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60 Cards in this Set

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  • Back
What type of cells composed most of the tissue in the pancreas?
acinar cells
What are the signs and symptoms of an acute pancreatitis?
acute onset
elevation of pancreatic enzymes in blood and urine
in severe cases: hemorrhaging
What are the metabolic etiologies behind pancreatitis?
alcoholism (most common)
What are the mechanical etiologies behing pancreatitis?
Gallstone (most common)
iatrogenic injury(perioperative injury (transverse colon operation) and endoscopic procedures with dy injection)
What are the vascular etiologies behind pancreatitis?
polyarteritis nodosa
What infections could cause pancreatitis?
mumps (pancreatitis OR orchitis)
mycoplasma pneumoniae
How does a pancreatitis progress?
1. proteolytic destruction
2.necrosis of blood vessels (hemorrhage following)
3.necrosis of fat (can be seen on omentum)
4.associated inflammatory reaction
5. blue-black hemorrhage with yellow-white chalky fat necrosis
What will you microscopically in an acute pancreatitis?
acini is almost all destroyed
fat tissue digested
acinar cell necrosis and hemorrhage
Does the yellow-white foci saponification/fat necrosis occure early or late in acute pancreatitis?
What are the three pathogenesis of acute pancreatitis? Give examples of each
1.Obstruction to the outflow (cholethiasis, chronic alcoholism) injury to acini (alcohol, viruses, drugs, trauma)
3.derangements of intracellular transport of enzymes (alcohol/metabolic injury)
What is the clinical picture of an acute pancreatitis?
acute epigastric pain with radiation to back
elevated serum amylase (rises in 12hrs, but returns to normal by 48-72 hrs)
elevated serum lipase (more specific)
What is the mortality rate in acute pancreatits?
HIGH: 10-15%
What are some predisposing factors for Chronic Pancreatitis?
What is chronic Pancreatitis?
repeated mild bouts of inflammation
Who is more likely to have chronic pancreatitis?
middle aged males (particularly alcoholics)
What role does biliary tract disease play in chronic pancreatitis?
biliary tract disease plays a less important role, compared to acute pancreatitis
What is common morphology in chronic pancreatitis?
1.fibrosing atrophy of exocrine glands
2.calcifying pancreatitis (proteinaceous and calcifying plugs in ducts)
3.duct epithelium changes (atrophic, hyperplastic, squamous metaplasia)
4.atrophic lobules surrounded by dense fibrous tissues infiltrated by lymphocytes
5.pancreatic ducts are dilated and contain mucus plugs
In chronic obstructive pancreatitis, what would be observed?
widespread atrophic changes
ductal dilation prominent
calcification are infrequent
ductal obstruction
malabsorption, steatorrhea
secondary diabetes
What is chronic obstructive pancreatitis associated with?
impacted gallstones in the sphincter of Oddi
stenosis of sphincter secondary to cholestheiasis
Give an example of an congenital disease with cysts. What other conditions arise because of this disease?
Von-Hippel-Lindau Disease

Cysts (3-5cm) in the pancreas, liver and kidney
lined with cuboidal epithelium
filled with clear to turbid mucoid/serous fluid
Angiomas in retina and cerebellum of brainstem
What is a pseudocyst?
localized collection of pancreatic secretions

unilocular-one cavity inside
NO epithelial lining (just fibrous tissue lining and inflammatory cells)
When do pseudocysts develop and what are some complications?
develop after acute or chronic pancreatitis and can have hemorrhage and infections as complications
What are some characteristics of cystic tumors?
presents as painless, slow growing masses
more common in body and tail
What type of pancreatic cyst do elderly women usely get and is it usually malignant?
Microcystic serous cystadenomas

Always benign
What type of pancreatic cyst do younger people usually get and is it usually malignant?
Mucinous cystic tumors

Potentially can be malignant
What is the epidemiology of pancreatic cancer?
5th most frequent cause of death (from cancer) in US
incidence is steadily increasing
cause is NOT known (2-3x more common in smokers)
Where does pancreatic cancer form?
60% head (earliest sign will be obstructive jaundice)
15% in body
5% in tail
20% involves the entire gland
What type of cancer is pancreatic cancer?
ALL are adenocarcinomas arising from ductal epithelium
What are some primary and secondary complications of pancreatic cancer?
Metastases: lung, liver, peritoneum
pancreatic carcinoma
abdominal pain (perineural lymphatic invasion)

weight loss
obstructive jaundice
courvoisier gallbladder
migratory thrombo-phlebitis
What is courvoisier gallbladder?
tumor in pancreas pushes against cystic duct and causes the gallbladder to dilate and enlarge
What are some characteristics of pancreatic cancer itself?
may secrete mucin and have abundant fibrous stroma

gritty, grey-white, HARD masses (from fibrosis)

it is hard to tell the difference btw carcinoma and chronic pancreatitis
What is diagnostic for panceatic cancer?
tumor in the perineural spaces (causes back pain)
What are the two types of Cholelithiasis?
What are the predispositions of cholelithiasis?
Two Types: cholesterol and pigmented

Predisposition: supersaturation of bile with cholesterol or bilirubin salts
What are the risk factors for cholesterol cholelithiasis?
native american
adults-industrialized nations
female, fat, forty, fertile (2:1, f to M)
estrogenic influence
rapid weight loss
gallbladder stasis (spinal cord injury or pregnancy)
What is the pathogenesis of cholesterol cholelithiasis?
supersaturated bile with cholesterol
gallbladder hypomotility (promotes crystal nucleation)
cholesterol nucleation in bile is accelerated
mucus hypersecretion in gallbladder traps crystals
nucleation is promoted by microprecipitates of Ca salts
What is the morphology of cholesterol cholilithiasis?
pale, yellow, hard
single stones are oval
multiple stones are faceted
bilirubin salts may have black color
What are the risk factors of pigmented (bilirubin Ca salts) cholelithiasis?
chronic hemolytic syndromes
biliary tract infection
Ileal disease (resection/bypass)
cystic fibrosis with pancreatic insufficiency
What is the pathogenesis of pigmented cholelithiasis?
presence of unconjugated bilirubin in biliary tree
precipitation of calcium bilirubin salts
infection of biliary tract (promotes deconjugation of bilirubin glucouronides secreted by liver)
chronic hemolytic conditions promote formation of unconjugated bilirubin in the biliary tree
What is the morphology of pigmented cholelithiasis?
black (found in sterile gallbladders)
brown (found in infected intrahepatic or extrahepatic bile ducts)
soft and usually multiple
based on Ca++ content (more radiopaque)
What are the clinical features of cholelithiasis?
70-80% remain asymptomatic
primary: spasmodic, colicky pain from obstruction of bile ducts
RUQ pain (gallbladder block)

Secondary: inflammation
biliary tree inflammation (cholangitis)
obstructive cholestasis or pancreatitis

Clear mucinous secretions in an obstructed gallbladder
distend gallbladder (mucocele)
What percentage of acute cholecystitis is caused by gallstone obstruction?
90% in the neck/cystic duct
When do cases pf cholecystitis without gallstone obstruction occur?
severely ill patients:
postoperative state
severe trauma
severe burns
multisystem organ failure
prolonged hyperalimentation
postpartum state
What is the pathogenesis of cholecystitis?
acute inflammation with gallstones initiated by bile acids, gallbladder dysmotility, distension and ischemia

Bacterial contamination (later complications)

ischemic compromise of gallbladder causes the cholecystitis
What are symptoms of acute cholecystitis?
attack of RUQ or epigastric pain

mild fever
anorexia, nausea, vomiting
Symptoms may be mild or intermittent or surgical emergencies
What is the morphology of acute cholecystitis?
enlarged gallbladder: tense, bright red to blotchy green-black

serosal covering of fibrin

luminal contents may be turbind or purulent
What is the pathogenesis of chronic cholecystitis?
arise from repeated bouts of symptomatic acute cholecystitis or in absence of antecedent attacks

gallstones are usually present (though may not play a role)

chronic supersaturation of bile with cholesterol (cholesterol suffusion of gallbladder wall and initiation of inflammation and gallbladder dysmotility)
How does the pt population and symptoms of chronic cholecystitis differ from acute?
they don't
What is the morphology of chronic cholecystitis?
gallbladder: contracted, normal size or enlarged

Wall: thickened/grey-white

Mucosa: normal or atrophic

Rokitansky-Aschoff sinuses: mucosal outpouchings through the wall

Cholesterolosis: cholesterol laden macrophages in lamina propria

Dystrophic calcification in wall (porcelain gallbladder) RARE
What are some complications with cholecystitis?
bacterial superinfection
gallbladder perforation with peritonitis
biliary-enteric fistula
aggravation of coexisting medical illnesses
mortality: <1%

in severely ill pts, symptoms might not be evident: mortality is higher
What are the symptoms of choledocholithiasis?
hepatic abscess
acute calculous cholecystitis
Comparing Asia and Western nations; What type of stone is seen in choledocholithiasis?
Asia countries have more primary and pigmented stones

Western countries usually have stones derived from cholesterol
What is ascending Cholangitis? And when and from what does it usually arise?
bacterial infection of the bile ducts

Arise from: choledocholithiasis, indwelling stents/catheters, tumors, acute pancreatitis and benign strictures

The main bacteria is usually E. Coli or klebsiella
What is biliary atresia?
What is the treatment and how frequently does it usually occur?
complete obstruction of bile flow owing to destruction/absence of all or part of extrahepatic bile ducts

1/10000 liver births

Treatment is liver transplant (curative) and if untreated will result in death w/in 2yrs
What is the pathogenesis of biliary atresia?
biliary tree is intact at birth with progressive inflammatory destruction after birth

Cause is unknown
What is the morphology of biliary atresia?
inflammation and fibrosing of stricture of both extrahepatic and intrahepatic (with progression) biliary tree
What are some tissue changes that can be seen in the gallbladder as a result of biliary atresia?
marked bile ductular proliferation

portal tract edema
fibrosis progressing to cirrhosis within 3-6 mos
What are the stats of carcinoma of the gallbladder?
5th most common of digestive cancers
more common in women(slightly)
pts present in their 60s
gallstones co-exist in 60-90% of pts in western nations
POOR prognosis
What are the two patterns of growth in gallbladder carcinoma?
1. infiltrating: diffuse thickening and induration of gallbladder

2. exophytic: growth into lumen as an irregular, cauliflower like mass
What are the clinical features of gallbladder carcinoma?
insidious symptoms and indistinguishable from those caused by cholelithiasis
What type of tumors are usually found with carcinoma of the gallbladder and can they be resected?
Most tumors are adenocarcinomas (rarely squamous cell carcinoma)

Tumors can be resected, but it is usually too infiltrated when found to be resectable.