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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
Chronic pancreatitis gross morphology
Hard, calcified foci, pancreatic calculus gland | sometimes pseudocyst
26
Chronic pancreatitis micro morphology
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
Chronic pancreatitis presentation
Repeated abdominal pain or back pain Vomiting Pancreatic insufficiency Weight loss Jaundice Steatorrhea Hypo albuminemia
28
Radiograph of chronic pancreatitis Yes
Pancreatic pseudocyst Calcification
29
When do you have chronic pancreatitis attacks
Précipitâted by alcohol, overeating, opiates
30
Is chronic pancreatitis linked to carcinoma ?
Yes
31
Types of tumors of pancreas
Non neoplastic cysts Neoplasm (Cystic tumors Or Solid neoplasm )
32
Non neoplastic cysts types
Congenital cysts Pseudocyst
33
Congenital cysts
Anomalous development of ducts Occur mostly with cyst of liver and kidneys in congenital polycystic disease
34
Name of disease where pancreatic cysts associated with CNS Angiomas
Von Hippel-lindau disease
35
Pseudocysts
Localised Unilocular cysts Localised hemorrhagic necrotic material with pancreatic enzyme
36
Pseudocyst may become …
Infected and hemorrhagic
37
Symptoms of pancreatic pseudocysts
Abdominal pain
38
Percentage of cystic tumors in pancreatic neoplasm
5%
39
Presentation of cystic tumors
Painless Slow Growing masses
40
Types of cystic tumors
Serous cystadenoma Mucinous cyst adenoma Intra ductal papillary mucinous neoplasm Solid pseudopapillary tumors
41
Origin of pancreatic carcinoma
Exocrines pancreas mostly from duct epithelium (just 1% acinar)
42
Pancreatic ca mortality
2-3 months survival post diagnostic
43
People at risk in pancreatic ca
60-70 yo Diabetics Males People with hereditary chronic pancreatitis
44
Which one is more common , cyst of solid tumors of pancreas
Solid neoplasm and are often malignant
45
Types of solid neoplasm of pancrea
Pancreatic carcinoma Endocrine tumors of pancreas benign: insulinoma Malignant : pancreatic gastrinoma
46
Risk factors of pancreatic carcinoma
Smoking Fat consumption Post gastrectomy Nitrous compounds
47
Area of distribution of pancreatic carcinoma in pancreas
Head - 60-70% Body 15-20% Tail 5-10%
48
Which area of pancrea present early due obstruction of bile in pancreatic carcinoma
The head
49
Pancreatic carcinoma morphology in head
Small inapparent mass or Large gray white Scirrhous Can invade CBD, duodenum , péri pancreatic lymph nodes
50
Body and tail pancreatic tumor morphology
Large tumors | Wide extension into vertebral column, spleen, liver, adrenal, t colon
51
Histology of pancreatic carcinoma
90% poorly differentiated adenocarcinoma 10% adenosquamous Anaplastic giant cell Sarcomatoid Plump eosinophils in acinar type
52
Presentation of pancreatic carcinomas
Waist pain Back pain Malaise Jaundice mostly because of head Migratory thrombo phlebitis Trousseau sign in 10%
53
Type of endocrine tumors of pancreas
Insulinomas | Gastrinomas
54
Endocrine tumors morphology
Resemble Normal islet Form cords Clusters separated by fibrous stroma
55
Commonest islet cell tumor
Insulinoma
56
Presentation of insulinoma
``` Hypoglycemia Confusion Mania Diziness Coma ```
57
Management of islet cell tumor
Glucose | Excision of tumor
58
Insulinoma benign ?
90% are
59
Commonest site of ectopic gastrinomas
Pancreas
60
Disease associated with zollinger Ellison syndrome and persistent hypersécrétion of acid gastric juice
Gastrinomas
61
Pancreatic gastrinomas malignant ?
Mostly yes

Gastrointestinal Module (15 decks)

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