Pathology - Pancreas and Gallbladder Flashcards by Art F

-Major metabolic cause of acute pancreatitis?-Other causes?

-ALCOHOL-hyperliporproteinemia-hypercalcemia-drugs (thiazides)-genetic

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-Major mechanical cause of acute pancreatitis?-Other causes?

-GALLSTONES-trauma-latrogenic injury (perioperative injury ; endoscopic procedures with dye injection)

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Vascular causes of acute pancreatitis?

-shock-atheroembolism-vasculitis (polyarteritis nodosa, SLE, Henoch-Schonlein purpura)

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Infectious causes of acute pancreatitis?

-mumps-coxsackievirus-mycoplasma pneumonia

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which enzyme is usually primary issue with acute pancreatitis?Why?

-trypsin-this enzyme activates all the other pancreactic enzymes

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Classic acute pancreatitis presentation?

epigastric pain with radiation to the back

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Acute pancreatitis - LABS

-first 24 hrs increase serum amylase (but NOT specific to pancreas)-72-96 hours inc serum lipase (more specific)-hypocalcemia - bc the enzymes digest fat = ppt of calcium soaps (poor prognosis)

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Does serum amylase or lipase stay elevated for long in acute pancreatitis?

lipase

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If serum amylase is elevated for longer than 2-4 days (normal) then what does that suggest?

pancreatic pseudocyst (amylase rich fluid collecting around pancreas)

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Primary concern with acute pancreatitis? WHY?

SHOCK - develop respiratory issues (ARDS) –> high mortality

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Mildest form of acute pancreatitis?

acute INTERSTITIAL pancreatitis = trivial inflammation and edema (organ can return to normal fucntion if treated)

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Serious forms of acute pancreatitis?

-acute NECROTIZING pancreatitis-acute HEMORRHAGIC pancreatitis(medical emergency –> SHOCK … and all that. - may still restore function but probs not- FYI chronic pancreattiis = irreversible damage)

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What is the pain like in acute necrotizing or hemorrhagic pancreatitis?Progression?

-constant pain radiating to UPPER back-Shock & acute tubular necrosis –> loss of blood volume and vasodilation (vasoactivators-inc effect of blood volume loss) –> DIC, ARDS…. all that stuff

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What are potential outcomes (sequelae) of acute pancreatitis?

-multiple acute bouts = chronic pancreatitis-sterile pancreatic abscess -*PSEUDOCYST - collection of blood, debris, tissue, fluid tht forms 1-4 weeks after onset (not true cyst bc no epithelial lining)-infected pancreatitic necrosis

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Defining feature of chronic pancreatits?

-fibrosis = irreversible loss of or damage to tissue

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Major cause of chronic pancreatitis?

ALCOHOL again

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Less common causes of chronic pancreattis?

-long-standing obstruction of pancreatic duct (pseudocysts, stones…)-Familial hereditary pancreatitis: mutations in PRSS1 or SPINK1 (associated with both acute and chronic)-Cystic fibrosis - mutation in CFTR gene = thick secretions

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90-95% of chronic pancreatitis are due to?Other 5% cause?

alcoholidiopathicgall stones

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Acute pancreatitis pathogenesis initiation?Over time pathogenesis?

-sequence of fibrosis around pancreatic lobules, duct distortion, and altered pancreatic secretions-with multiple episodes = loss of pancreatic parenchyma and fibrosis

Pathogenic events?

-ductal obstruction by concretions (ductal plugs –> calcification, alcohol=more protein in secretions)-toxic metabolites - especially alcohol= lipids accumulate in cells–> death and fibrosis

How does alcohol predispose patient to pancreatitis?

-decreased bicarbonate secretion-inc protein secretion===>favors formation of inspissated ductal secretions that, in turn, leads to ductal obstruction with inflammation, fibrosis, and atrophy

What happens to acinar cells in chronic pancreatitis?

drop out - dec numbers and sizeACINAR LOSS IS A CONSTANT FEATURE

progressive inflammatory disease of pancreatitis is characterized by what clinical triad?

diabetessteatorrheacalcifications (radiology)

non neoplastic cysts:

-congenital-pseudocyst

neoplastic cysts:

**-microcystic serous cystadenomas (older women-benign)**-mucinous cystic neoplasms (younger women-malignant potential)-solid pseudopapillary tumor-rare adolescent girls and young women)**-intraductal papillary mucinous cystic neoplasms (IPMNS) - more men and in head of pancreas

congenital cyst-type?-what about it?

-non-neoplastic-has cuboidal epithelium-component of von Hippel-Lindau disease = cysts in pancreas, liver and kidney; angiomas in retina and cerebellum or brain stem-BASICALLY they have a greater risk of having more cysts or cancers in many places

Most common non-neoplastic cyst?

pseudocyst

Pseudocysts-type?-how to get?-features/what abou ti?

-non-neoplastic-unilocular cyst = lacks true epithelial lining but is fluid filled (collection of pancreatic secretions-develop after acute or chronic pancreatitis-hemorrhage and infection complications

Where do neoplastic cystic pancreatic tumors arise from?

pancreatic duct tissue

What does a pancreatic serous cystadenoma look like grossly?

honey comb like

Intraductal papillary mucinous neoplasms--dangerousness?-men or woemn?-where in pancreas?-what happens to epithelium?

-super bad - benign, malignant or boderline malignant-MEN>women-head of pancreas > tailchanges:1) cuboid to columnar2) papillary infoldings3) papillary epithelium with architectural and cytologic changes4) significant atypia and budding off of clusters of cells

pancreatic cancer - prognosis?

-poor prognosis - most dead within first year

pancreatic cancer - who gets most often, comobidiites? race?

-elderly-men-African americans-diabetics

major risk factor for pancreatic cancer?other factors?

-SMOKING**-hereditary pancreatitis-high fat diet-chronic pancreatitis-diabetes

90% of pancreatic cancers have what gene mutiation?

K-Ras (usually due to smoking)

Most common location for pancreatic cancer?

head

risk factors for gallbaldder stones:

-diet (cholesterol stones common)-pregnancy-oral contraceptives

3 types of gallstones:

1) cholesterol stones (biliary hypersecretion of cholesterol/supersaturation of bile with cholesterol)2) pigmented stones (mostly bilirubin calcium salts)3) mixed

4 processes that cause (cholesterol) stones:

-supersaturation (lots of cholesterol or bile)-gallbladder hypomotility (slow flow of bile)-crystal nucleating -accretion within the gallbladder mucous layer

Pigmented gallstones- risk factors:

-chronic hemolytic syndromes-biliary tract infection (bacterial or parasitic)-ileal disease (resection or bypass)-CALCIUM PRECIPITATION OF BILIRUBIN

gross appearance term for high levels of cholesterol in the gallbladder?-what is going on?

-strawberry gallbladder (cholesterolosis)-cholesterol laden macrophages build up under epithelium = bumpy white/yellow

common acute types of cholecystitis:

1) Acute calculous cholecystitis2) acuet acalculous cholecystits-postop-sever burn or trauma-mutli organ failure-sepsis-prolonged hyperalimentation-postpartum

stones in the gallbladder most likely?

CHRONIC cholecystits

special types of chronic cholcestitis:

-porcelain gallblader - stiff wall with dystrophic calicification-hydrops of the gallbladder-stone blocks and GB enlarges and atrophic - filled wtih clear fluid

main concern with acute and chronic cholecystitis?

Gb perforation or rupturesuperinfection or peritonitislocal abscess formation

Most common cancer type of the gallbladder?

adenocarcinoma