Path of Gallbladder & Exocrine Pancreas

Question 1

Describe the pathogenesis of gallstones

Answer 1

1. Cholesterol: Composed of cholesterol, bile acids, phospholipids ad lecithin. Develop as a result of cholesterol/bile-salt supersaturation.
2. Pigment: Develop in patients with increased bilirubin concentration in bile. Often in obstructed gallbladder or bile duct. May develop from chronic parasitic infection of biliary tree

Question 2

What is the etiologic significance of gallstones in other diseases

Answer 2

Complications:

Biliary colic, Acute cholescystitis, Choledocholithiasis, Ascending cholangitis, Chronic cholescystitis

Question 3

Name the more common neoplasms of the pancreatobiliary tree, and their clinical and histological aspects

Answer 3

Pancreatic carcinoma: Most are ductal adenocarcinomas, forming glands and secreting mucin. Aggressive and deeply infiltrative. Most often at head of pancreas. Patients often present late (back pain and/or painless jaundice). Five year survival is 2-4%

Islet cell tumors: Endocrine appearance. Cells have uniform nuclei and are separated into small nests and cords separated by strands of collagen. Tumors may be linked to tumor syndromes such as multiple endocrine neoplasia syndrome 1 (MEN1- pancreas, parathyroid and pituitary tumors) and von Hipple Lindau syndrome. Insulinomas may release insulin and cause hypoglycemia; they are usually benign. Gastromas can cause Zollinger-Ellison syndrome; up to 60% of these tumors are malignant

Question 4

Outline the pathogenesis of the common forms of pancreatitis

Answer 4

Acute: Can be caused by gallstones or alcohol.
Presents as constant, intense abdominal pain that is often referred to the upper back. Anorexia, n/v associated with pain.

Chronic: Can be caused by alcohol abuse (most common identifiable cause), long-standing duct obstruction, genetics, or idiopathic (40%)
Presents as malabsorption/Steatorrhea, malnutrition and waxing and waning abdominal pain.

Question 5

What are the anatomic and histologic appearance of pancreatitis and its common sequalae

Answer 5

Acute: Pancreas looks chalky and white due to fat necrosis. Edema, interstitial hemorrhage, parenchymal necrosis, PMN infiltrate

Chronic: Pancreas has marked atrophy, diffuse scarring, dilation of the duct of Wirsung. There are a moderate number of lymphocytes on histology

Sequelae of pancreatitis: Pseudocysts, Abscesses, Pancreatic insufficiency, Secondary diabetes