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Pathology by week > W28 - Pancreas & GB > Flashcards

W28 - Pancreas & GB Flashcards

1
Q

The common bile duct joins the ___________ at the drainage site in the _______, or sometimes they join together to form the…

A

The common bile duct joins the main pancreatic duct at the drainage site in the duodenum, or sometimes they join together to form the ampulla of Vater

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2
Q

The pancreatic cells responsible for production of digestive enzymes are…

A

Pancreatic acinar cells

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3
Q

Acute pancreatitis definition

A

Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes.

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4
Q

Causes of acute pancreatitis

A

I GET SMASHED

I: idiopathic (15%)

G: gallstones (50%)

E: ethanol (33%)

T: trauma

S: steroids

M: mumps (and other infections)/malignancy

A: autoimmune

S: scorpion stings/spider bites

H: hyperlipidaemia/hypercalcaemia/hyperparathyroidism (metabolic disorders)

E: ERCP

D: drugs (tetracyclines, furosemide, azathioprine, thiazides and many others)

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5
Q

Acute pancreatitis pathogenesis:

  • gallstones
  • alcohol
  • direct acinar injury
A
  1. gallstone stuck distal to where the common bile duct and pancreatic duct join => reflux of bile up to to the pancreatic duct => damge to acini => release of pro-enzymes => become activated = pancreatic duct obstruction
  2. alcohol leads to spasm/oedema of sphincter of Oddi = formation of a protein-rich pancreatic fluid => pancreatic duct obstruction
  3. direct acinar injury
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6
Q

Acute pancreatitis - patterns of injury (3)

A
  1. Periductal = necrosis of acinar cells near ducts (usually 2ndary to obstruction)
  2. Perilobular = necrosis at edges of the lobules (usually due to poor blood supply)
  3. Panlobular = mix of 1 + 2
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7
Q

In acute pancreatitis, what happens when there is release of activated enzymes?

A

Effects range from stromal oedema to haemorrhagic necrosis

Release of lipase leads to digestion of fat => fat necrosis => calcium ions bind to FFA => form soaps seen as yellow-white foci (soap spots)

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8
Q

Complications of acute pancreatitis

Prognosis?

A

Complications:

  • Pancreatic => 1) pseudocyst 2) abscess
  • Systemic => 1) shock 2) hypoglycaemia 3) hypocalcaemia

Prognosis = 50% mortality for haemorrhagic pancreatitis

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9
Q

Pancreas specimen

What does it show?

A

Acute pancreatitis (soap loci = combination of Ca2+ and FFA)

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11
Q

Chronic pancreatitis definition

A

Chronic pancreatitis is a painful disease of the pancreas in which inflammation has resolved, but with resultant damage to the gland characterized by fibrosis, calcification and ductal inflammation. It is possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.

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12
Q

Chronic pancreatitis - 2 subtypes

A

Chronic pancreatitis:

  1. Relapsing
  2. Persistent
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13
Q

Chronic pancreatitis causes

A

A) Metabolic:

1. Alcohol (80%)

  1. Haemochromatosis

B) Duct obstruction:

  1. Gallstones
  2. Cystic fibrosis
  3. abnormal pancreatic duct anatomy

C) Tumours

D) Idiopathic/autoimmune

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14
Q

Pathogenesis of chronic pancreatitis

A

Same as acute pancreatitits (inapporpriate activation of enzymes leading to damage, but over a longer period of time)

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15
Q

Patterns of injury in chronic pancreatitis

A
  • chronic inflammation with parenchymal fibrosis
  • loss of parenchyma
  • duct strictures with calcified stones with 2ndary dilatation
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16
Q

Complications of chronic pancreatitis (4)

A
  1. Malabsorption
  2. DM
  3. Pseudocysts
  4. Carcinoma of the pancreas?
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17
Q

Pancreatic pseudoyct is associated only with chronic pancreatitis - T or F?

A

False - acute and/or chronic pancreatitis

18
Q

Autoimmune pancreatitis is also known as…

A

IgG4 related disease

19
Q

What happens to the pancreas in IgG4 related disease?

A

Large numbers of IgG4+ plasma cells that attack the pancreas, causing lots of fibrosed and inflamed tissue

20
Q

Carcinomas of the pancreas - 2 types

A

Ductal (85% of all pancreatic neoplasms)

Acinar

21
Q

Tumours of the pancreas (3 groups)

A
  1. Carcinomas (ductal, acinar)
  2. Cystic neoplasms (serous cystadenoma, mucinous cyst neoplasm)
  3. Pancreatic neuroendocrine tumours (Islet cell tumours)
22
Q

Ductal pancreatic carcinoma:

M:F ratio

5 year survival?

A

Ductal pancreatic carcinoma:

M:F 2:1

5 year survival = 5% (pancreas is a retroperitoneal organ and we don’t see these cancers usually until they metastasise)

23
Q

RF (4) for pancreatic carcinoma

A
  1. Smoking
  2. BMI/dietary factors
  3. Chronic pancreatitis
  4. Diabetes
24
Q

Pancreatic ductal carcinomas arise from dysplastic ductal lesions - name 2 types of this dysplastic ductal lesions

A
  1. PanIN = Pancreatic intraductal neoplasia
  2. IMPN = Intraductal mucinous papillary neoplasm
25
Q

Which mutation is associated with pancreatic ductal carcinoma?

A

k-ras mutation (95% cases)

26
Q

Pancreatic ductal carcinoma - tumours in which part present earlier? why?

A

Tumours in the pancreatic head present earlier because they obstruct the biliary tree earlier and person becomes jaundiced.

27
Q

Pancreatic ductal carcinomas - which site do they occur in? commonest site?

A
  1. Head (60%)
  2. Body
  3. Tail
  4. Diffuse
28
Q

Pancreatic ductal carcinoma - 4 ways of spread?

A
  1. Direct = bile ducts, duodenum
  2. Lymphatic = LNs
  3. Blood = liver
  4. Serosa = peritoneum
29
Q

Cystic tumours of the pancreas - 2 types

A
  1. serous tumours
  2. mucinous tumours
30
Q

Cystic tumours of the pancreas are usually malignant - T or F?

A

False - usually benign

31
Q

Pancreatic neuroendocrine neoplasms:

  • 1 neuroendocrine marker in blood?
  • behaviour?
  • associations?
  • example of commonest secretory tumour
A

Pancreatic neuroendocrine neoplasms:

  • 1 neuroendocrine marker in blood = chromogranin
  • behaviour = difficult to predict
  • associations = MEN1 syndrome
  • example of commonest secretory tumour = insulinoma
32
Q

Gallstones is also known as ______, and affects ___% of adults in the West

A

Gallstones is also known as cholelithiasis, and affects 20% of adults in the West

33
Q

Gallstone - RFs (7)

A
  1. Older age
  2. Female
  3. Obesity
  4. Native Americans
  5. Hereditary - disorders of bile metabolism
  6. Drugs - i.e. OCP
  7. Acquired disorders, i.e. rapid weight loss
34
Q

Gallstones - types (2)

A
  1. Cholesterol (>50% cholesterol):
    - usually is 1 big stone
    - mostly radiolucent
  2. Pigment (contain ca2+ salts of unconjugated bilirubin):
    - usually multiple
    - mostly radio-opaque
35
Q

Gallstones - complications (4)

A
  1. Bile duct obstruction
  2. Acute and chronic cholecystitis
  3. GB cancer
  4. Pancreatitis
36
Q

Acute cholecystitis - most likely cause is…

A

90% associated with gallstones

37
Q

This is a gallbladder - what do you think it is?

A

chronic cholecycstitis due to thickenned edges (fibrosis!!)

38
Q

Chronic cholecystitis

  • what is an imp feature of it?
  • what 2 things are they associated with?
A

Chronic cholecystitis

  • what is an imp feature of it = fibrosis!!
  • what 2 things are they associated with:

1) 90% contain gallstones

2) Diverticular (Rokitansky-Aschoff sinuses)

40
Q

Gallbladder cancer

  • type?
  • associations?
A

adenocarcinomas (most common)

  • 90% associated with gallstones

Pathology by week (70 decks)

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