Pancreatic and Gall Bladder Pathology

Question 1

2 main role of pancreas

Answer 1

Endocrine and exocrine function

Question 2

Label the anatomy of the pancreas

Answer 2

Lecture Slide

Question 3

Pancreas: Exocrine Function
- what cells involved? Contain what?

Answer 3

Composed of acinar cells and ducts
Acinar cells contain zymogen granules (Zymogens = inactive enzyme precursors for trypsin, chymotrypsin, amylase, lipase, nuclease, elastase)

Question 4

Pancreas: Endocrine Function
- cells involved? Contain/secrete what

Answer 4

Islets of Langerhans
Secrete insulin, glucagon, other hormones

Question 5

Acute pancreatitis
- what is it?

Answer 5

Inflammation of the pancreas – associated with acinar cell injury. Causes release of enzymes causing severe inflammation

Question 6

Causes of pancreatitis

Answer 6

4 major causes
1. Metabolic: Alcohol (direct damage to acinar cells as well as obstruction in the pancreatic duct)
2. Mechanical: Gallstones (cholelithias), trauma (obstruction of pancreatic duct)
3. Vascular: Shock (hypotension, ↓ perfusion and decreased oxygen to pancreas), vasculitis (impaired blood supply to pancreas)
4. Infection: Mumps

Question 7

how does pancreatitis cause inflammation

Answer 7

Autodigestion by pancreatic enzymes
eg: obstruction in the pancreatic duct
↑ pressure damage to acinar cells, release of enzymes
LEADING TO

Cell injury response mediated by inflammatory cytokines

Question 8

Consequences of enzyme release:
What is released from pancreas and the effect of it

Answer 8

Proteases: destruction of acini, ducts, islets

Lipases: Fat necrosis – pancreas and other
sites

Elastases: blood vessel destruction leading to interstitial haemorrhage

Cell injury response : inflammation, oedema

Question 9

What triggers the acute event

Answer 9

1. Obstruction of the pancreatic duct
2. Direct injury to acinar cells

Question 10

Draw the flowchart showing the processes leading to acute pancreatitis

Answer 10

Lecture Slide

Question 11

Clinical symptoms/signs of acute pancreatitis

Answer 11

Acute abdominal pain – epigastric
Nausea and vomiting
Fever, tachycardia
Marked abdominal tenderness

Question 12

Acute pancreatitis Diagnosis is made using..

Answer 12

1. Clinical symptoms and signs
2. Neutrophil leucocytosis
3. Elevated serum amylase and lipase
4. CT scan abdomen– oedema, necrosis, pseudocysts of the pancreas
5. Rarely may need laparotomy to confirm
   diagnosis

Question 13

managment of acute pan

Answer 13

IV fluids
NG suction
Analgesia
Close monitoring

Question 14

Define chronic pancreatitis

Answer 14

Defined as repeated bouts of pancreatic inflammation with loss of pancreatic parenchyma and replacement by fibrous tissue

· see more chronic inflammatory cells - monocytes macrophages
. loss of pancreatic tissue
· fibrosis
. not necessarily larger, can be normal or even reduced in size

Question 15

Processes causing Chronic Pancreatitis

Answer 15

Atrophy of the exocrine component but relative sparing of the islets
Mild chronic inflammatory infiltrate
Calcification

Question 16

Clinical symptoms of chronic pan

Answer 16

Repeated attacks of abdominal pain – often bought on by alcohol
Can be more persistent pain

Question 17

Pancreatic Carcinoma
-risk factors
-type of cancer

Answer 17

Tobacco smoking
Heavy alcohol intake
High BMI

Adenocarcinoma

Question 18

Differences in Pancreatic Carcinoma when in head vs body/tail

Answer 18

Head of pancreas: invade Ampulla , biliary obstruction

Body and tail: remain silent, often large and disseminated at presentation, spread to nodes, adjacent organs, liver, bones, lungs

Question 19

Symtpoms of pancreatic cancer

Answer 19

Obstructive jaundice
Pain
Weight loss
Pancreatitis (if theres obstruction)
Thrombophlebitis (inflammation of the veins associated wi clotting)/ venous thrombosis

Question 20

Diagnosis of cancer based on

Answer 20

Confirmed by CT or US guided FNA and core biopsy or open biopsy at laparotomy

Question 21

Pancreatic Endocrine Tumours
- two main types and findings

Answer 21

1. Islet cell Tumours
2. Insulinoma (tumor of beta cells)

• Present with symptoms of hypoglycaemia
  Blood glucose low, raised insulin levels

Question 22

Cholelithiasis: Gallstones
-describe how it happens

Answer 22

About 80% of gallstones contain crystalline cholesterol monohydrate and are called
cholesterol stones

1. Bile supersaturated with cholesterol
2. Conditions favour crystal formation
3. Cholesterol crystals remain in gallbladder long enough for stones to form eg stasis

Question 23

Risk factors for cholelithiasis

Answer 23

1. Increase chance with age and women
   (Estrogenic influences (oral contraceptives, pregnancy), obesity and rapid weight loss favour stone formation)
2. Gallbladder stasis favours stone formation
   3.A family history of gallstones

Question 24

Clinical consequences of Gallstones (eg where it can block and the name for that location of stones)

Answer 24

1.Cholecystitis – acute / chronic
2. Biliary colic – due to choledocholithiasis
3.Complications of above eg cholangitis, obstructive choleostasis, pancreatitis

Question 25

Acute Cholecystitis -what is it -caused by

Answer 25

Obstruction of the neck of the gallbladder or of the cystic duct Most cases precipitated by gallstones

Question 26

Clinical Features Cholecystitis -symptoms lab results

Answer 26

RUQ abdominal pain and tenderness Febrile tachycardia Laboratory: Neutrophil leucocytosis Raised bilirubin, ALP and GGT if stone in the common bile duct Imaging – ultrasound of gall bladder

Question 27

Chronic Cholecystitis - what is it

Answer 27

Chronic cholecystitis results from long-term association of gallstones and low-grade inflammation.

Question 28

Management of cholecystitis

Answer 28

Initial acute event Many settle with conservative therapy – iv fluids, pain relief or even surgery Longer term: Cholecystectomy – most now laparoscopic

Question 29

What is Choledocholithiasis - complications

Answer 29

Choledocholithiasis is the presence of stones within the biliary tree Complications: Biliary obstruction – colicky abdominal pain Obstructive jaundice Pancreatitis Cholangitis

Question 30

Cancers of the Biliary System -2 locations -main type of cancer

Answer 30

Carcinoma of the Gall Bladder Carcinoma of the extrahepatic ducts Most are adenocarcinomas

Question 31

cholecystitis vs cholelithiasis vs choledocholithiasis vs cholangitis

Answer 31

Cholelithiasis: presence of gallstones within the gallbladder itself Cholecystitis: Inflammation of the gallbladder, usually caused by a gallstone obstructing the cystic duct Choledocholithiasis: gallstones within the common bile duct Cholangitis: Inflammation and infection of the bile ducts, often caused by gallstones