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Gastrointestinal Module > Pancreas Pathology > Flashcards

Pancreas Pathology Flashcards

1
Q

Pancreatitis

A

Pancreas inflammation

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2
Q

Types of pancreatitis

A

Acute pancreatitis
Acute hemorrhagic pancreatitis
Chronic pancreatitis

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3
Q

Presentation of acute pancreatitis

A

Enzymatic necrosis and inflammation of pancreas with abdominal pain

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4
Q

Acute pancreatitis biochemistry

A

Raised level of pancreatic enzymes, amylase and lipase in urine and in blood

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5
Q

Is acute pancreatitis mild and self limiting ?

A

Yes

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6
Q

Pancreas gross morphology In acute pancreatitis

A

Edema
Inflammation
Limited tissue necrosis

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7
Q

Acute hemorrhagic pancreatitis

A

Around pancreas :
Extensive necrosis and hemorrhage
Extensive fat necrosis

In tissue cells :
Fat deposits with hemorrhage

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8
Q

Acute hemorrhagic pancreatitis incidence

A

5% of cases

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9
Q

What population has acute pancreatitis associated with alcoholism

A

Middle aged man (6:1)

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10
Q

What population has acute pancreatitis associated with biliary dx

A

Middle aged Female (3:1)

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11
Q

Etiology of acute pancreatitis

A 
Cholelithiasis (30-35%)
Alcoholism (60-65%)
Abdominal procedures
Infections (mumps, cocksackie,mycoplasma, ascaris,  clonorchis sinensis)
Vasculitiz
Ischemia
Trauma
Drugs (thiazides diuretics)
Hereditary hyperlipidemias
Hypercalcemia
Uremia
Hemochromatosis
Idiopathic
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12
Q

Pathogenesis of acute pancreatitis

A

Enzymes released from pancreatic acinar
Enzymes cause Proteolysis, lipolysis, hemorrhage
Lipids digested by trypsin, chimotrypsin, lipase, phospholipase etc
Vessel walls destroyed by elastase

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13
Q

3 hypothesis of release of enzymes in acute pancreatitis

A

1st
Direct obstruction by stone -> rupture of ductules ->release of enzymes
Obstruction could be caused by alcohol

2nd
Acinar cell injury by direct effect, (alcohol, viruses, trauma, shock)

3rd
Deranged intracellular transport of pancreatic enzymes

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14
Q

Acute pancreatitis morphology

A

Proteolytic destruction of pancreatic substance
Necrosis of blood vessels
May have Hemorrhage
Necrosis of fat
Early Inflammation (edema)
Late inflammation (edema, necrosis, neutrophil infiltration, hemorrhage, focal fat necrosis, amorphous basophilic deposits of calcium)

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15
Q

Hemorrhagic pancreatitis morphology

A

Blue black hemorrhage
Grey white necrosis
Chalky white areas of fat necrosis

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16
Q

Clinical presentation of acute pancreatitis

A

Abdominal pain (epigastric, constant, severe, radiating to the back)

Elevation of serum amylase (24h) and lipase (72-96h)

Leucocytosis

Hemolysis

DIC

ARDS

diffuse fat necrosis

Shock ( bradykinin, pgs, pancreatic cardiac depressant agents released. Vasodilation. )

ARF

Glycosuria

Hypocalcemia

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17
Q

Differential of serum amylase and lipase to test before

A

Ruptured appendicitis

Perforated duodenal ulcer

Acute cholecystitis

Mesenteric vein thrombosis with bowel infarction

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18
Q

X ray of acute pancreatitis

A

Large pancreas shadow

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19
Q

Prognosis of acute pancreatitis

A

5% die from shock

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20
Q

Complications of acute pancreatitis

A 
Shock 
ARDS
ARF (acute renal failure)
Abscess 
Pseudocyst
Duodenal obstruction from inflammation of pancreas
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21
Q

Chronic pancreatitis

A

Chronic relapsing inflammation of pancreas
Leading to progressive destruction of pancreas
Repeated flare ups of silent or mildly symptomatic pancreatitis

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22
Q

Patient at risk of chronic pancreatitis

A

Middle age
Male over female
Alcoholics
Biliary disease

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23
Q

Causes of chronic pancreatitis

A 
Alcoholism 
Biliary disease 
Hypercalcemia 
Hyperlipidemia 
Familial 
Idiopathic (40%)
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24
Q

Chronic pancreatitis pathogenesis

A

Ductal obstruction by concretions (alcohol induced abnormal secretion)

Interstitial fat necrosis and hemorrhage -> fibrosis, duct distortion, altered pancreatic secretions, flow

PCM (protein calorie malnutrition) especially

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25
Q

Chronic pancreatitis gross morphology

A

Hard, calcified foci, pancreatic calculus gland

sometimes pseudocyst

26
Q

Chronic pancreatitis micro morphology

A

Irregular distribution of fibrosis

Reduced number and size of acini

Variable destruction of pancreatic ducts

Inflammatory infiltrate around lobules and ducts

Protein plugs in lumina of ducts

Atrophied or hyperplastic Duct epithelium ( sometimes squamous metaplasia)

27
Q

Chronic pancreatitis presentation

A

Repeated abdominal pain or back pain

Vomiting

Pancreatic insufficiency

Weight loss

Jaundice

Steatorrhea

Hypo albuminemia

28
Q

Radiograph of chronic pancreatitis

Yes

A

Pancreatic pseudocyst

Calcification

29
Q

When do you have chronic pancreatitis attacks

A

Précipitâted by alcohol, overeating, opiates

30
Q

Is chronic pancreatitis linked to carcinoma ?

A

Yes

31
Q

Types of tumors of pancreas

A

Non neoplastic cysts

Neoplasm (Cystic tumors Or Solid neoplasm )

32
Q

Non neoplastic cysts types

A

Congenital cysts

Pseudocyst

33
Q

Congenital cysts

A

Anomalous development of ducts

Occur mostly with cyst of liver and kidneys in congenital polycystic disease

34
Q

Name of disease where pancreatic cysts associated with CNS Angiomas

A

Von Hippel-lindau disease

35
Q

Pseudocysts

A

Localised
Unilocular cysts
Localised hemorrhagic necrotic material with pancreatic enzyme

36
Q

Pseudocyst may become …

A

Infected and hemorrhagic

37
Q

Symptoms of pancreatic pseudocysts

A

Abdominal pain

38
Q

Percentage of cystic tumors in pancreatic neoplasm

A

5%

39
Q

Presentation of cystic tumors

A

Painless
Slow
Growing masses

40
Q

Types of cystic tumors

A

Serous cystadenoma

Mucinous cyst adenoma

Intra ductal papillary mucinous neoplasm

Solid pseudopapillary tumors

41
Q

Origin of pancreatic carcinoma

A

Exocrines pancreas mostly from duct epithelium (just 1% acinar)

42
Q

Pancreatic ca mortality

A

2-3 months survival post diagnostic

43
Q

People at risk in pancreatic ca

A

60-70 yo

Diabetics

Males

People with hereditary chronic pancreatitis

44
Q

Which one is more common , cyst of solid tumors of pancreas

A

Solid neoplasm and are often malignant

45
Q

Types of solid neoplasm of pancrea

A

Pancreatic carcinoma

Endocrine tumors of pancreas benign: insulinoma
Malignant : pancreatic gastrinoma

46
Q

Risk factors of pancreatic carcinoma

A

Smoking
Fat consumption
Post gastrectomy
Nitrous compounds

47
Q

Area of distribution of pancreatic carcinoma in pancreas

A

Head - 60-70%

Body 15-20%

Tail 5-10%

48
Q

Which area of pancrea present early due obstruction of bile in pancreatic carcinoma

A

The head

49
Q

Pancreatic carcinoma morphology in head

A

Small inapparent mass or Large gray white

Scirrhous

Can invade CBD, duodenum , péri pancreatic lymph nodes

50
Q

Body and tail pancreatic tumor morphology

A

Large tumors

Wide extension into vertebral column, spleen, liver, adrenal, t colon

51
Q

Histology of pancreatic carcinoma

A

90% poorly differentiated adenocarcinoma

10% adenosquamous

Anaplastic giant cell

Sarcomatoid

Plump eosinophils in acinar type

52
Q

Presentation of pancreatic carcinomas

A

Waist pain

Back pain

Malaise

Jaundice mostly because of head

Migratory thrombo phlebitis

Trousseau sign in 10%

53
Q

Type of endocrine tumors of pancreas

A

Insulinomas

Gastrinomas

54
Q

Endocrine tumors morphology

A

Resemble Normal islet
Form cords
Clusters separated by fibrous stroma

55
Q

Commonest islet cell tumor

A

Insulinoma

56
Q

Presentation of insulinoma

A 
Hypoglycemia
Confusion 
Mania
Diziness
Coma
57
Q

Management of islet cell tumor

A

Glucose

Excision of tumor

58
Q

Insulinoma benign ?

A

90% are

59
Q

Commonest site of ectopic gastrinomas

A

Pancreas

60
Q

Disease associated with zollinger Ellison syndrome and persistent hypersécrétion of acid gastric juice

A

Gastrinomas

61
Q

Pancreatic gastrinomas malignant ?

A

Mostly yes

Gastrointestinal Module (15 decks)

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