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Leila's Yr 5 Pathology > Histopathology 10 - Pancreas and gall bladder > Flashcards

Histopathology 10 - Pancreas and gall bladder Flashcards

1
Q

What is the exocrine pancreas composed of?

A

Ducts and acini

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2
Q

What do the acini do?

A

Secrete enzymes

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3
Q

What hormones secreted by the endocrine component?

A

Insulin and glucagon, somatostatin

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4
Q

Acute pancreatitis pathophysiology

A

Acute inflammation of pancreas caused by aberrant release of pancreatic enzymes

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5
Q

Most common cause of acute pancreatitis

A

Gallstones (50%)

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6
Q

I GETSMASHED

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs
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7
Q

What effect on calcium can acute pancreatitis have?

A

Can cause HYPOcalcaemia so if hypercalcaemia is the cause of someone’s pancreatitis, in the acute phase their calcium may be normal

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8
Q

Pathogenesis of acute pancreatitis (Two main mechanisms)

A

Duct obstruction

  • Stone distal to where common bile duct and pancreatic duct meet results in reflux of bile up the pancreatic duct followed by acinar injury and release of proenzymes
  • Alcohol causes spasm/oedema of sphincter of oddi + the production of protein rich pancreatic fluid which obstructs the pancreatic ducts

Direct acinar injury (all other causes)

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9
Q

3 patterns of injury in acute pancreatiits

A

Periductal
Perilobular
Panlobular

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10
Q

Casue of periductal

A

Usually obstruction of the ducts

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11
Q

Cause of perilobular

A

Poor blood supply

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12
Q

Panlobular cause

A

Worsening of either periductal or perilobular

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13
Q

Why can pancreatitis cause hypocalcaemia?

A

Lipases are released from the inflamed pancreas and become activated, leading to fat necrosis. These free fatty acids will bind to calcium –> saponification which are seen as yellow-white foci

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14
Q

Pancreatic complication of acute AND chronic pancreatitis

A

Pancreatic pseudocyst formation

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15
Q

What is a pancreatic pseudocyst?

A

Collection of fluid WITHOUT an epithelial lining, only lined by fibrous tissue

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16
Q

Mortality rate for haemorrhagic pancreatitis

A

50%

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17
Q

Main cause of chronic pancreatitis

A

ETHANOL (80%)

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18
Q

Another common cause of chronic pancreatitis

A

50% cases associated with acute pancreatitis

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19
Q

Causes other than GETSMASHED for chronic panc?

A

Haemochromatosis, Cystic fibrosis (mucoviscocity)

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20
Q

Pattern of injury in chronic pancreatitis

A

Chronic inflammation with parencyhmal fibrosis and loss of parenchyma
Duct strictures with calcified stones
FIBROSIS AND SCARRING

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21
Q

What feature is pathognomic of chronic panc?

A

Pancreatic calcifications

22
Q

Complications of chronic pancreatitis

A

Pancreatic pseudocysts
Malabsorption (Early)
Diabetes mellitus
Pancreatic cancer

23
Q

What is Pancreatic autoimmune disease characterised by/ what is it now called?

A

IgG4 Related disease thus lots of igG4 plasma cells

24
Q

Treatment of IgG4 related disease

A

Steroid responsive

25
Q

3 types of pancreatic cancer

A

Carcinomas, neuroendocrine tumours and cystic neoplasms

26
Q

2 types of pancreatic carcinoma and whcih one is most common?

A

Ductal and acinar, DUCTAL most common

27
Q

What % of cancer deaths is due to pancreatic ductal carcinoma?

A

5%

28
Q

Which mutation seen in pancreatic ductal carcinoma?

A

k-RAS

29
Q

Which cells give rise to pancreatic NETs?

A

Islet cell tumours

30
Q

Risk factors for pancreatic cancer

A

Smoking, raised BMI, chronic panc, DM

31
Q

Ductal carcinoma arises from 2 types of dysplastic ductal lesions (pre-cancerous i.e. do not invade through BM)

A

1) Pancreatic Intraductal Neoplasia (PanIN)

2) Intraductal mucinous papillary neoplasm

32
Q

Microscopic appearance of ductal carcinomas

A

They are adenocarcinomas i.e. mucin secreting, form glands, set in desmoplastic stroma

33
Q

Common sites of ductal carcinoma

A

HEAD (60%) >body >tail

34
Q

Common sites of NETs

A

Tail>body>head

35
Q

Most common site of blood metastasis of panc Ca

A

Liver

36
Q

Complications of ductal carcinoma

A

Spread, chronic pancreatitis, venous thrombosis (migratory thrombophlebitis)

37
Q

What is venous thrombosis/migratory thrombophlebitis?

A

Circulating pacnreatic cells release mucous which activates the coagulation cascade and leads to thrombosis in the venous system

38
Q

Why are pancreatic NETs mainly found in the tail?

A

That is where most of the neuroendocrine cells reside

39
Q

Are pancreatic NETs usually secreotry or non-secretory?

A

NON-SECRETORY

40
Q

Stain for NETs

A

Chromogranin

41
Q

Most common type of pancreatic NET

A

Insulinoma (causes hypoglycaemia)

42
Q

What syndrome is pancreatic NETs associated with?

A

MEN1 (pituitary adenoma, parathyhroid hyperplasia and pancreatic tumours)

43
Q

Risk factors for gall stones

A

Fat, female, forty, fertile, fair

44
Q

Types of gallstone

A

Cholesterol (usually single), pigment (multiple) and mixed

45
Q

Imaging for cholesterol and pigment stones

A

Cholesterol stones are mainly radiolucent so will not be seen on plain abdominal X-ray, USS required
Pigment stones mainly radioopaque

46
Q

Main cause of acute cholecystitis?

A

90% associated with gallstones

47
Q

Features of chronic cholecystitis

A

chronic inflammation, Fibrosis and scarring, ROKITANSKY ASCHOFF SINUSES

48
Q

What are rokitansky aschoff sinuses?

A

Diverticula caused by gall bladder contracting against obstruction

49
Q

What type of cancer is GB cancer?

A

Adenocarcinoma

50
Q

GB cancer associations

A

90% due to gall stones, v rare

51
Q

What do alpha, beta and delta cells of the pancreas produce?

A

Alpha: glucagon
Beta: insulin
Delta: somatostatin

52
Q

Pancreatic cancer tumour marker

A

Ca 19-9

Leila's Yr 5 Pathology (100 decks)

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