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Gastrointestinal > Gallbladder and Pancreas Path > Flashcards

Gallbladder and Pancreas Path Flashcards

1
Q

What is acute pancreatitis?

A

a group of reversible lesions characterized by inflammation of the pancreas ranging in severity from edema and fat necrosis to parenchymal necrosis with severe hemorrhage

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2
Q

What are the top two etiologies of acute pancreatitis?

A

Alcoholism

Hyperlipoproteinemia

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3
Q

What drugs can lead to acute pancreatitis?

A

Thiazide diuretics

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4
Q

What genetic mutations can lead to acute pancreatitis?

A

PRSS1 (trypsinogen) or SPINK1 (trypsin inhibitor

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5
Q

What are the three major mechanical causes of acute pancreatitis?

A

Gallstones
Trauma
iatrogenic injury

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6
Q

What are the three vascular etiologies of acute pancreatitis?

A

Shock
Atheroembolism
vasculitis

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7
Q

What are the three infectious etiologies of acute pancreatitis?

A

Mumps
Coxsackie virus
Mycoplasma pneumoniae

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8
Q

What is the cell in the pancreas that release trypsin? What does this cause when these cells are damaged?

A

Acinar cells

Premature activation of enzymes, causing pancreatitis

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9
Q

What enzyme in the pancreas produce hemorrhage?

A

elastase

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10
Q

What enzyme causes the fat necrosis of acute pancreatitis?

A

Lipase

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11
Q

What is the intrinsic cause of pancreatitis within acinar cells?

A

Defective transport failure to bring out enzymes

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12
Q

What are the two enzymes that are released with pancreatic acinar cell damage?

A

Lipase

Trypsin

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13
Q

What is the role that Ca plays in pancreatitis?

A

Ca activates enzymes–thus the hypocalcemia that can be seen in acute pancreatitis

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14
Q

What is the significant sequelae of acute pancreatitis?

A

Shock

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15
Q

What is the significant sequelae with the fat necrosis seen in acute pancreatitis?

A

Hypocalcemia

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16
Q

What is the time frame difference between lipase and amylase?

A

Amylase peaks first, then lipase

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17
Q

Increase in amylase that lasts >7 days, suggests what?

A

Pancreatic pseudocyst

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18
Q

What is the cause of renal failure with acute pancreatitis?

A

Enzyme activation hurts the tubules

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19
Q

What is the cause of ARDS with acute pancreatitis?

A

Elastase will degrade the lung BM

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20
Q

What is acute interstitial pancreatitis?

A

Inflammation and edema

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21
Q

What are the three morphologies of acute pancreatitis?

A

Interstitial
Necrotizing
Hemorrhagic

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22
Q

What is the cause of hemorrhagic pancreatitis?

A

Elastase degrades arteries

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23
Q

What are the systemic effects of acute pancreatitis?

A

Leukocytosis
DIC
Shock

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24
Q

What is the color of the Ca that builds up in acute pancreatitis with staining?

A

Blue

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25
Q

What is a pancreatic pseudocyst?

A

Collection of blood, enzymes, and debris

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26
Q

What is the difference between a pancreatic pseudocyst, and an abscess?

A

Abscess has an epithelial lining, and is filled with bacteria. Pseudocysts do not.

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27
Q

What is the definition of chronic pancreatitis?

A

Irreversible loss of exocrine pancreas

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28
Q

What are the main cytokines that are released with chronic pancreatitis? What does this cause?

A

TGF-b
PDGF

Fibrosis about the acinar cells

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29
Q

What is the main histological difference between acute and chronic pancreatitis?

A

Fibrosis

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30
Q

What is the most common cause of chronic pancreatitis?

A

Etoh

31
Q

What are the two genetic mutations that can result in chronic pancreatitis?

A

PRSS1 (trypsinogen)

SPINK1 (Serine protease inhibitor)

32
Q

What is the cause of chronic pancreatitis in CF?

A

Build up of thick pancreatic secretions, leading to fibrosis and causing blockage.

33
Q

What are the three pathologies of chronic pancreatitis?

A

Fibrosis
Duct distortion
Altered pancreatic secretions

34
Q

What is the MOA of EtOH causing pancreatitis?

A

EtOH induces protein secretions in the pancreas. which causes increased viscosity of secretions. These can later calcify

35
Q

What happens to the acinar cells with chronic pancreatitis?

A

Acinar cell drop out

36
Q

What are the three ssx of chronic pancreatitis, besides abdo pain?

A

DM
Steatorrhea
Calcifications

37
Q

What are the gross characteristics of the pancreas with chronic pancreatitis?

A

Rosary beads secondary to areas of stenosis

38
Q

What are the two types of non-neoplastic pancreatic cysts?

A

Congenital

Pseudocysts

39
Q

What is von Hippel-Lindau disease? How does this relate to the pancreas?

A

Mutation in the VHL factor, causing angiomas and cysts in the pancreas.

40
Q

What are pseudocysts seen in pancreatitis?

A

Localized collections of pancreatic secretions, that lack a true epithelial lining

41
Q

What do pancreatic pseudocysts look like histologically?

A

fibrin and granulation tissue surrounding the cys

42
Q

What are the three types of cystic tumors of the pancreas?

A
  1. Microcystic serous cystadenomas
  2. Mucinous cystic tumors
  3. Solid pseudopapillary tumors
43
Q

What are the microcystic serous cystadenomas?

A

Usually benign collections of serous fluid in the pancrease

44
Q

What are the mucinous cystic tumors?

A

a grouping of cystic neoplasms that arise from the pancreas. They may be benign, malignant or in between.

45
Q

What are the solid pseudopapillary tumors?

A

a type of tumor (neoplasm) that grows within the pancreatic ducts (intraductal) and is characterized by the production of thick fluid by the tumor cells (mucinous).

46
Q

What are the histological characteristics of Pancreatic serous cystadenomas? Pancreatic mucinous cystadenomas?

A

cuboid epithelial lined cyst-like structures, without cellular atypia

Columnar epithelium with fibrous tissue

47
Q

What are the intraductal papillary mucinous neoplasms?

A

Benign, or borderline malignant neoplasms in the ductal apparatus

48
Q

In whom does pancreatic cancer occur?

A

Elderly, black, diabetic men

49
Q

Where does pancreatic cancer arise from in the pancreas?

A

Ducts

50
Q

What causes the ssx of pancreatic cancer?

A

Painless jaundice caused by obstruction of the common bile duct

51
Q

What are the antigens that are elevated in pancreatic cancer?

A

CEA and CA19-9

52
Q

What is the most significant risk factor for pancreatic cancer? What does this cause?

A

Smoking causes KRAS mutations

53
Q

What is the most common genetic mutation found in pancreatic cancers?

A

KRAS

54
Q

What is the genetic cause of Peutz-Jegher syndrome? What are the ssx?

A

STK11

macules around the mouth, with associated increase in polyposis and chance of pancreatitis

55
Q

What are the histological characteristics of pancreatic cancer?

A

Papillary epithelium with moderate architectural and cytological atypia

56
Q

What is the sequence of genetic mutations that occur in pancreatic cancer?

A

KRAS2
p16/CDKN2A
p53

57
Q

Where in the pancreas do most cancers occur? What type of cancer is this?

A

Head of the pancreas

Adenocarcinoma

58
Q

What is Courvoisier’s Gallbladder?

A

An enlarged, often palpable gall bladder associated with carcinoma of the head of the pancreas.

59
Q

What are the three common sites of mets from pancreatic cancer?

A

Lung
Liver
Peritoneum

60
Q

Most gallstones are comprised of what?

A

Cholesterol

61
Q

What are the three types of gallstones?

A
  1. Cholesterol
  2. Pigmented (from bili)
  3. Mixed
62
Q

What is the drug used to treat cholesterol gallstones? How does this work?

A

Cholestyramine–sequesters bile and cholesterol in the duodenum

63
Q

What are the four contributing factors for cholelithiasis?

A
  • Supersaturation
  • Gallbladder hypomotility
  • Crystal nucleation
  • Accretion within the gallbladder mucous layer
64
Q

What causes pigmented gallstones?

A

Ca precipitations of bili

65
Q

What are the ssx of cholelithiasis?

A

Spasmodic, colicky, RUQ pain after eating fatty meals

66
Q

What is the cause of strawberry gallbladder?

A

Foam cells within the gallbladder

67
Q

What is acute cholecystitis?

A

Calculi cause inflammation and PMN infiltration of the gallbladder

68
Q

What is the cause of chronic cholecystitis?

A

Chronic, longstanding inflammation of the gallbladder, probably caused by accumulation of damage in acute attacks.

69
Q

What are the gross characteristics of cholecystitis?

A

GB is thickened and fibrotic

70
Q

What are the microscopic appearance of chronic cholecystitis?

A

Collagen in wall
Lymphocytic infiltration
Plasma cells
Macrophages

71
Q

What are Rokitansky-Aschoff sinuses?

A

outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall.

72
Q

What type of cancer is gallbladder cancer? Ssx?

A

Adenocarcinoma

Ssx indistinguishable from cholelithiasis

73
Q

What are the two morphological characteristics of adenocarcinomas of the gallbladder?

A

Infiltrating

Exophytic

Gastrointestinal (42 decks)

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