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60 Cards in this Set
- Front
- Back
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What type of cells composed most of the tissue in the pancreas?
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acinar cells
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What are the signs and symptoms of an acute pancreatitis?
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acute onset
elevation of pancreatic enzymes in blood and urine in severe cases: hemorrhaging |
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What are the metabolic etiologies behind pancreatitis?
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alcoholism (most common)
hyperlipoproteinemia hypercalcemia genetic |
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What are the mechanical etiologies behing pancreatitis?
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Gallstone (most common)
iatrogenic injury(perioperative injury (transverse colon operation) and endoscopic procedures with dy injection) |
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What are the vascular etiologies behind pancreatitis?
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shock
atheroembolism polyarteritis nodosa |
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What infections could cause pancreatitis?
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mumps (pancreatitis OR orchitis)
coxsachievirus mycoplasma pneumoniae |
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How does a pancreatitis progress?
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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 |
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What will you microscopically in an acute pancreatitis?
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acini is almost all destroyed
fat tissue digested acinar cell necrosis and hemorrhage |
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Does the yellow-white foci saponification/fat necrosis occure early or late in acute pancreatitis?
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late
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What are the three pathogenesis of acute pancreatitis? Give examples of each
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1.Obstruction to the outflow (cholethiasis, chronic alcoholism)
2.direct injury to acini (alcohol, viruses, drugs, trauma) 3.derangements of intracellular transport of enzymes (alcohol/metabolic injury) |
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What is the clinical picture of an acute pancreatitis?
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acute epigastric pain with radiation to back
shock elevated serum amylase (rises in 12hrs, but returns to normal by 48-72 hrs) elevated serum lipase (more specific) |
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What is the mortality rate in acute pancreatits?
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HIGH: 10-15%
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What are some predisposing factors for Chronic Pancreatitis?
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hypercalcemia
hyperlipoproteinemia |
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What is chronic Pancreatitis?
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repeated mild bouts of inflammation
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Who is more likely to have chronic pancreatitis?
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middle aged males (particularly alcoholics)
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What role does biliary tract disease play in chronic pancreatitis?
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biliary tract disease plays a less important role, compared to acute pancreatitis
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What is common morphology in chronic pancreatitis?
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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 |
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In chronic obstructive pancreatitis, what would be observed?
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widespread atrophic changes
ductal dilation prominent calcification are infrequent ductal obstruction malabsorption, steatorrhea secondary diabetes pseudocyst |
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What is chronic obstructive pancreatitis associated with?
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impacted gallstones in the sphincter of Oddi
stenosis of sphincter secondary to cholestheiasis |
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Give an example of an congenital disease with cysts. What other conditions arise because of this disease?
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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 |
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What is a pseudocyst?
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localized collection of pancreatic secretions
unilocular-one cavity inside NO epithelial lining (just fibrous tissue lining and inflammatory cells) |
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When do pseudocysts develop and what are some complications?
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develop after acute or chronic pancreatitis and can have hemorrhage and infections as complications
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What are some characteristics of cystic tumors?
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multilocular
presents as painless, slow growing masses more common in body and tail |
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What type of pancreatic cyst do elderly women usely get and is it usually malignant?
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Microcystic serous cystadenomas
Always benign |
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What type of pancreatic cyst do younger people usually get and is it usually malignant?
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Mucinous cystic tumors
Potentially can be malignant |
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What is the epidemiology of pancreatic cancer?
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5th most frequent cause of death (from cancer) in US
incidence is steadily increasing cause is NOT known (2-3x more common in smokers) |
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Where does pancreatic cancer form?
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60% head (earliest sign will be obstructive jaundice)
15% in body 5% in tail 20% involves the entire gland |
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What type of cancer is pancreatic cancer?
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ALL are adenocarcinomas arising from ductal epithelium
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What are some primary and secondary complications of pancreatic cancer?
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Primary:
Metastases: lung, liver, peritoneum pancreatic carcinoma abdominal pain (perineural lymphatic invasion) Secondary: weight loss obstructive jaundice courvoisier gallbladder migratory thrombo-phlebitis |
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What is courvoisier gallbladder?
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tumor in pancreas pushes against cystic duct and causes the gallbladder to dilate and enlarge
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What are some characteristics of pancreatic cancer itself?
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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 |
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What is diagnostic for panceatic cancer?
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tumor in the perineural spaces (causes back pain)
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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 |
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What are the risk factors for cholesterol cholelithiasis?
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native american
adults-industrialized nations female, fat, forty, fertile (2:1, f to M) estrogenic influence obesity rapid weight loss gallbladder stasis (spinal cord injury or pregnancy) hypercholesterolemic |
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What is the pathogenesis of cholesterol cholelithiasis?
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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 |
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What is the morphology of cholesterol cholilithiasis?
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pale, yellow, hard
single stones are oval multiple stones are faceted bilirubin salts may have black color |
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What are the risk factors of pigmented (bilirubin Ca salts) cholelithiasis?
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asian
rural chronic hemolytic syndromes biliary tract infection Ileal disease (resection/bypass) cystic fibrosis with pancreatic insufficiency |
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What is the pathogenesis of pigmented cholelithiasis?
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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 |
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What is the morphology of pigmented cholelithiasis?
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black (found in sterile gallbladders)
brown (found in infected intrahepatic or extrahepatic bile ducts) soft and usually multiple based on Ca++ content (more radiopaque) |
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What are the clinical features of cholelithiasis?
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70-80% remain asymptomatic
primary: spasmodic, colicky pain from obstruction of bile ducts RUQ pain (gallbladder block) Secondary: inflammation empyema perforation fistulas biliary tree inflammation (cholangitis) obstructive cholestasis or pancreatitis Clear mucinous secretions in an obstructed gallbladder distend gallbladder (mucocele) |
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What percentage of acute cholecystitis is caused by gallstone obstruction?
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90% in the neck/cystic duct
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When do cases pf cholecystitis without gallstone obstruction occur?
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severely ill patients:
postoperative state severe trauma severe burns multisystem organ failure sepsis prolonged hyperalimentation postpartum state |
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What is the pathogenesis of cholecystitis?
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acute inflammation with gallstones initiated by bile acids, gallbladder dysmotility, distension and ischemia
Bacterial contamination (later complications) ischemic compromise of gallbladder causes the cholecystitis |
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What are symptoms of acute cholecystitis?
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attack of RUQ or epigastric pain
mild fever anorexia, nausea, vomiting tachcardia Symptoms may be mild or intermittent or surgical emergencies |
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What is the morphology of acute cholecystitis?
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enlarged gallbladder: tense, bright red to blotchy green-black
serosal covering of fibrin luminal contents may be turbind or purulent |
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What is the pathogenesis of chronic cholecystitis?
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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) |
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How does the pt population and symptoms of chronic cholecystitis differ from acute?
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they don't
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What is the morphology of chronic cholecystitis?
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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 |
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What are some complications with cholecystitis?
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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 |
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What are the symptoms of choledocholithiasis?
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pancreatis
cholangitis hepatic abscess acute calculous cholecystitis |
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Comparing Asia and Western nations; What type of stone is seen in choledocholithiasis?
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Asia countries have more primary and pigmented stones
Western countries usually have stones derived from cholesterol |
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What is ascending Cholangitis? And when and from what does it usually arise?
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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 |
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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 |
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What is the pathogenesis of biliary atresia?
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biliary tree is intact at birth with progressive inflammatory destruction after birth
Cause is unknown |
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What is the morphology of biliary atresia?
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inflammation and fibrosing of stricture of both extrahepatic and intrahepatic (with progression) biliary tree
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What are some tissue changes that can be seen in the gallbladder as a result of biliary atresia?
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marked bile ductular proliferation
portal tract edema fibrosis progressing to cirrhosis within 3-6 mos |
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What are the stats of carcinoma of the gallbladder?
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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 |
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What are the two patterns of growth in gallbladder carcinoma?
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1. infiltrating: diffuse thickening and induration of gallbladder
2. exophytic: growth into lumen as an irregular, cauliflower like mass |
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What are the clinical features of gallbladder carcinoma?
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insidious symptoms and indistinguishable from those caused by cholelithiasis
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What type of tumors are usually found with carcinoma of the gallbladder and can they be resected?
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Most tumors are adenocarcinomas (rarely squamous cell carcinoma)
Tumors can be resected, but it is usually too infiltrated when found to be resectable. |
