Pancreatic and Gall bladder Flashcards

1
Q

Main cause of gallstones

A

Gallstones

Ethanol

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2
Q

Pathogenesis of acute pancreatitis

A

Gallstones block CBD- reflect of bile up pancreatic duct- damage to acini and release of proenzymes

Alcohol leads to spasm of sphincter of Oddi and the formation of protein-rich pancreatic fluid which obstructs the pancreatic ducts

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3
Q

Patterns of injury in acute pancreatitis

A

o Periductal – necrosis of acinar cells near the ducts (usually secondary to obstruction)

o Perilobular – necrosis at the edges of the lobules (usually due to poor blood supply)

o Panlobular – this will develop from worsening of either periductal or perilobular inflammation

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4
Q

Complications fo Acute pancreatitis

A

pseudocyst formation

shock, hypoglycaemia, hypocalcaemia

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5
Q

Causes of Chronic pancreatitis

A

Ethanol (80%)
Gallstooens
Haemachromatosis
CF

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6
Q

Pattern of injury of chronic pancreatitis

A

o Chronic inflammation with parenchymal fibrosis and loss of parenchyma (ascini become atrophic)
o Duct strictures with calcified stones with secondary dilatations
 Pancreatic calcifications are diagnostic of chronic pancreatitis

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7
Q

Complications of chronic pancreatitis

A

o EARLY: Malabsorption (occurs much earlier as lipases, etc. are not produced)
o LATE: Diabetes mellitus (late stage as endocrine parts survive much longer than exocrine components)
o Pseudocysts
o Carcinoma of the pancreas (?)

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8
Q

What is IG4 related disease

A

Autoimmune Pancreatitis
by large numbers of IgG4 positive plasma cells
o Duct is surrounded by loads of IgG4 expressing plasma cells
o These patients respond very well to steroids

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9
Q

Types of pancreatic cancer

A

Carcinoma- ductal (85%), acinar
Cystic neoplasm- serous, mutinous
Pancreatic neuroendocrine tumours

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10
Q

What dysplastic lesson do ductal carcinomas arise from

A

 Pancreatic Intraductal Neoplasia (PanIN)

 Intraductal Mucinous Papillary neoplasm

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11
Q

What mutation is present in most DC cases

A

o K-Ras mutations are present in 95% of cases

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12
Q

Sites of ductal carcinoma in pancreas

A

Head (60%)> body> tail

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13
Q

Spread of DC

A

 DIRECT: bile ducts, duodenum
 LYMPHATIC: lymph nodes
 BLOOD: liver
 SEROSA: peritoneum

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14
Q

Complications of DC

A

 Chronic pancreatitis
 Venous thrombosis (migratory thrombophlebitis) – CHARACTERISTIC
• Circulating pancreatic cancer cells releasing mucous which activates the clotting cascade

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15
Q

Cystic tumours characteristics

A

o Contain serous or mucin secreting epithelium (like ovarian tumours)
o Usually benign

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16
Q

Pancreatic Endocrine Neoplasms Characteristics

A

 Usually non-secretory
 Stained by neuroendocrine markers (chromogranin stain)

Types
Types of secretory- Insulinomas
MEN1

17
Q

Risk factors of gallstones

A

Female, fat, forty, fair

Rapid weight loss, oral contraceptives

18
Q

Types of gallstones

A
o	Cholesterol (>50% cholesterol) 
	May be single 
	Mostly radiolucent (you will NOT see them on a plain abdominal X-ray  hence, USS 

o Pigment (contain calcium salts of unconjugated bilirubin)
 Often multiple
 Mostly radio-opaque (because they contain calcium)

19
Q

Complications of gallstones

A

o MOST PEOPLE do not have any problems

o Bile duct obstruction Acute and chronic cholecystitis
o Gallbladder cancer Pancreatitis

20
Q

Histology of acute cholecystitis

A

 Acute inflammation (neutrophils, oedema)

 90% are associated with gallstones

21
Q

Histology of chronic cholecystitis

A

 90% contain gallstones
 Fibrosis, small, neoangiogenesis
 Diverticula (Rokitansky-Aschoff sinuses) – gallbladder contracting against obstruction  diverticula

22
Q

Characteristics of Gallbladder cancer

A

o Adenocarcinoma
o 90% associated with gallstones
o This is UNCOMMON
o It is technically a type of cholangiocarcinoma