Pancreas Pathology

Question 1

Is the pancreas Retroperitoneal or Intra?

Answer 1

Retro

Question 2

2 main causes of pancreatitis

Answer 2

metabolic - alcohol, mechanical - gall stones

Question 3

pathology of pancreatitis

Answer 3

autodigestion by pancreatic enzymes, cell injury response mediated by cytokines

Question 4

consequences of enzyme release in pancreatitis

Answer 4

1. proteases - acini, ducts islets
2. Lipases - fat necrosis (pancrease and other sites)
3. Elastatses - blood vessel destruction - lead to interstitail hemorage
4. Cell injury response - inflamation, odema, imparied blood flow, ishcaemia

Question 5

what triggers acute pancreatitis event

Answer 5

1. obstruction - gallstones, and ductal concretions present in alcoholics. Increase ductal pressure, accumulate enzyme rich fluid, fat necrosis, promotes odema and local inflamation, odema compromises blood flow,
2. Diect injury to acinar cells - viruses, drugs, trauma, ischaemia - release of enzymes

Question 6

clinical features of acute pancreatitis

Answer 6

acute abdominal pain (epigastric), nausea vomiting, fever , abdominal tenderness

Question 7

diagnosis of acute pancreatitis

Answer 7

high white cell coun, elevated serum amylase, ct scan - odema, necrosis, may need laparotomy

Question 8

management of acute pancreatitis

Answer 8

IV fluid, dont eat - no stimulating pancrease, analgesia, close monitoring

Question 9

Causes of chronic pancreatitis

Answer 9

repeated bouts of pancreatic inflamation, loss of function and replacement by fibrous tissue

Question 10

Pathology of chronic panreatitis

Answer 10

fibrotic organ, atrophy of exocrine compoenent (not so much endocrine), mild chronic inflammatory infiltrate , intraductal protein plugs and calcified concretions

Question 11

clinical features of chronic pancreatitis

Answer 11

• repeatated attacks of abdominal pain (can be after alcohol)
• more persistant pain
• if ongoing - loss of exocrine funciton (malabsorption), psudocysts, rarely diabetes mellitus

Question 12

diagnosis of chronic pancreatitis

Answer 12

serum amlylase, CT imaging

Question 13

Pancreatic carcinoma - who normally gets it and cause

Answer 13

males, older, poor survival, poor prognosis. Smoking risk, maybe also alcohol and caffiene

Question 14

pathology of pancreatic carcinoma

Answer 14

most occurs in head, then invades ampulla and then bilary obstruction occurs

Question 15

Clincal features of pancreatic carcinoma

Answer 15

obstructive jaundice, pain, weight loss, pancreatitis, usually seen on CT scan

Question 16

Cholelithiasis - what are the 2 types of gall stones made of

Answer 16

cholesterol stones, pigment stones

Question 17

How do cholesterol gall stones form?

Answer 17

bile supersaturated with cholesterol, and this favors crystal formaiton, then if they remain in gallbladder stones will form

Question 18

Risk factors for cholelithiasis

Answer 18

Incidence rises for increasing age in women, estrogenic influences, obesity, rapid wiehgt loss favor stone formaiton , history of glal stones

Question 19

Risk factors for pigment stones

Answer 19

chronic haemolytic syndromes, bacterial infection of bilary tree, pigment stones are predominant in non-western populations due to infections and parasites

Question 20

clinical consequences of gallstones

Answer 20

only about 1-3% symptomatic, cholecystitis - acute/chronic, bilary colic (bile duct obstructed - pain), complications of above e.g cholangitis - bacterial infeciton

Question 21

Acute cholecystitis

Answer 21

mostly due to gallstones, obstruction of the neck of gallbladder or cystic duct

Question 22

clinical features cholecystitis

Answer 22

RUQ - abdominal pain and tenderness (often after fatty meals), fever, neutrophil leucocytosis, raised bilirubin, ALP, GGT if stone in common bile duct

Question 23

Chronic cholecystitis

Answer 23

multiple episodes of acute inflamation, generaly due to gall stones,

Question 24

management of chornic cholecystitts

Answer 24

• Initaly - iv and pain releif, long tmer - cholecystecotmy but need inflamation settled down first

Question 25

choledocholithiasis

Answer 25

presence of stones in bilary tree, cmplications - bilary obstruction (coliky abdonminal pain, obstructive jaundice), pancreatitis, cholangitits

Question 26

3 things that can go wrong with the pancreas

Answer 26

Cystic fibrosis
Acute and chronic pancreatitis (inflammation of pancreas, acinar cell injury)
Carcinoma of the pancreas

Question 27

Carcinoma of gallbladder

Answer 27

• older people
• mainly adenocarcinoma
• most go to liver
• low survival

Question 28

Carcinoma of extrahepatic ducr

Answer 28

• uncommon
• adenocarcinoma
• slowely obstruct biled duct - get jaundice, pale stools, weight loss, nausea

Question 29

Cholelithiasis
Cholecystitis
Choledocholithiasis
Cholangitis
Cholestasis

Answer 29

Cholelithiasis - gall stones
Cholecystitis - inflamed gall bladder
Choledocholithiasis - gall stone in common bile duct
Cholangitis - bacterial infection due to obstruction
Cholestasis - decrease bile flow, due to obstruction of intra or extrahepatic ducts