Pancreatic and Gall bladder Flashcards
Main cause of gallstones
Gallstones
Ethanol
Pathogenesis of acute pancreatitis
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
Patterns of injury in acute pancreatitis
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
Complications fo Acute pancreatitis
pseudocyst formation
shock, hypoglycaemia, hypocalcaemia
Causes of Chronic pancreatitis
Ethanol (80%)
Gallstooens
Haemachromatosis
CF
Pattern of injury of chronic pancreatitis
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
Complications of chronic pancreatitis
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 (?)
What is IG4 related disease
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
Types of pancreatic cancer
Carcinoma- ductal (85%), acinar
Cystic neoplasm- serous, mutinous
Pancreatic neuroendocrine tumours
What dysplastic lesson do ductal carcinomas arise from
Pancreatic Intraductal Neoplasia (PanIN)
Intraductal Mucinous Papillary neoplasm
What mutation is present in most DC cases
o K-Ras mutations are present in 95% of cases
Sites of ductal carcinoma in pancreas
Head (60%)> body> tail
Spread of DC
DIRECT: bile ducts, duodenum
LYMPHATIC: lymph nodes
BLOOD: liver
SEROSA: peritoneum
Complications of DC
Chronic pancreatitis
Venous thrombosis (migratory thrombophlebitis) – CHARACTERISTIC
• Circulating pancreatic cancer cells releasing mucous which activates the clotting cascade
Cystic tumours characteristics
o Contain serous or mucin secreting epithelium (like ovarian tumours)
o Usually benign