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9
Q

Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes is ____?

A

acute pancreatitis

-> auto digestion process

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10
Q

List the most common causes of acute pancreatitis in order?

A

Gall stones 50%

Alcohol 33%

Idiopathic 15%

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11
Q

list some obstructive cuases of acute pancreatitis?

A

Gall stones (50%)
Trauma
Tumours

alcohol can be as well

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12
Q

list some metabolic/toxic cuases of acute pancreatitis?

A

Alcohol 33%

Drugs (e.g. thiazide diuretics)
Hypercalcaemia
Hyperlipidaemia

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13
Q

list some haematological cuases of acute pancreatitis?

A

Poor blood supply due to:

  • Shock
  • Hypothermia
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14
Q

list some infectious causes of acute pancreatitis?

A

Viruses (e.g. mumps)

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15
Q

how does alcohol causes obstructive acute pancreatitis?

A

Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts

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16
Q

what is the mecahnsim of obstructive acute pancreatitis by gallstone?

A

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

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17
Q

what is the relationship of hyper and hypo calcaemia to acute pancreatitis?

A

HYPER calcaemia can cause acute pancreatitis

which can cause HYPO calcaemia

(remember -> hyper comes first)

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18
Q

summarise the pathogenesis of acute pancreatitis?

A
  1. DUCT OBSTRUCTION

2. DIRECT ACINAR INJURY

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19
Q

What are the patterns of injury in acute pancreatitis?

A

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.

20
Q

what happens when lipases are released from the acinar in a pancreatitis?

A

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
21
Q

why can patients with AP present as normo calceamic?

A

Hypercal causes ap which causes hypocal

22
Q

DEFINITION of pseudocyst?

A

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
23
Q

LIST some importsnt causes of chronic pancreatitis?

A 
Alcohol (80%)
				Haemochromatosis 
 		Gallstones
				Abnormal pancreatic duct anatomy
				Cystic fibrosis (“mucoviscoidosis”)
idiopathic
autoimmune
24
Q

pattern of injury in chronic P?

A

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

25
Q

which cells will be seen in AP vs CP?

A

Acute inflammation – neutrophils present

Chronic inflam – lymphocytes

26
Q

complications and prognosis of AP?

A

ComplicationsAP
Pancreatic : pseudocyst, abscess
Systemic: shock, hypoglycaemia, hypocalcaemia

Prognosis AP
Overall mortality up to 50% for haemorrhagic pancreatitis

27
Q

Autoimmune pancreatitis is aka?

aetiology?

A

IgG4 Related Disease

large numbers of IgG4 positive plasma cells

deposited in various tissue around body

causing fibrosis

28
Q

list tumours of the types of tumours in pancreas?

A

Carcinomas
Ductal (85% of all neoplasms)
Acinar

Cystic neoplasms
Serous cystadenoma
Mucinous cystic neoplasm

Pancreatic neuroendocrine tumours (Islet cell tumours)

29
Q

what are RFs for P Carcinoma?

A

Smoking
BMI and dietary factors
Chronic pancreatitis
Diabetes

30
Q

K-Ras mutations occur in 95% of what?

A

Intraducal Mucinous Papillary Neoplasm -> ductal carcinoma

31
Q

Ductal carcinoma arise from?

A

dysplasia;

dysplastic ductal lesions:
1. Pancreatic Intraductal Neoplasia (PanIN)
2. Intraducal Mucinous Papillary Neoplasm
K-Ras mutations

32
Q

what is the micro & macroscopic appearance of ductal carcinoma?

A

Macroscopic Appearance :
Gritty and grey
Invades adjacent structures
Tumours in the head present earlier

Micro:
Adenocarcinomas:
mucin secreting glands set in desmoplastic stroma

33
Q

most common area in pancreas for ductal carcinoma?

A

Head (60%) of pancreas

34
Q

how and where does a ductal carcinoma spread?

A

Direct: Bile ducts, duodenum
Lymphatic: Lymph nodes
Blood: Liver
Serosa: Peritoneum

35
Q

complications of ductal carcinoma?

A

Due to spread
Chronic pancreatitis
Venous thrombosis (“migratory thrombophlebitis”)

36
Q

which tumour is describd as follows;

Contain serous or mucin secreting epithelium
cf. ovarian tumours
Usually benign

A

cystic tumours

37
Q

most common area in pancreas for neuroendocrine tumours?

A

in tail of pancreas as there are more neuroendocrine cells there

38
Q

the commonest type of secretory tumour in pancreas?

A

Insulinomas (derived from beta cells)

39
Q

cholelithiasis is?

A

gall stones

40
Q

RFs for cholelithiasis?

A

5Fs

Fair
Female
fat-  BMI >30 kg/m2 and hyperlipidaemia
 fertile - 1+ kids
forty
41
Q

RFs for cholelithiasis according to lecture slides?

A

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

42
Q

name the 2 types of gallstones and how to identify them?

A

Cholesterol
(more than 50% cholesterol)
May be single, mostly radiolucent

Pigment
(contain calcium salts of unconjugated bilirubin)
Multiple, mostly radio-opaque

43
Q

complications of gall stones ?

A

Bile duct obstruction*
Acute and chronic cholecystitis
Gall bladder cancer
Pancreatitis

44
Q

most common cause of Acute cholecystitis?

A

90% gallstones

45
Q

what can be measured in the blood as a screening test for neuroendocrine tumours?

A

chromogranin

46
Q

what features are seen in CPancreatitis?

A

Chronic inflammation
Fibrosis
Diverticula – Rokitansky-Aschoff sinuses created
90% contain gall stones

47
Q

Gall bladder cancer is of what type?

most common cause?

A

Adenocarcinoma
90% associated with gall stones
UNCOMMON

Path - Histopath (21 decks)

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