Pathology of gallbladder and pancrease

Question 1

1. List the clinical factors that increase risk for cholelithiasis, including the major types of gallstones and clinical implications of each type.

Answer 1

cholesterol stones 80%

• Ethnicity: U.S.; North Europe; Native Americans
• Advancing age
• Female sex hormones, Female gender, Oral contraceptivesPregnancy
• Obesity
• Rapid weight loss

pigment stones 20%

• Ethnicity: Asian; rural
• Chronic hemolytic syndromes
• Biliary infection
• Ileal disease

Question 2

2. List at least three important complications of cholelithiasis.

Answer 2

choledocolithiasis- major cause of ascending cholangitis

Question 3

3. Compare and contrast the macroscopic (visible appearance) and microscopic features of acute and chronic cholecystitis.

Answer 3

acute

• erythema, prominant vascular pattern, mural hemmorhage, edema
• inflammatory disruption of mucosa

chronic

• inflammation and fibrosis of the gallbladder with poor correlation to clinical symptoms, high correlation to gall stones
• thickened fibrotic wall,
• macrophage inflitrate, thickening of muscular layer
• ashe croft sinuses (mucosal herniations)

Question 4

4. Describe the histopathologic features of gallbladder cancer.

Answer 4

mostly adenocarcinomas. infiltrate of gland forming neoplasm, atypical cytology, mitotic figures, high N/C ratio

Question 5

5. Compare and contrast the histopathologic and clinical features of acute and chronic pancreatitits.

Answer 5

Acute-

• hemmorhagic necrosis, autodigested areas of fat (yellow)
• edematous, fibrotic, PMN infiltrate

Chronic-

• irreversible paranchymal destruction and fibrosis of pancrease
• acinar atrophy

Question 6

6. Describe a pancreatic pseudocyst and state the clinical settings where a pseudocyst sometimes occurs.

Answer 6

psuedocysts- irregular shape and surface, doesn’t have a true epithelial lining. hemmorhage inflammation debris

Pancreatic pseudocysts most often develop after an episode of severe, acute pancreatitis.

Question 7

7. Recognize the two common types of pancreatic neoplasms and compare and contrast the clinical syndromes and microsopic appearance of each type of lesion.

Answer 7

ductal adenocarcinoma- 4th leading cause of death from cancer in us

• 5% 5 year survival
• mass forming lesion that obstructs either pancreatic duct, bile duct, or both
• gland forming tumor

neuroendocrine- 
-round fleshy demarcated tumor
-dont cause the ductal obstruction
-ribbon like growth pattern, regular round nuclei, granular chromatin
PENs
functional- (cause clinical syndrome) 
- insulinoma- hypoglcyemic
- gastrinoma ZE syndrome (ulcers) 
non-functional
well differentiated 
poorly differentiated