Pathology of the Pancreas, Gallbladder and Bile Ducts

Question 1

List 5 causes of biliary tree obstruction

Answer 1

Stones
Tumours
Trauma
Congenital abnormalities
Fibrosing/sclerosing conditions

Question 2

What are the 3 main endocrine cell types in the pancreas and what is the role of each?

Answer 2

Alpha: produce glucagon
Beta: produce insulin (majority of cells)
Delta: produce somatostatin

Question 3

Describe the structure of the exocrine pancreas and link this to its function

Answer 3

Secretory acini and ducts

Acinar cells contain zymogen granules

Question 4

What are the most common causes of acute pancreatitis?

Answer 4

Gallstones

Alcohol

Question 5

List 4 medications which may cause pancreatitis

Answer 5

NSAIDs
Thiazide diuretics
Sulfonamides
Acetaminophen

Question 6

When does pain begin for alcohol-induced pancreatitis?

Answer 6

12-48 hrs after intoxication

Question 7

What signs are associated with haemorrhage into the retroperitoneum secondary to severe pancreatitis?

Answer 7

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

Question 8

When does amylase become elevated in the setting of acute pancreatitis?

Answer 8

24 hrs post-onset of symptoms

Rapidly return to normal

Question 9

What does persistent hyperamylasaemia indicate?

Answer 9

Development of complications

Question 10

What imaging is used to aid diagnosis of pancreatitis and what are the expected findings for each?

Answer 10

Abdo U/S: may be pancreatic oedema with fat stranding, gallstones
CT and MRI (more specific)

Question 11

List 6 possible complications of pancreatitis

Answer 11

Pseudocyst
Infection (abscess, infected pseudocyst, necrosis with infection; all life-threatening complications)
Haemorrhage
Hypocalcaemia
Shock

Question 12

What is chronic pancreatitis?

Answer 12

Continuing, chronic inflammation of the pancreas leading to irreversible parenchymal damage and fibrosis; in late stages, the endocrine parenchyma is also affected

Question 13

What is the most common cause of chronic pancreatitis?

Answer 13

Alcohol abuse

Question 14

What are 3 other causes of chronic pancreatitis?

Answer 14

CF
Congenital
Trauma

Question 15

What other chronic disease is associated with chronic pancreatitis?

Answer 15

Many patients develop T2DM

Question 16

What are the symptoms of chronic pancreatitis?

Answer 16

Recurrent epigastric abdominal pain with radiation to back
Anorexia, weight loss
May have steatorrhoea

Question 17

How is chronic pancreatitis diagnosed?

Answer 17

XR: may reveal calcifications
CT: useful in evaluating size and texture of pancrease
ERCP
Pancreatic function tests (??)

Question 18

How can exocrine pancreatic adenomas be described?

Answer 18

Solid or cystic

Mucinous or serous

Question 19

Describe the epidemiology of pancreatic adenocarcinoma

Answer 19

Male
Smokers
May be linked to T2DM, chronic pancreatitis, long-term high-fat diets

Question 20

What is the most common type of malignant pancreatic exocrine tumour? What is the most common site of origin?

Answer 20

Duct cell adenocarcinoma

Most commonly head of pancreas

Question 21

What are the most common clinical features of periampullary adenocarcinoma?

Answer 21

Jaundice
Weight loss
Abdominal pain

Question 22

What is the DDx for a periampullary neoplasm?

Answer 22

Periampullary adenocarcinoma
Ampullary carcinoma
Duodenal carcinoma
Carcinoma of the distal CBD

Question 23

What laboratory abnormalities are seen in periampullary adenocarcinoma?

Answer 23

Elevated bilirubin, ALP, CEA, CA19-9

Question 24

How is periampullary adenocarcinoma diagnosed?

Answer 24

Imaging: ??

Biopsy

Question 25

What are CEA and CA 19-9?

Answer 25

Tumour markers?

Question 26

Describe the Whipple procedure

Answer 26

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