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H - Pancreas And Gallbladder Flashcards

(59 cards)

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1
Q

Which pancreas cells secrete enzymes

A

Acinar

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2
Q

Name another type of cell in the pancreas

A

Islets of langerhan
Ducts

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3
Q

Define pancreatitis

A

Inflammation due to aberrant release of pancreatic enzymes

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4
Q

5 groups of Causes of pancreatitis

A

Duct obstruction
Metabolic / toxic
Poor blood supply
Infection / inflammation
Autoimmune / idiopathic

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5
Q

Duct obstruction causes of pancreatitis

A

Gallstones
Trauma
Tumours

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6
Q

Metabolic causes of pancreatitis

A

Alcohol
Drugs eg thiazides
High calcium
Hyperlipidaemia

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7
Q

Poor blood supply causes of pancreatitis

A

Shock
Hypothermia

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8
Q

Infectious cause of pancreatitis

A

Mumps

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9
Q

2 main causes of pancreatitis

A

Gallstones 50%
Alcohol 33%

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10
Q

Pathogenesis of gallstones causing pancreatitis

A

Gallstone distal to CBD and PD join
Leads to bile reflux into PD - damage to acini
Proenzymes released which are activated

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11
Q

Pathogenesis of alcohol causing pancreatitis

A

Spasm / oedema of sphincter of oddi
Formation of protein rich pancreatic fluid - obstructs PD

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12
Q

3 patterns of injury of acute pancreatitis (location) & what causes each

A

Periductal - necrosis of acinar near ducts post obstruction
Perilobular - necrosis at edge of lobules due to poor blood supply
Panlobular - after the above 2

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13
Q

What is the real problem with pancreatitis in terms of doing the damage

A

Activated enzymes cause acinar necrosis and enzyme release
Ranges from Stromal oedema to haemorrhagic necrosis

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14
Q

What do yellow - white foci on pancreas indicate and why

A

Fat necrosis
Lipases necrose fat causing Ca to bind FFA forming white soaps

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15
Q

Complications of pancreatitis

A

Pseudocyst
Abscess
Shock
Hypoglycaemia
Low Ca

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16
Q

Mortality in haemorrhagic pancreatitis

A

50%

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17
Q

What can you see on histology of acute pancreatitis

A

White deposits that stain blue under scope / stain

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18
Q

Define chronic pancreatitis

A

Relapsing / persistent pancreatitis
Associated w acute in half cases

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19
Q

Causes of chronic pancreatitis inc most common cause

A

Alcohol 80%
Hameochromotosis
Gallstones (rare)
Abnormal PD anatomy
CF
Tumours
Autoimmune / idiopathic

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20
Q

Describe pattern of injury of chronic pancreatitis

A

Chronic inflammation with parenchymal fibrosis and loss of parenchyma
Duct strictures with calcified stones & secondary dilatation

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21
Q

Complications of chronic panc

A

Malabsorption
DM
Pseudocysts
Carcinoma of panc (?unproven)

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22
Q

Order of loss of function of pancreas once blood supply cut off

A

Fibrosis
Loss of acini func
Loss of endocrine func

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23
Q

Describe structure of pancreatic pseudocyst

A

Lined by fibrous tissue - NO EPITHELIAL LINING
Fluid inside w pancreatic enzymes / necrotic material

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24
Q

Where do pseudocysts connect to

25
Fate of pseudocysts (4)
Resolve Compress adjacent structures Infected Perforate
26
What Ig is AI pancreatitis associated with
IgG4
27
What is AI pancreatitis characterised by
IgG4+ plasma cells
28
How does AI pancreatitis stain and why
Brown - IgG4
29
Tx for AI pancreatitis
Steroids
30
3 Types and 2 subtypes of each for pancreatic cancer
Carcinomas - ductal / acinar Cystic neoplasm - serous / mucinous cystadenoma Neuro endocrine -islet cell tumours or insulinomas
31
Most common type of pancreatic cancer
Ductal carcinoma 85%
32
Where are ductal carcinomas of pancreas mainly found
Head 60% Tail
33
Prognosis of ductal carcinoma of pancreas
5% 5 year survival
34
Macroscopic appearance of ductal carcinoma of pancreas
Gritty and grey
35
Microscopic appearance of ductal carcinoma of pancreas
Mucin secreting glands set in desmoplastic stroma
36
2 types of precancerous ductal carcinoma of pancreas
PanIM - pancreatic introductal neoplasm IMPN - intraductal mucinous papillary neoplasm
37
What is raised in 95% of precancerous ductal carcinoma of pancreas
K RAS
38
RFs for ductal carcinoma of pancreas
Older Male Smoking Chronic pancreatitis High BMI and poor diet DM
39
How and to where do ductal carcinoma of pancreas spread
Blood and lymphatics Duodenum, liver, peritoneum
40
Complications of spread of ductal carcinoma of pancreas
Chronic pancreatitis Venous thrombosis (migratory thrombophlebitis)
41
What other organs has cystic neoplasms & why
Ovary - also contains serous / mucinous epithelium
42
Neuroendocrine marker of islet cell tumour
Chromogranin
43
Are neuroendocrine tumours secretory
No not usually but they can be (insulinoma)
44
What syndrome can neuroendocrine pancreatic tumours be associated with
MEN1
45
Where do insulinomas come from and what do they do
From b cells Secrete insulin
46
Prevalence of gall stones in the west
20% of adults have them
47
RFs for gallstones
Women Older Native Americans COCP Rapid weight loss Disorders of bile metabolism
48
2 types of gall stones
Cholesterol Pigmented
49
Which type of gallstones occur singularly vs multiples
Single = cholesterol Multiple = pigment
50
Which type of gallstones are radio opaque / radiolucent
Opaque = pigment Lucent = cholesterol
51
Components of each type of gallstone
Pigment = calcium salts of unconj BR Cholesterol = >50% cholesterol
52
Complications of gallstones
Obstruction of bile duct Acute / chronic cholecystitis Gall bladder cancer Pancreatitis
53
90% of acute cholecystitis is associated with what ?
Gallstones
54
What are 10% of acute cholecystitis cases associated with
Infections like Typhoid etc
55
Hallmark of chronic cystitis
Fibrosis leading to very thickened gallbladder wall
56
What are gall bladder diverticula called
Rokitanksy Aschoff sinuses
57
What do Rokitanksy Aschoff sinuses look like
Black circles Outpouching into walls
58
90% of adenocarcinomas of the gall bladder are associated with what
Gallstones
59
90% of chronic cholecystitis cases are associated with what
Gallstones

Pathology (87 decks)

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