Week 4: Gallbladder and Exocrine Pancreas Flashcards
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.
Acute (calculous) cholecystitis
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
Acute acalculous cholecystitis
What is the symptom of Acute Cholecystitis
Murphy’s sign
Type of stone
Pale yellow/grey-white/black stones and lecithin acts as a detergent
Cholesterol stones
Type of stone
sterile and form with abnormally high unconjugated bilirubin levels
Black stones
Type of stone
infection and form with abnormally high unconjugated bilirubin levels
Brown stones
Prolonged inflammation of the gallbladder due to supersaturation/stasis of bile and are associated with gallstones (cholelithiasis) in >90% of cases
Chronic Cholecystitis
What are the 4 risk factors for gallstones
Female sex
Fat
Forty (age > 40)
Fertile (reproductive age, pregnancy, and oral contraception use)
The 4 “F” Rule
ID
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
ID
Hyalining Cholecystitis “Porcelain Gallbladder”
ones that have minimal or no calcification (so called ‘incomplete porcelain’) do carry an increased risk of gallbladder cancer
ID
Gallbladder Carcinoma
80% of cases of acute pancreatitis are caused by what?
Alcohol and Gallstones
‘GET SMASHED’ mnemonic
What is the mutation that causes hereditary pancreatitis?
gain-of-function mutation in PRSS1 encoding trypsinogen leads to a resistance of trypsin being self inactivated
ID
Acute Pancreatitis
Fat Saponification
ID
Acute Pancreatitis
a region of fat necrosis (orange arrow) and focal pancreatic parenchymal necrosis (yellow arrow)
Most common cause of Chronic Pancreatitis
Long-term alcohol abuse
ID
Chronic pancreatitis
widespread fibrosis and acinar cell drop out
Where does Pancreatic Ductal Adenocarcinoma arise?
- 60% pancreatic head
- 20% entire gland
- 15% pancreatic body
- 5% pancreatic tail
ID
Pancreatic Intraepithelial Neoplasia (PanIN)
Left - Low Grade
Right - High Grade
What mutation is associated with Pancreatic Intraepithelial Neoplasia (PanIN)
KRAS activation point mutation
PanIN the KRAS(S).
“Pain in the ass”
ID
Pancreatic Ductal Adenocarcinoma
Infiltrative, haphazard malignant glands in inflamed, disorganized ‘desmoplastic’ fibrous stroma (yellow arrows)
ID
Pancreatic Ductal Adenocarcinoma
the tumor is hugging the nerve in some histology PDA.
tumor (yellow arrow) in contact with and tracking along the nerve (orange arrow) is termed perineural invasion
