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Pathology - Y5 > Pancreas and Gallbladder Pathology > Flashcards

Pancreas and Gallbladder Pathology Flashcards

1
Q

What is this?

A

Exocrine component of pancreas

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2
Q

What is this?

A

Endocrine component of pancreas

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3
Q

What is acute pancreatitis?

A

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

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4
Q

What are general categories of causes of acute pancreatitis?

A

Duct obstruction

Metabolic/toxic

Poor blood supply

Infection/Inflammation

Autoimmune

Idiopathic (15%)

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5
Q

What are examples of duct obstruction which may lead to acute pancreatitis?

A

Gall stones (50%)

Trauma

Tumours

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6
Q

What are examples of metabolic/toxic which may cause acute pancreatitis?

A

Alcohol (33%) - 5% of alcoholics develop acute pancreatitis

Drugs (e.g. thiazides)

Hypercalcaemia

Hyperlipidaemia

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7
Q

What are examples of poor blood supply which may cause acute pancreatitis?

A

Shock

Hypothermia

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8
Q

What are examples of infection/inflammation which may cause acute pancreatitis?

A

Viruses (e.g. mumps)

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9
Q

How can duct obstruction lead to acute pancreatitis?

A

Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to: reflux of bile up the pancreatic duct followed by damage to acini and release of proenzymes which then become activated.

Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts.

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10
Q

What are patterns of injury for acute pancreatitis?

A

Periductal: Necrosis of acinar cells near ducts (usually secondary to obstruction).

Perilobular: Necrosis at the edges of the lobules (usually due to poor blood supply).

Panlobular: Develops from periductal and perilobular.

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11
Q

What is the pathophysiology of acute pancreatitis?

A

Activated enzymes > acinar necrosis > enzyme release etc.

Ranges from stromal oedema, to haemorrhagic necrosis.

e.g. Lipases > fat necrosis (calcium ions bind to free fatty acids forming soaps which are seen as yellow-white foci)

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12
Q

What are pancreatitic complications of acute pancreatitis?

A

Pseudocyst

Abscess

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13
Q

What are systemic complications of acute pancreatitis?

A

Shock

Hypoglycaemia

Hypocalcaemia

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14
Q

What is the prognosis of acute pancreatitis?

A

Overall mortality up to 50% for haemorrhagic pancreatitis

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15
Q

What is this?

A

Acute pancreatitis

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16
Q

What is this?

A

Acute pancreatitis

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17
Q

What is chronic pancreatitis?

A

Relapsing or persistent, associated with acute pancreatitis in half of cases.

Relatively uncommon.

Mortality 3% per year.

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18
Q

What are causes of chronic pancreatitis?

A

Metabolic/toxic:

  • Alcohol (80%)
  • Haemochromatosis

Duct obstruction:

  • Gallstones
  • Abnormal pancreatic duct anatomy
  • Cystic fibrosis (“mucoviscoidosis”)

Tumours

Idiopathic: Autoimmune

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19
Q

What is the pattern of injury of chronic pancreatitis?

A

Chronic inflammation with parenchymal fibrosis and loss of parenchyma.

Duct strictures with calcified stones with secondary dilatations.

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20
Q

What are complications associated with chronic pancreatitis?

A

Malabsorption

Diabetes mellitus

Pseudocyts

Carcinoma of the pancreas

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21
Q

What is this?

A

Chronic pancreatitis

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22
Q

What is this?

A

Chronic pancreatitis

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23
Q

What is this?

A

Chronic pancreatitis

24
Q

What is a pancreatic pseudocyst?

A

Associated with acute and/ or chronic pancreatitis.

Lined by fibrous tissue (no epithelial lining), contain fluid rich in pancreatic enzymes or necrotic material.

Connect with pancreatic ducts.

May resolve, compress adjacent structures, become infected or perforate.

25
Q

What is this?

A

Pancreatic pseudocyst

26
Q

What is this?

A

Pancreatic pseudocyst

27
Q

What is autoimmune pancreatitis also known as?

A

IgG4 related disease

28
Q

What is the pathophysiology of autoimmune pancreatitis?

A

Characterised by large numbers of IgG4 positive plasma cells.

May involve the pancreas, bile ducts and almost any other part of the body.

29
Q

What is this?

A

Autoimmune pancreatitis

30
Q

What is this?

A

Autoimmune pancreatitis

31
Q

What types of tumours can occur in the pancreas?

A

Carcinomas:

  • Ductal (85% of all neoplasms)
  • Acinar

Cystic neoplasms:

  • Serous cystadenoma
  • Mucinous cystic neoplasm

Pancreatic neuroendocrine tumours (Islet cell tumours)

32
Q

What is the most common neoplasm of the pancreas?

A

Ductal carcinomas (85% of all neoplasms)

33
Q

What is the epidemiology and prognosis of ductal carcinoma of the pancreas?

A

5% of cancer deaths

Increasingly common with age, 2M: 1F

5 year survival: 5%

34
Q

What are risk factors for pancreatic carcinomas?

A

Smoking

BMI and dietary factors

Chronic pancreatitis

Diabetes

35
Q

What do ductal carcinomas of the pancreas commonly arise from?

A

Arise from dysplastic ductal lesions:

  • Pancreatic Intraductal Neoplasia (PanIN)
  • Intraducal Mucinous Papillary Neoplasm
36
Q

What is the most common mutation associated with ductal carcinoma?

A

K-Ras mutations in 95% of cases

37
Q

What is the macroscopic appearance of ductal carcinoma?

A

Gritty and grey

Invades adjacent structures

Tumours in the head present earlier

38
Q

What is the microscopic appearance of ductal carcinomas?

A

Adenocarcinomas: Mucin secreting glands set in desmoplastic stroma.

39
Q

What is this?

A

Ductal carcinoma

40
Q

What is this?

A

Ductal carcinoma

41
Q

What are common sites of ductal carcinomas?

A

Head (60%)

Body

Tail

Diffuse

42
Q

Where do ductal carcinomas commonly spread?

A

Direct: Bile ducts, duodenum

Lymphatic: Lymph nodes

Blood: Liver

Serosa: Peritoneum

43
Q

What are complications associated with ductal carcinoma?

A

Due to spread

Chronic pancreatitis

Venous thrombosis (“migratory thrombophlebitis”)

44
Q

What are cystic tumours?

A

Contain serous or mucin secreting epithelium (cf. ovarian tumours)

Usually benign

45
Q

What is this?

A

Cystic tumour

46
Q

What are typical behaviours of pancreatic endocrine neoplasms?

A

Usually non-secretory

Contain neuroendocrine markers e.g. chromogranin

Behaviour difficult to predict

47
Q

What are pancreatic endocrine neoplasms associated with?

A

Multiple Endocrine Neoplasia (MEN) 1 syndrome

48
Q

What is this?

A

Insulinoma

49
Q

What is this?

A

Insulinoma

50
Q

What are common pathologies associated with the gall bladder?

A

Gall stones

Inflammation

Cancer

51
Q

What are risk factors for gall stones (cholelithiasis)?

A

Age and gender: Increasing age, F>M

Ethnic and geographic: e.g. Native Americans

Hereditary: e.g. disorders of bile metabolism

Drugs: e.g. oral contraceptive

Acquired disorders: e.g. rapid weight loss

52
Q

What are the two types of gall stones?

A

Cholesterol (more than 50% cholesterol): May be single, mostly radiolucent.

Pigment (contain calcium salts of unconjugated bilirubin): Multiple, mostly radio-opaque.

53
Q

What are complciations associated with gall stones?

A

Bile duct obstruction

Acute and chronic cholecystitis

Gall bladder cancer

Pancreatitis

54
Q

What is acute cholecystitis?

A

Acute inflammation

90% associated with gall stones

55
Q

What is chronic cholecystitis?

A

Chronic inflammation

Fibrosis

Diverticula – Rokitansky-Aschoff sinuses

90% contain gall stones

56
Q

What is this?

A

Rokitansky-Aschoff sinsus

57
Q

What is gall bladder cancer?

A

Adenocarcinomas

90% associated with gall stones

Pathology - Y5 (59 decks)

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