Flashcards in L74 Deck (32):
What is biliary atresia?
- Pt pop
Narrowing of biliary tract
NEWBORNS: most common cause of liver disease in infants
1. Kasai procedure
- Act quickly b/c cirrhosis faster in infants
Biliary atresia histo
See proliferation of ducts around the native duct -> liver trying to find a way out for excess bile
What is a choledochal cyst?
Cystic dilation of bile duct
Present early in life - obstructive jaundice
Treat = resection
2 complications of bile stones?
Choledocholithiasis = stones in common bile duct
Cholangitis = bacterial infection of bile ducts
- Can ascend from pt of obstruction
Seen in liver biopsy (don't biopsy the bile duct itself)
- Pus = PMNs in lumen
- Liver parenchyma might be inflammed
Symptoms of cholangitis
Jaundice due to obstruction
Acute cholecystitis usually due to stones. What is the other rare cause?
Aka hosp pts who have systemic issues
Tree doesn't move bile correctly
Stagnant bile in GB = inflammation
How does the GB change with chronic cholecystitis?
Healing response due to repeated injury
Main GB cancer
- Gland formation
Thickened GB wall around mass
May migrate w/ nerves
- Pt pop
Bad prognosis b/c detected late
Asymptomatic or pain (behaves like cholecystitis)
Carcinoma of extrahepatic bile ducts
- 3 risk factors
- Looks like
1. PSC - primary sclerosing cholangitis
2. Choledochal cyst
3. Inflammatory states - parasites
What is pancreas divisum
Ducts don't form to primarily drain out the papilla of Vater
Instead, most drains via minor papilla
↑risk chronic pancreatitis
What is pancreatic heteropia?
Normal pancreatic tissue elsewhere in GI
Clinically irrelevant to pts life
Slight ↑risk -> tumor
What is annular pancreas?
Pancreas forms as a ring around duodenum
3 main outcomes of acute pancreatitis
Fat necrosis (as inflam damages acinar cells so they release enzymatic contents)
Are exocrine or endocrine pancreatic fxns lost first in chronic pancreatitis?
Exocrine goes 1st
Histo of chronic pancreatitis
Maybe loss of acini
What are serous pancreatic cysts?
Benign - sponge like and can get big but won't kill
What type of cells line serous cysts?
Cleared out cells (glycogen)
What pancreatic cyst has malignant potential? Name 2 subtypes.
1. Mucinous cystic neoplasms
2. Intraductal papillary mucinous neoplasms
**On a spectrum:
Benign --> borderline --> malignant parts within 1 tumor
Pt pop + describe mucinous cystic neoplasms
Ovarian type cyst @ body or tail of pancreas
Mucinous lining epithelium
Describe intraductal papillary mucinous neoplasms
Interfere w/ main duct
Look like have papillae
See mucin oozing out ampulla from camera in duodenum
Solid pseudo-papillary tumor
Solid or cystic?
Malignant or benign
MALIGNANT but more likely to die from treatment complications
Mutation to beta-catenin / APC pathway
Solid AND cystic regions
Strongly young female
What type of cancer is traditional pancreatic cancer?
Describe development of pancreatic cancer
Cyst that might progress to cancer
Benign -> low grade -> high grade -> invasion
More likely to be ductal
Location in pancreas
Older pts - associated w/ SMOKING
Most = head = jaundice
- If body/tail -> pain due to neural invasion
High MORTALITY b/c present at high stage
Ductal adenocarcinoma histo
Looks like cholangiocarcinoma - won't need to tell difference
Treat pancreatic adenocarcinoma
- Head - take out some SI (Whipple)
- Body/take - take out spleen
+ Adj chemo/radiation
3 types of pancreatic endocrine neoplasms (fxnal classification)
Insulinomas (benign) will present as hypoglycemia
Stain for pancreatic endocrine neoplasms
Chromogranin // synapthophysin
What do you need to know about acinar cell carcinoma?