Pancreatic and Gall bladder

Question 1

Main cause of gallstones

Answer 1

Gallstones

Ethanol

Question 2

Pathogenesis of acute pancreatitis

Answer 2

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

Question 3

Patterns of injury in acute pancreatitis

Answer 3

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

Question 4

Complications fo Acute pancreatitis

Answer 4

pseudocyst formation

shock, hypoglycaemia, hypocalcaemia

Question 5

Causes of Chronic pancreatitis

Answer 5

Ethanol (80%)
Gallstooens
Haemachromatosis
CF

Question 6

Pattern of injury of chronic pancreatitis

Answer 6

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

Question 7

Complications of chronic pancreatitis

Answer 7

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 (?)

Question 8

What is IG4 related disease

Answer 8

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

Question 9

Types of pancreatic cancer

Answer 9

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

Question 10

What dysplastic lesson do ductal carcinomas arise from

Answer 10

 Pancreatic Intraductal Neoplasia (PanIN)

 Intraductal Mucinous Papillary neoplasm

Question 11

What mutation is present in most DC cases

Answer 11

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

Question 12

Sites of ductal carcinoma in pancreas

Answer 12

Head (60%)> body> tail

Question 13

Spread of DC

Answer 13

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

Question 14

Complications of DC

Answer 14

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

Question 15

Cystic tumours characteristics

Answer 15

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

Question 16

Pancreatic Endocrine Neoplasms Characteristics

Answer 16

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

Types
Types of secretory- Insulinomas
MEN1

Question 17

Risk factors of gallstones

Answer 17

Female, fat, forty, fair

Rapid weight loss, oral contraceptives

Question 18

Types of gallstones

Answer 18

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)

Question 19

Complications of gallstones

Answer 19

o MOST PEOPLE do not have any problems

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

Question 20

Histology of acute cholecystitis

Answer 20

 Acute inflammation (neutrophils, oedema)

 90% are associated with gallstones

Question 21

Histology of chronic cholecystitis

Answer 21

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

Question 22

Characteristics of Gallbladder cancer

Answer 22

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