Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PATHOLOGY > Pancreatic histopath > Flashcards

Pancreatic histopath Flashcards

1
Q

summarise pancreatic microanatomy

A

main pancreatic duct goes into intralobular duct and intercalated duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is acute pancreatitis

A

acute inflammation of the pancreas

caused by aberrent release of pancreatic enzymes

Activation on enzymes secreted by pancreas is the main cause for the damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

incidence of acute pancreatitis

A

common

incidence is increasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

categories of causes for acute pancreatitis

A
  • duct obstruction
  • metabolic/toxic
  • poor blood supply
  • infection/inflammation
  • autoimmune
  • idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

duct obstruction causes of acute pancreatitis

A

Enzymes cant go where meant to go - activated in wrong place

  1. gall stones - most comon
  2. trauma
  3. tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

metabolic and toxic causes of acute pancreatitis

A

Alcohol - 1/3 cases of ac panc
* 5% of alcoholics will get ac panc

Thiazides

Hypercalcaemia

Hyperlipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

poor blood supply causes of acute pancreatitis

A

shock - hypovolaemia
hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

infection and inflammation causes of acute pancreatitis

A

is the cause and consequence

Virus - mumps = inflam of salivary glands too which secrete amylase

Coxacki

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pathogenesis of obstruction -> pancreatitis

A

gallstone distal to where common bile duct and panc duct join
-> reflux of bile up panc duct
-> **damage to acini **
and release of proenzymes -> activated

alcohol -> spasm/oedema of sphincter of Oddi and formation of protein rich panc fluid
-> **obstruction **of panc duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathogenesis of acute panc except from obstruction

A

direct acini injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

patterns of injury in acute pancreatitis

A

periductal:
* necrosis of acini cells near ducts - secondary to obstruction

perilobular
* necrosis at edges of the lobules
* usually from poor blood supply

panlobular
* develops from periductal and perilobular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how does injury propagate in acute pancreatitis

A

activated enzymes -> acinar necrosis -> enzyme release
+ve feedback
range from stromal oedema to haemorrhagic necrosis

eg lipases -> fat necrosis
1. (hydrolyse triglycerides)
2. (Ca ions bind to FFA
3. -> precipitated as soaps
4. seen as yellow-white foci)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

complications of acute pancreatitis

A

pancreatic
* pseudocyst
* abscess

systemic
* shock
* hypoglycaemia - shock and a lot of insulin released
* hypocalcaemia - ca combine with fatty acid -> fat necrosis, ca taken out of blood and ppte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a pseudocyst

A

(cysts not lined by epithelium)

  • may communicate with ducts,
  • may burst,
  • have stasis -> abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

acute pancreatitis and ca

A

Hyperca is the cause

Acute panc causes low ca

->

If acute panc and normal ca - could have been high and then fat necorsis normalises it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Px of acute pancreatitis

A

overall mortality of up to 50% for haemorrhagic pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

histo path of acute panc

A

White things - fat necrosis

Microscopic - blue - are ca combined with FFA -> fat necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is acute pancreatitis

A

relapsing or persistent

associated with acute in 1/2 case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

epidemiology and px of chronic pancreatitis

A

uncommon

3% mortality per yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

causes of chronic pancreatitis

A

metabolic/toxic
* alcohol - 80%
* haemochromatosis

duct obstruction
* gallstones
* abnormal pancreatic duct anatomy
* CF (mucoviscoidosis)

tumours

idiopathic - autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

haemochromatosis as a cause of chronic pancreatitis

A

iron overload - iron deposited in parenchymal cells of pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

duct obstruction as a cause of chronic pancreatitis

A
  • Gall stones
    • Abnormal pancreatic duct anatomy -> reflux of bile into pancreas
    • CF (mucoviscioidosis) - thick mucin deposited -> obstruction
  • Chronic disease -> chronic pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pathogenesis of chronic pancreatitis

A

same as acute

Direct damage to acini eg by iron deposited in cells

Acute = neutrophils
Chronic = lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pattern of damage in chronic pancreatitis

A

chronic inflammation with parenchymal fibrosis
associated with atrophy of the acini - loss of parenchyma
islets will be squeezed out too

haemochromatosis ‘‘bronze diabetes’’ - initially effect acini but will go on to effect islets

duct strictures with calcified stones and secondary dilations

25
Q

chronic pancreatitis complications

A

malabsorption - acini gone and ducts obstructed

DM - in late stage

pseudocysts

?carcinoma of pancreas - unclear whether associated
- But tumour cause of acute and chronic panc - unclear which comes 1st

26
Q
A
  • Calcification of pancreas
    • Chronic calcifying pancreatitis
27
Q
A
  • Scarring pale tissue
    • Cysts
    • Chronic panc
28
Q
A
  • Fibrosis
    • Islets left behind
      Acini have gone - might start to look like a neuroendocrine tumour
29
Q

summarise pancreatic pseudocyst

A

associated with acute and chronic pancreatitis

lined by fibrous tissue (no epithelial tissue)

contain fluid rick pancreatic enzymes or necrotic material

connect with pancreatic ducts

may resolve
may compress structures
befome infected
perf -> necrotic material and pancreatic enzymes -> peritonitic reaction

30
Q
A
  • Fibrous tissue
    • Pseudocyst
31
Q
A
  • Fibrous tissue
    • Pseudocyst
32
Q
A

no epithelial lining

33
Q

What is autoimmune hepatitis

A

IgG4 related

characterised by large numbers of IgG4 positive plasma cells

can involve any part of pancreas, bile ducts, and any other part of the body

34
Q
A

Top L
- May look like ca

On immunohistochem
- IgG4 positive plasma cells

Ddx for panc cancer

35
Q

Mx of autoimmune hepatitis

A

responds well to steroids

36
Q

what are the types of pancreatic cancer

A

carcinomas
* ductal - 85% of all neoplasms
* acinar

cystic
* serous cystadenoma
* mucinous cystic neoplasm

pancreatic neuroendocrine tumours (islet cell tumours)

37
Q

Summarise ductal cell carcinomas

A

5% all cancer deaths
more common with age
>men

5ur survival - 5%

38
Q

rf for ductal carcinoma - pancreas

A

Smoking
BMI
Chronic pancreatitis
Diabetes

39
Q

pathogenesis of pancreatic ductal carcinomas

A

arise from dysplastic ductal lesions

  • pancreatic intraductal neoplasma (PanIN)
  • Intraductal Mucinous Papillary neoplasm

K-Ras mutation in 95%

40
Q

microscopic appearance of ductal pancreatic carcinoma

A

gritty and grey
invades adjecent structures
tumour in head present earlier - because duct obstruction (when in back of panc - present when they met to liver

41
Q

macroscopic appearance of ductal carcinomas

A

adenocarcinomas = mucin secreting glands set in desmoplastic stroma

42
Q

sites of ductal ca

A

head - 60%
body
tail
diffuse

43
Q
A
  • Glands
    • Mucin
      Perineural invasion - the bit in the middle is nerve
44
Q

spread of ductal ca

A

direct - bile ducts, duodenum
lymphatic - lymph nodes (coeliac)
blood - liver (via oancreatic and portal vein)
serosa - peritoneum
perineural very common

45
Q

complications of ductal carcinoma

A

due to spread
chronic pancreatitis
venous thrombosis - migratory thrombophlebitis
* a lot of mucin produced by ca
* -> secrete into blood stream
* -> act like tissue factor
* -> activate thrombosis all over the body

46
Q

summarise cystic pancreatic tumours

A

contain serous or mucin secreting epithelium
like ovarian

usually benign (cystadenocarcinomas are malignant)

47
Q

summarise cystic pancreatic tumours

A

contain serous or mucin secreting epithelium
like ovarian

usually benign (cystadenocarcinomas are malignant)

48
Q

summarise pancreatic endocrine neoplasms

A

usually non-secretory

contain neuroendocrine markers - chromogranin - can measure in blood

behaviour difficult to predict - low grade can met

associated with MEN 1

49
Q

summarise insulinomas

A

derived from beta cells

commonest type of secretory tumour

50
Q
A

Characteristic
Stain for - chromogranin!

51
Q

RF for gallstones

A

More common with age

20% adults in west have
more common in native americans

> female

hereditory - disorder of bile metabolism

drugs - COCP

acquired - rapid wht loss - lose fat - secrete via bilairy system -> stones

52
Q

Types of gallstones

A

Cholesterol
- Most contain >50% cholesterol
- May be single
- Radiolucent - don’t see them on plain AXR

Pigment
- Associated with BR
- Contain ca salts
- Combined to conjugated BR
- Because contain ca - radioopaqye
Small and multiple

53
Q

complications of gallstones

A
  • Bile duct obstruction
    • Acute and chronic cholecystitis
    • Gall bladder ca
    • Pancreatitis - due to obstruction
54
Q

summarise acute cholecystitis

A

90% associated with gall stones

acute inflammation - Neutrophils

Can be salmoneela/typhoid - much rarer

55
Q

summarise chronic cholecystitis

A

Fibrosis
chronic inflammation -> Lymphocytes

Diverticular - obstruction by stone - gall bladder try to push through - raised pressure - diveritucular - rokitansky-Aschoff sinuses

90% contain gall stones

56
Q
A
  • Thickness of wall because of fibrosis
    Round - is diverticular
57
Q
A
  • Lumen
    • Outpocketing of diverticular
      Can get obstruction?
58
Q

summarise gall bladder cancer

A

adenoca

90% associated with gall stones

PATHOLOGY (94 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions