Pathology of the Pancreas, Gallbladder and Bile Ducts Flashcards
List 5 causes of biliary tree obstruction
Stones Tumours Trauma Congenital abnormalities Fibrosing/sclerosing conditions
What are the 3 main endocrine cell types in the pancreas and what is the role of each?
Alpha: produce glucagon
Beta: produce insulin (majority of cells)
Delta: produce somatostatin
Describe the structure of the exocrine pancreas and link this to its function
Secretory acini and ducts
Acinar cells contain zymogen granules
What are the most common causes of acute pancreatitis?
Gallstones
Alcohol
List 4 medications which may cause pancreatitis
NSAIDs
Thiazide diuretics
Sulfonamides
Acetaminophen
When does pain begin for alcohol-induced pancreatitis?
12-48 hrs after intoxication
What signs are associated with haemorrhage into the retroperitoneum secondary to severe pancreatitis?
Grey Turner’s sign (https://pbs.twimg.com/media/BpH-O2nIEAAh_uk.jpg)
Cullen’s sign (https://lippiejunkie.files.wordpress.com/2011/04/figure-1-cullens-sign1.jpg)
Circulatory derangement
When does amylase become elevated in the setting of acute pancreatitis?
24 hrs post-onset of symptoms
Rapidly return to normal
What does persistent hyperamylasaemia indicate?
Development of complications
What imaging is used to aid diagnosis of pancreatitis and what are the expected findings for each?
Abdo U/S: may be pancreatic oedema with fat stranding, gallstones
CT and MRI (more specific)
List 6 possible complications of pancreatitis
Pseudocyst Infection (abscess, infected pseudocyst, necrosis with infection; all life-threatening complications) Haemorrhage Hypocalcaemia Shock
What is chronic pancreatitis?
Continuing, chronic inflammation of the pancreas leading to irreversible parenchymal damage and fibrosis; in late stages, the endocrine parenchyma is also affected
What is the most common cause of chronic pancreatitis?
Alcohol abuse
What are 3 other causes of chronic pancreatitis?
CF
Congenital
Trauma
What other chronic disease is associated with chronic pancreatitis?
Many patients develop T2DM
What are the symptoms of chronic pancreatitis?
Recurrent epigastric abdominal pain with radiation to back
Anorexia, weight loss
May have steatorrhoea
How is chronic pancreatitis diagnosed?
XR: may reveal calcifications
CT: useful in evaluating size and texture of pancrease
ERCP
Pancreatic function tests (??)
How can exocrine pancreatic adenomas be described?
Solid or cystic
Mucinous or serous
Describe the epidemiology of pancreatic adenocarcinoma
Male
Smokers
May be linked to T2DM, chronic pancreatitis, long-term high-fat diets
What is the most common type of malignant pancreatic exocrine tumour? What is the most common site of origin?
Duct cell adenocarcinoma
Most commonly head of pancreas
What are the most common clinical features of periampullary adenocarcinoma?
Jaundice
Weight loss
Abdominal pain
What is the DDx for a periampullary neoplasm?
Periampullary adenocarcinoma
Ampullary carcinoma
Duodenal carcinoma
Carcinoma of the distal CBD
What laboratory abnormalities are seen in periampullary adenocarcinoma?
Elevated bilirubin, ALP, CEA, CA19-9
How is periampullary adenocarcinoma diagnosed?
Imaging: ??
Biopsy
What are CEA and CA 19-9?
Tumour markers?
Describe the Whipple procedure
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