Week 4: Gallbladder and Exocrine Pancreas

Question 1

Obstruction of neck or cystic duct by gallstone (90% of cases) -> chemical irritation/inflammation disrupts normal protective mucus layer exposing mucosa to detergent action of bile salts + wall distension causing ischemia.

Answer 1

Acute (calculous) cholecystitis

Question 2

Thought to result from ischemia. Seen in patients with sepsis, immunosuppression, trauma, burns, DM, infections. Fatal if not recognized.The gallbladder can become gangrenous and perforate

Answer 2

Acute acalculous cholecystitis

Question 3

What is the symptom of Acute Cholecystitis

Answer 3

Murphy’s sign

Question 4

Type of stone

Pale yellow/grey-white/black stones and lecithin acts as a detergent

Answer 4

Cholesterol stones

Question 5

Type of stone

sterile and form with abnormally high unconjugated bilirubin levels

Answer 5

Black stones

Question 6

Type of stone

infection and form with abnormally high unconjugated bilirubin levels

Answer 6

Brown stones

Question 7

Prolonged inflammation of the gallbladder due to supersaturation/stasis of bile and are associated with gallstones (cholelithiasis) in >90% of cases

Answer 7

Chronic Cholecystitis

Question 9

What are the 4 risk factors for gallstones

Answer 9

Female sex
Fat
Forty (age > 40)
Fertile (reproductive age, pregnancy, and oral contraception use)

The 4 “F” Rule

Question 10

ID

Answer 10

Chronic Cholecystitis

Rokitansky-Aschoff Sinuses (yellow arrow) - herniations of gallbladder mucosa that protrude through the smooth muscle layer of the gallbladder, formed in response to increased luminal pressure from bile outflow obstruction

Question 11

ID

Answer 11

Hyalining Cholecystitis “Porcelain Gallbladder”

ones that have minimal or no calcification (so called ‘incomplete porcelain’) do carry an increased risk of gallbladder cancer

Question 12

ID

Answer 12

Gallbladder Carcinoma

Question 13

80% of cases of acute pancreatitis are caused by what?

Answer 13

Alcohol and Gallstones

‘GET SMASHED’ mnemonic

Question 14

What is the mutation that causes hereditary pancreatitis?

Answer 14

gain-of-function mutation in PRSS1 encoding trypsinogen leads to a resistance of trypsin being self inactivated

Question 15

ID

Answer 15

Acute Pancreatitis

Fat Saponification

Question 16

ID

Answer 16

Acute Pancreatitis

a region of fat necrosis (orange arrow) and focal pancreatic parenchymal necrosis (yellow arrow)

Question 17

Most common cause of Chronic Pancreatitis

Answer 17

Long-term alcohol abuse

Question 18

ID

Answer 18

Chronic pancreatitis

widespread fibrosis and acinar cell drop out

Question 19

Where does Pancreatic Ductal Adenocarcinoma arise?

Answer 19

• 60% pancreatic head
• 20% entire gland
• 15% pancreatic body
• 5% pancreatic tail

Question 20

ID

Answer 20

Pancreatic Intraepithelial Neoplasia (PanIN)

Question 21

What mutation is associated with Pancreatic Intraepithelial Neoplasia (PanIN)

Answer 21

KRAS activation point mutation

Question 22

ID

Answer 22

Pancreatic Ductal Adenocarcinoma

Infiltrative, haphazard malignant glands in inflamed, disorganized ‘desmoplastic’ fibrous stroma (yellow arrows)

Question 23

ID

Answer 23

Pancreatic Ductal Adenocarcinoma

tumor (yellow arrow) in contact with and tracking along the nerve (orange arrow) is termed perineural invasion