pancreas and gallbladder pathology Flashcards by RK Splendid

the exocrine pancreas is composed of?

Ductal and Acinar components

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where in the pancreas are enzymes made?

Acini

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what is a cholangiocarcinoma?

prognosis vs pancreatic cancer?

Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile duct

better prognosis than pancreatic cancer

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what are the types of cancers you can get from the pancreas?

ENDOCRINE

cancer of the ductal epithelium
variations of this name may add “invasive” and “ductal”

NEUROENDOCRINE

cancer of the neuroendocrine cells
sometimes called “islet cell cancers” - not from there
functioning types ; secrete hormones such as insulin, gastrin, and glucagon
non-functioning types; dont secrete

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descriibe structure of islet of langerhans?

grouped, surrounding a capillary

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descrihbe structure of pancreatric acinus?

Pancreatic acinar cells most distal

contain zymogen granules
secrete into;

Intercellular canaliculi

Centro-acinar cells line the Intercalated duct
- this is connected to the;

Intralobular duct, which is connected to the

Main pancreatic duct

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source of hormones in pancreas?

islet cells

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source of digestive enxymes in pancreas?

acinar cells;

storage organelles in the exocrine pancreas

allow the sorting, packaging and regulated

APICAL secretion of digestive enzymes

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Acute inflammation of the pancreas caused by aberrant release of pancreatic enzymes is ____?

acute pancreatitis

-> auto digestion process

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List the most common causes of acute pancreatitis in order?

Gall stones 50%

Alcohol 33%

Idiopathic 15%

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list some obstructive cuases of acute pancreatitis?

Gall stones (50%)
Trauma
Tumours

alcohol can be as well

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list some metabolic/toxic cuases of acute pancreatitis?

Alcohol 33%

Drugs (e.g. thiazide diuretics)
Hypercalcaemia
Hyperlipidaemia

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list some haematological cuases of acute pancreatitis?

Poor blood supply due to:

Shock
Hypothermia

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list some infectious causes of acute pancreatitis?

Viruses (e.g. mumps)

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how does alcohol causes obstructive acute pancreatitis?

Alcohol leads to spasm/oedema of Sphincter of Oddi and the formation of a protein rich pancreatic fluid which obstructs the pancreatic ducts

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what is the mecahnsim of obstructive acute pancreatitis by gallstone?

Gallstone stuck distal to where the common bile duct and pancreatic ducts join leads to:

reflux of bile up the pancreatic duct followed by damage to acini (NECROSIS) causing ->

release of proenzymes which then become activated

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what is the relationship of hyper and hypo calcaemia to acute pancreatitis?

HYPER calcaemia can cause acute pancreatitis

which can cause HYPO calcaemia

(remember -> hyper comes first)

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summarise the pathogenesis of acute pancreatitis?

DUCT OBSTRUCTION

2. DIRECT ACINAR INJURY

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What are the patterns of injury in acute pancreatitis?

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Periductal - necrosis of acinar cells near ducts (usually secondary to obstruction)

Perilobular – necrosis at the edges of the lobules (usually due to poor blood supply)

Panlobular – develops from 1. and 2.

what happens when lipases are released from the acinar in a pancreatitis?

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become activated.
This will lead to fat necrosis.

		§ Then, calcium will bind to the free fatty acids forming soaps (saponification) which are seen as yellow-white foci

why can patients with AP present as normo calceamic?

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Hypercal causes ap which causes hypocal

DEFINITION of pseudocyst?

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a collection of fluid rich in pancreatic enzymes or necrotic material without an epithelial lining

lined with fibrous tissue

		§ Pseudocysts can become infected leading to abscess formation

LIST some importsnt causes of chronic pancreatitis?

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Alcohol (80%)
				Haemochromatosis 
 		Gallstones
				Abnormal pancreatic duct anatomy
				Cystic fibrosis (“mucoviscoidosis”)
idiopathic
autoimmune

pattern of injury in chronic P?

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Chronic inflammation with parenchymal fibrosis and loss of parenchyma

Duct strictures with calcified stones with secondary dilatations

simplified;
fibrosis and scarring will be present
Strictures caused by fibrosis

which cells will be seen in AP vs CP?

Acute inflammation – neutrophils present Chronic inflam – lymphocytes

complications and prognosis of AP?

Complications AP Pancreatic : pseudocyst, abscess Systemic: shock, hypoglycaemia, hypocalcaemia Prognosis AP Overall mortality up to 50% for haemorrhagic pancreatitis

Autoimmune pancreatitis is aka? aetiology?

IgG4 Related Disease large numbers of IgG4 positive plasma cells deposited in various tissue around body causing fibrosis

list tumours of the types of tumours in pancreas?

Carcinomas Ductal (85% of all neoplasms) Acinar Cystic neoplasms Serous cystadenoma Mucinous cystic neoplasm Pancreatic neuroendocrine tumours (Islet cell tumours)

what are RFs for P Carcinoma?

Smoking BMI and dietary factors Chronic pancreatitis Diabetes

K-Ras mutations occur in 95% of what?

Intraducal Mucinous Papillary Neoplasm -> ductal carcinoma

Ductal carcinoma arise from?

dysplasia; dysplastic ductal lesions: 1. Pancreatic Intraductal Neoplasia (PanIN) 2. Intraducal Mucinous Papillary Neoplasm K-Ras mutations

what is the micro & macroscopic appearance of ductal carcinoma?

Macroscopic Appearance : Gritty and grey Invades adjacent structures Tumours in the head present earlier Micro: Adenocarcinomas: mucin secreting glands set in desmoplastic stroma

most common area in pancreas for ductal carcinoma?

Head (60%) of pancreas

how and where does a ductal carcinoma spread?

Direct: Bile ducts, duodenum Lymphatic: Lymph nodes Blood: Liver Serosa: Peritoneum

complications of ductal carcinoma?

Due to spread Chronic pancreatitis Venous thrombosis (“migratory thrombophlebitis”)

which tumour is describd as follows; | Contain serous or mucin secreting epithelium cf. ovarian tumours Usually benign

cystic tumours

most common area in pancreas for neuroendocrine tumours?

in tail of pancreas as there are more neuroendocrine cells there

the commonest type of secretory tumour in pancreas?

Insulinomas (derived from beta cells)

cholelithiasis is?

gall stones

RFs for cholelithiasis?

5Fs ``` Fair Female fat- BMI >30 kg/m2 and hyperlipidaemia fertile - 1+ kids forty ```

RFs for cholelithiasis according to lecture slides?

Age and gender: increasing age, F>M Ethnic and geographic: e.g. Native Americans Hereditary: e.g. disorders of bile metabolism Drugs e.g. oral contraceptive Acquired disorders e.g. rapid weight loss

name the 2 types of gallstones and how to identify them?

Cholesterol (more than 50% cholesterol) May be single, mostly radiolucent Pigment (contain calcium salts of unconjugated bilirubin) Multiple, mostly radio-opaque

complications of gall stones ?

Bile duct obstruction* Acute and chronic cholecystitis Gall bladder cancer Pancreatitis

most common cause of Acute cholecystitis?

90% gallstones

what can be measured in the blood as a screening test for neuroendocrine tumours?

chromogranin

what features are seen in CPancreatitis?

Chronic inflammation Fibrosis Diverticula – Rokitansky-Aschoff sinuses created 90% contain gall stones

Gall bladder cancer is of what type? most common cause?

Adenocarcinoma 90% associated with gall stones UNCOMMON

pancreas and gallbladder pathology Flashcards

(47 cards)