Pancreatic and Gall Bladder Pathology Flashcards
2 main role of pancreas
Endocrine and exocrine function
Label the anatomy of the pancreas
Lecture Slide
Pancreas: Exocrine Function
- what cells involved? Contain what?
Composed of acinar cells and ducts
Acinar cells contain zymogen granules (Zymogens = inactive enzyme precursors for trypsin, chymotrypsin, amylase, lipase, nuclease, elastase)
Pancreas: Endocrine Function
- cells involved? Contain/secrete what
Islets of Langerhans
Secrete insulin, glucagon, other hormones
Acute pancreatitis
- what is it?
Inflammation of the pancreas – associated with acinar cell injury. Causes release of enzymes causing severe inflammation
Causes of pancreatitis
4 major causes
1. Metabolic: Alcohol (direct damage to acinar cells as well as obstruction in the pancreatic duct)
2. Mechanical: Gallstones (cholelithias), trauma (obstruction of pancreatic duct)
3. Vascular: Shock (hypotension, ↓ perfusion and decreased oxygen to pancreas), vasculitis (impaired blood supply to pancreas)
4. Infection: Mumps
how does pancreatitis cause inflammation
Autodigestion by pancreatic enzymes
eg: obstruction in the pancreatic duct
↑ pressure damage to acinar cells, release of enzymes
LEADING TO
Cell injury response mediated by inflammatory cytokines
Consequences of enzyme release:
What is released from pancreas and the effect of it
Proteases: destruction of acini, ducts, islets
Lipases: Fat necrosis – pancreas and other
sites
Elastases: blood vessel destruction leading to interstitial haemorrhage
Cell injury response : inflammation, oedema
What triggers the acute event
- Obstruction of the pancreatic duct
- Direct injury to acinar cells
Draw the flowchart showing the processes leading to acute pancreatitis
Lecture Slide
Clinical symptoms/signs of acute pancreatitis
Acute abdominal pain – epigastric
Nausea and vomiting
Fever, tachycardia
Marked abdominal tenderness
Acute pancreatitis Diagnosis is made using..
- Clinical symptoms and signs
- Neutrophil leucocytosis
- Elevated serum amylase and lipase
- CT scan abdomen– oedema, necrosis, pseudocysts of the pancreas
- Rarely may need laparotomy to confirm
diagnosis
managment of acute pan
IV fluids
NG suction
Analgesia
Close monitoring
Define chronic pancreatitis
Defined as repeated bouts of pancreatic inflammation with loss of pancreatic parenchyma and replacement by fibrous tissue
· see more chronic inflammatory cells - monocytes macrophages
. loss of pancreatic tissue
· fibrosis
. not necessarily larger, can be normal or even reduced in size
Processes causing Chronic Pancreatitis
Atrophy of the exocrine component but relative sparing of the islets
Mild chronic inflammatory infiltrate
Calcification
Clinical symptoms of chronic pan
Repeated attacks of abdominal pain – often bought on by alcohol
Can be more persistent pain
Pancreatic Carcinoma
-risk factors
-type of cancer
Tobacco smoking
Heavy alcohol intake
High BMI
Adenocarcinoma
Differences in Pancreatic Carcinoma when in head vs body/tail
Head of pancreas: invade Ampulla , biliary obstruction
Body and tail: remain silent, often large and disseminated at presentation, spread to nodes, adjacent organs, liver, bones, lungs
Symtpoms of pancreatic cancer
Obstructive jaundice
Pain
Weight loss
Pancreatitis (if theres obstruction)
Thrombophlebitis (inflammation of the veins associated wi clotting)/ venous thrombosis
Diagnosis of cancer based on
Confirmed by CT or US guided FNA and core biopsy or open biopsy at laparotomy
Pancreatic Endocrine Tumours
- two main types and findings
- Islet cell Tumours
- Insulinoma (tumor of beta cells)
- Present with symptoms of hypoglycaemia
Blood glucose low, raised insulin levels
Cholelithiasis: Gallstones
-describe how it happens
About 80% of gallstones contain crystalline cholesterol monohydrate and are called
cholesterol stones
- Bile supersaturated with cholesterol
- Conditions favour crystal formation
- Cholesterol crystals remain in gallbladder long enough for stones to form eg stasis
Risk factors for cholelithiasis
- Increase chance with age and women
(Estrogenic influences (oral contraceptives, pregnancy), obesity and rapid weight loss favour stone formation) - Gallbladder stasis favours stone formation
3.A family history of gallstones
Clinical consequences of Gallstones (eg where it can block and the name for that location of stones)
1.Cholecystitis – acute / chronic
2. Biliary colic – due to choledocholithiasis
3.Complications of above eg cholangitis, obstructive choleostasis, pancreatitis
Acute Cholecystitis
-what is it
-caused by
Obstruction of the neck of the gallbladder or of the cystic duct
Most cases precipitated by gallstones
Clinical Features Cholecystitis
-symptoms
lab results
RUQ abdominal pain and tenderness
Febrile
tachycardia
Laboratory:
Neutrophil leucocytosis
Raised bilirubin, ALP and GGT if stone in the common bile duct
Imaging – ultrasound of gall bladder
Chronic Cholecystitis
- what is it
Chronic cholecystitis results from long-term association of gallstones and low-grade inflammation.
Management of cholecystitis
Initial acute event
Many settle with conservative therapy – iv fluids, pain relief or even surgery
Longer term:
Cholecystectomy – most now laparoscopic
What is Choledocholithiasis
- complications
Choledocholithiasis is the presence of stones within the biliary tree
Complications:
Biliary obstruction – colicky abdominal pain
Obstructive jaundice
Pancreatitis
Cholangitis
Cancers of the Biliary System
-2 locations
-main type of cancer
Carcinoma of the Gall Bladder
Carcinoma of the extrahepatic ducts
Most are adenocarcinomas
cholecystitis vs cholelithiasis vs choledocholithiasis vs cholangitis
Cholelithiasis:
presence of gallstones within the gallbladder itself
Cholecystitis:
Inflammation of the gallbladder, usually caused by a gallstone obstructing the cystic duct
Choledocholithiasis:
gallstones within the common bile duct
Cholangitis:
Inflammation and infection of the bile ducts, often caused by gallstones
