Histopath - Pancreas and Gall bladder pathology

Question 1

Acute pancreatitis

Answer 1

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

Question 2

*Acute pancreatitis causes

(most common)

Answer 2

• Idiopathic
• Gallstones* (most common!!)
• Ethanol* (most common)
• Trauma*
• Steroids
• Mumps/malignancy*
• Autoimmune
• Scorpion sting
• Hyperlipidaemia/hypercalcaemia*
• ERCP
• Drugs (thiazides)

Question 3

Acute pancreatitis patterns of injury - periductal cause

Answer 3

Obstructive cause (necrosis of acinar cells near ducts)

Question 4

Acute pancreatitis patterns of injury - perilobular cause

Answer 4

Ischaemic causes (necrosis at edge of lobules)

Question 5

Actue pancreatitis patterns of injury - panlobular cause

Answer 5

Combination of obstructive and ischaemic causes

Question 6

*Complications of acute pancreatitis

Answer 6

• Pancreatic
  
  • Pseudocyst*
  • Abscess*
• Systemic
  
  • Shock
  • Hypoglycaemia*
  • Hypocalcaemia*

Question 7

Chronic pancreatitis

Answer 7

Chronic inflammation with parenchymal fibrosis and loss of parenchyma

Relapsing or persistent

Question 8

Most common cause of chronic pancreatitis

Answer 8

Alcohol

Question 9

Complications of chronic pancreatitis

Answer 9

• Malabsorption
• DM
• Pseudocysts

Question 10

What is autoimmune pancreatitis associated with?

Answer 10

IgG4 +ve plasma cells

Question 11

What are the types of tumours of the pancreas?

Which is most common?

Answer 11

• Carcinoma
  
  • Ductal (85%)
  • Acinar
• Pancreatic neuroendocrine tumours

Question 12

What lesions do ductal carcinomas arise from/precursor lesion?

Answer 12

Dysplastic ductal lesions called PanIN (pancreatic intraductal neoplasia)

Question 13

Which mutation is most common for ductal carcinoma?

Answer 13

K-Ras

Question 14

*Most common site of ductal carcinoma

Answer 14

Head of tumour (painless jaundice)

Question 15

*What type of cells are ductal carcinomas?

Answer 15

Generally adenocarcinomas -> mucin secreting glands

Question 16

*Ductal carcinoma prognosis

Answer 16

Poor, invades adjacent structures (incl pancreas)

Question 17

Ductal carcinoma complications

Answer 17

• Chronic pancreatitis
• Venous thrombosis -> migratory thrombophlebitis

Question 18

What are the neuroendocrine markers associated with pancreatic endocrine neoplasms (PEN)?

Answer 18

Chromogranin

Question 19

Which syndrome are pancreatic endocrine neoplasms (PEN) associated with?

Answer 19

MEN 1

Question 20

Are pancreatic endocrine neoplasms secretory?

Answer 20

No, however if yes, most commonly insulinoma

Question 21

Gallstones RF

Answer 21

Increasing and age F>M

Question 22

Which kind of gallstones are most common?

Answer 22

Cholesterol stones

Mostly radiolucent

Question 23

Gallstone complications

Answer 23

• Bile duct obstruction
• Acute or chronic cholecystitis
• Gall bladder cancer
• Pancreatitis

Question 24

What is acute cholecystitis associated with?

Answer 24

Gallstones (and acute inflammation)

Question 25

What is chronic cholecystitis associated with?

Answer 25

Gallstones (and chronic inflamm + fibrosis)

Question 26

What is gallbladder cancer associated with?

Answer 26

Gallstones

Question 27

*Insulinoma (tumour of pancreas). What would you find?

Answer 27

low FFAs (Free fatty acids)

Question 28

Chronic pancreatitis shows white specks on laparoscopy

Answer 28

intrapancreatic calculi and fibrosis

Question 29

*Insulinoma (tumour of pancreas) what would you find

Answer 29

Increased free fatty acids (FFAs)