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Pathology > Pancreas and Hepatobiliary Disease > Flashcards

Pancreas and Hepatobiliary Disease Flashcards

1
Q

Pancreatic exocrine cells forming the _____ secrete digestive enzymes into the ductules.

A

acinus

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2
Q

What do the exocrine cells secrete in pancreas

A

enzymes

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3
Q

What do the ductal cells secrete in the pancreas?

A
  1. Bicarbinates

2. Mucins

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4
Q

What are the two most common causes of pancreatitis?

A
  1. Bile stones

2. Alcohol (causing spasm of the sphincter of Oddi)

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5
Q

Name the 5 ways pancreatic tissue digestion can be induced

A
  1. Obstruction of the main pancreatic duct
  2. Mechanical disruption of Pancreatic cells (ex. trauma from seat belt injury)
  3. Chemical Injury (ex. induced by cytotoxic anticancer drugs)
  4. Overstimulation of Pancreatic cells (ex. secretin in obese patients who eat too much fatty food)
  5. Alcohol
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6
Q

How can alcohol lead to acute hemorrhagic pancreatitis?

A

alcohol stimulates pancreatic secretion
and
causes partial obstruction of the pancreatic duct due to spasm of the Sphincter of Oddi

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7
Q

What 2 things are associated with over 80% of acute pancreatitis cases?

A
  1. Gallstones

2. Alcohol

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8
Q

What causes proteolysis leading to necrosis of tissue?

A

Trypsinogen activated and becomes Trypsin

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9
Q

When Trypsinogen is activated and becomes Trypsin, what type of tissue destruction occurs in the pancreas?

A

autodigestion causes liquefaction

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10
Q

When fluid accumulates within cystic spaces within the pancreas, why are they called pseudocysts?

A

Because they are not lined by an epithelial cell layer

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11
Q

What does necrotic pancreas tissue tend to attract?

A

calcium salts that undergo calcification

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12
Q

What is formed when free fatty acids bind to calcium ions?

A

calcium soaps seen as white flecks within the pacreatic tissue

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13
Q

What are 3 main pathological characteristics of acute hemorrhagic pancreatitis?

A
  1. Massive Edema
  2. Hemorrhage
  3. Necrosis
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14
Q

What are 2 complications of Acute Pancreatitis?

A
  1. Peritonitis, if enzymes spill into abd cavity (peritoneal rigidity)
  2. Infection - by enteric bacteria causing abscesses and pus
  3. Paralytic ileus
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15
Q

What is a consequence of chronic pancreatitis?

A

exocrine pancreatic insufficiency

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16
Q

Acute pancreatitis - clinical

A
  • sudden onset
  • Uncontrollable abdominal pain
  • abdominal distention
  • Sweat profusely
  • N/V

-Syncope and rapidy developing shock

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17
Q

What will labs show in acute pancreatitis

A
  1. Leukocytosis (acute inflammation)
  2. Elevated amylase
  3. Elevated Lipase
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18
Q

When will you seen elevation in amylase and lipase in acute pancreatitis?

A

in the first 24 hours

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19
Q

Best way to visualize swelling in the pancreas and rule out intestinal perforation?

A

CT

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20
Q

Tx for Acute pancreatitis

A
  1. Pain relief
  2. Restore lost fluids
  3. Hold oral foods/fluids and gastric suction to prevent further stimulation of secretion of pancreatic enzymes
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21
Q

How long do people live with adenocarcinoma of the pancreas after diagnosis before they die?

A

12-24 months

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22
Q

What is the strongest risk factors for adenocarcinoma of the pancreas?

A
  1. Smoking
  • high fat diet
  • ETOH abuse
  • Chronic pancreatitis
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23
Q

From where does adenocarcinoma of the pancreas originate?

A

epithelial cells in the ducts

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24
Q

What part of the pancreas do most (60%)of the adenocarcinomas originate?

A

head of the pancreas

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25
Q

What do adenocarcinomas of the head of the pancreas do that make them more readily diagnosed than those of the tail?

A

obstruct bile ducts –> jaundice!

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26
Q

At the time of diagnosis, where are metastatic lesions most often seen in adenocarcinoma of the pancreas?

A
  • Liver**
  • lungs
  • bones

-lymph nodes (local and distant)

27
Q

What are the three common nonspecific symptoms of pancreatic cancer?

A
  1. Weight loss
  2. Loss of appetite
  3. N/V
28
Q

Courvoisier’s Sign

A

presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones

29
Q

What do cancers in the tail of the pancreas cause?

A

-pain**
-splenomegaly (if splenic vein obstructed)
(no jaundice)

30
Q

What will occur with peritoneal seeding of pancreatic cancer?

A

Protruding abdomen with ascites (seen in 1/3 of patients at first presentation)

31
Q

What is the most reliable technique for visualizing pancreatic tumors?

A

CT

32
Q

Two special techniques for distinguishing carcinoma from chronic pancreatitis?

A
  • Endoscopic Retrograde Cholangiopancreato-graphy (ERCP)

- Percutaneous Transhepatic Cholangiography (PTC)

33
Q

What is the most common type of gallstone?

A

cholesterol stone

34
Q

What is the second most common gallstone?

A

pigmented stone

35
Q

What types of cancer is gallbladder cancer?

A

Adenocarcinoma origintating from surface epithelium

36
Q

What type of person is at higher risk of gallbladder cancer?

A
  • older patients

- Female patients

37
Q

What ethnic minority has a higher incidence of gallbladder cancer?

A

Pima indians

38
Q

Where is carcinoma of the gallbladder metastasis most prominent (2)?

A
  1. Local lymph nodes

2. Adjacent abdominal organs

39
Q

What is fat accumulation in the liver called?

A

steatosis

40
Q

How does alcohol stimulate accumulation of fat in the liver

A
  1. Alcohol has a high caloric content and serves as a substrate for new fat formation in the liver cells
  2. Alcohol inhibits breakdown of triglycerides (decreased fatty acid oxidation)
  3. Alcohol inhibits export of fats from the liver (lipoproteins)
41
Q

Liver becomes enlarged, tan-yellow, fatty and greasy without any symptoms or metabolic consequences

A

steatosis

42
Q

Signs of alcoholic Hepatitis

A
  1. Fever
  2. Leukocytosis
  3. ABD pain
  4. Jaundice
  5. AST increase!!!!!
43
Q

Mallory Bodies

A

eosinophilic aggregates of alcohol hyaline in the cytoplasm of hepatocytes

44
Q

What are the gross characteristics of liver cirrhosis?

A
  • yellow-orange
  • fatty
  • scarred and shrunken liver
  • deformed by bands of fibrous tissue
45
Q

Early manifestations of liver cirrhosis?

A
  • Ascites
  • Weight loss
  • Jaundice
  • Diarrhea
  • ABD pain in epigastric or RUQ
46
Q

Late manifestations of liver cirrhosis?

A
  • portal hypertension

- liver cell failure

47
Q

What does the enlargement of a shrunken, cirrhotic liver usually indicate?

A

development of hepatocellular carcinoma :(

48
Q

Micronodular cirrhosis if nodules ______

A

<5mm

49
Q

Macro-nodular if nodules are ______

A

> 5mm

50
Q

Alcoholic cirrhosis is more likely to be ______ and bright yellow due to marked fat accumulation

A

micronodular

51
Q

Histological characteristics of cirrhosis?

A

-normal parenchyma replaced with fat-laden liver cells with mallory bodies separated by fibrous tissue strands

52
Q

What is the most common benign hepatic neoplasm?

A

Cavernous Hemangioma

53
Q

Cavernous Hemangioma

A
  • most common benign liver tumor
  • small
  • vascular tumor
  • typically asymptomatic
54
Q

Hepatocellular adenoma: who gets these? why?

A
  • almost exlusive to women

- female sex hormones

55
Q

What is the most important primary liver tumor?

A

hepatocellular carcinoma

56
Q

Most hepatocellular carcinomas originate in cirrhotic livers secondary to ?(3)

A
  1. Hepatitis B virus
  2. Hepatitis C virus
  3. Hemochromatosis
57
Q

What are the 3 forms hepatocellular carcinoma presents in?

A
  1. Diffuse, infiltrative lesion
  2. Solitary mass, in one lobe of the liver
  3. Multiple nodules
58
Q

Grossly Hepatocellular carcinoma lesions can be 2 colors. what are they and why?

A

Yellow - glycogen and lipids

or

Green - bile

59
Q

Hepatocellular carcinomas often synthesize what protein that is used as a tumor marker useful for early diagnosis?

A

AFP (alpha fetoprotein)

60
Q

Budd-Chiari Syndrome Triad

A
  1. ABD pain
  2. Ascites
  3. Liver Enlargement
61
Q

Liver enlargement secondary to venous congestion is called _________

A

Budd-Chiari Syndrome

62
Q

What types of liver cancer is associated with vinyl chlorid workers in the rubber tire industry?

A

Kupffer cell sarcoma

-rare

63
Q

Mets to Liver: appearance

A

round nodules with central necrosis

64
Q

Where do cancers metastasizing to the liver typically come from?

A
  1. GI
  2. Lungs
  3. Breast

Pathology (15 decks)

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