Lecture 15: Pathology of Pancreas and Gallbladder Flashcards Preview

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Flashcards in Lecture 15: Pathology of Pancreas and Gallbladder Deck (36):
1

Congenital pancreatic abnormalities

Pancreas agenesis/hypoplasia (rare, associated with other malformations), pancreas divisum, annular pancreas, heterotopic/ectopic pancreas

2

Pancreas divisum: main following

Main pancreatic duct drains through smaller minor papilla

3

Annular pancreas: define, disease, association

Band-like ring of pancreatic tissue around duodenum; can lead to obstruction; trisomy 21

4

Heterotopic/ectopic pancreas: define, common/rare? Disease?

Pancreatic tissue in an abnormal location (stomach, duodenum); very common; can lead to pain and bleeding if the enzymes accumulate

5

Pathophysiology of pancreatitis and 3 main ways

Digestion of pancreatic tissue due to inappropriate release of pancreatic enzymes; 1. Obstruction of duct; 2. Acinar cell injury; 3. Defective intraceullar transport

6

Alcohol can lead to which of the three pancreatitis pathways?

ALL THREE

7

Classification of pancreatitis (note: one pancreas can have all three patterns)

Interstitial edema, acute necrotizing pancreatitis, acute hemorrhagic pancreatitis

8

True/False: Acute pancreatitis is reversible

True

9

How is chronic pancreatitis different from acute?

Ongoing inflammation due to rounds of acute --> release of cytokines like TGFbeta and PDGF (fibrogetic) --> fibrosis and loss of acinar cells

10

Chronic pancreatitis: three patterns

1. Duct dilation with abnormal shapes and calcification; 2. Fibrosis; 3. Atrophy of ACINAR CELLS FIRST (and eventually islet cells)

11

How to detect chronic pancreatitis on CT scan

Calcification

12

Chronic pancreatitis: sx, prognosis, complications

Silent until insufficiency occurs: malabsorption and diabetes; 25 year mortality = 50%; pseudocyst and adenocarcinoma

13

Describe pancreatic pseudocyst. IF a pancreatic cyst has an epithelium, what do you think about?

Most common pancreatic cyst, can be quite large, often peripancreatic (in ST around pancreas), hemorrhagic debris lined by capsule (NOT epithelium); cancer

14

T/F: Pancreatic ductal adenocarcinoma is preceded by dysplasia

True: there is a series of early lesions called "PanINs"

15

Almost all pancreatic ductal adenocarcinoma have these two lesions; half have these two

KRAS and p16/CDKN2A; TP53 and SMAD4/DPC4

16

Pancreatic cancer and genes (top three genetic associations)

1. Peutz-Jeghers = 130x; 2. Hereditary pancreatitis = 75x; 3. Family history (>3 relatives) = 20x

17

Pancreatic cancer: gross

Firm, stellate, poorly defined, head of pancreas

18

Pancreatic cancer: histological

Irregular, infiltrating, gland-like

19

Pancreatic cancer: histological findings unique to pancreas (3)

1. STRONG desmoplastic reaction; 2. Tends to spread outside pancreas EARLY; 3. Perineural invasion (explains pain presentation and spread)

20

Trousseau sign

Migratory thrombophlebitis: painful nodules that appear and disappear, usually on legs due to tumor-produced prothrombotic factors

21

What kind of jaundice and what sign might you get with pancreatic cancer?

Onset of acute, PAINLESS jaundice with dilated gallbaldder (Courvoisier sign)

22

Virchow's node

Nontender, firm, fixed left supraclavicular lymph node

23

Pancreatic cancer: risk factors

Old age, smoking, chronic pancreatitis, hereditary factors

24

5-year survival for pancreatic cancer. Why so low?

5-10%; typically non-resectable due to growth into SMA

25

List pancreatic neuroendocrine tumors and the clinical syndrome they cause

Insulinoma, gastrinoma (ZE syndrome), glucagonoma, somatostatinoma, VIPoma (Verner-Morison/WDHA syndrome with watery diarrhea, hypokalemia, achlorhydria)

26

Pancreatic neuroendocrine tumors tend to be...

Soft, well-differentiated, with SALT AND PEPPER CHROMATIN

27

How to figure out what kind of neuroendocrine tumor you're dealing with...However, most of these tumors are...?

Stain for antigen; non-functional

28

Calculous cholecystitis means...

Accumulation of stones INSIDE gallbladder

29

Histology of gallbladder disease. This can lead to? If the gallbladder wall is transmurally involved and you get exudate on serosal surface, you get...

Fibrin, blood, neutrophils --> bag of pus = EMPYEMA of gallbladder; gangrenous cholecystitis (if gas-producing = emphysematous)

30

Chronic cholecystitis means you don't have _________, but you still have stones

Obstruction (in fact, due to stones)

31

Histological finding of chronic cholecystitis

Rokitansky-Anschoff sinuses (out pouching of epithelium to wall of gall bladder, like a diverticulum)

32

Gross findings of chronic cholecystitis (3)

Fibrosis, porcelain gallbladder (calcification) or atrophy

33

Long-term structural complications of chronic cholecystitis

Fistula (dx with barium enema); e.g. cholecysto-colonic

34

What do you get if you have a gallbladder fistula into small bowel?

Gallstone ileus (irritation of small bowel due to stones)

35

Adenocarcinoma of gallbladder characteristic

1. Firm growth along wall (like linitus in stomach) or 2. Fungating growth in lumen of gall bladder

36

Adenocarcinoma of gallbladder: who gets it, risk, prognosis

Females, associated with gall stones and also with fungal infections in some parts of the world; poor prognosis (5 year = 5% due to difficult resection and silent growth)