Gallbladder and Pancreas Pathology

Question 1

what commonly accompanies congenital agenesis/hypoplasia of the gallbladder?

Answer 1

the bile ducts are also abnormal and can prevent bile from draining properly

Question 2

what is cholesterolosis?

Answer 2

a frequent incidental finding of cholesterol deposits in the gallbladder due to excess secretion

Question 3

What is the epidemiology of cholelithiasis?

Answer 3

10-20% of adults (25-40 million)

one of the top 10 surgical procedures

Question 4

People with gall stones are at increased risk for what?

Answer 4

gall bladder carcinoma

Question 5

pigment stones are also called what?

Answer 5

bilirubinate stone (10% of stones)

*they appear black and are derived from hemoglobin and bilirubin

Question 6

what is the frequency of different gall stone types?

Answer 6

cholesterol - 90%

bilirubinate - 10%

CaCO3 - extremely rare

Question 7

What are the risk factors for cholelithiasis?

Answer 7

the 4 Fs

female

fat

fertile

forties

Question 8

what symptoms do most people with gallstones have?

Answer 8

None - 80%

Question 9

what is cholangitis?

Answer 9

stone obstructing CBD

pain, fever, jaundice, can lead to liver abscess

Question 10

what is gallbladder hydrops?

Answer 10

when the gallbladder becomes enlarged from the filling with mucin due to blockage in the cystic duct

Question 11

what is gallstone ileus?

Answer 11

intestinal obstruction from gall stone passing through a fistula

into the intestine (very rare)

Question 12

what is acute cholecystitis?

Answer 12

primary complication of cholelithiasis where cystic duct/neck becomes obstructed (can occur without stone)

Question 13

what is the epi of cholecystitis?

Answer 13

60% female

10% acalculous

10% perforate without surgery

Question 14

what are the histological findings in chronic cholecystitis?

Answer 14

smooth muscle hypertrophy

lymphocytic infiltrate

Rokitanksy-Aschoff sinuses (hallmark)

Question 15

what is the epidemiology of carcinoma of the gallbladder?

Answer 15

older adults

hx of cholelithiasis

poor prognosis

geographic distribution suggests genetics

Question 16

what are the two types of gallbladder tumors?

Answer 16

exophytic

infiltrating

Question 17

how do you distinguish Rochansky sinuses from carcinoma?

Answer 17

both can invade muscle, but Rochansky are lined with benign epithelial layer

Question 18

what hallmark sign do you see with gall stones on ultrasound?

Answer 18

hyperdensity within the gallbladder with a shadow below

Question 19

what does the pancreas do?

Answer 19

produce digestive enzymes that flow into the duodenum

Question 20

what digestive enzyme is only made by the pancreas?

Answer 20

lipase

(so if you lose it, you lose fat digesting capability)

Question 21

what two disorders outside the pancreas affect it?

Answer 21

hemochromotosis

cystic fibrosis

Question 22

what are the leading causes of acute pancreatitis?

Answer 22

alcohol

stones

unkown

Question 23

what is a major complication of chronic pancreatitis?

Answer 23

pseudocyst (up to 25% of cases)

results from liquefactive necrosis

Question 24

95% of pancreatic neoplasms are:

Answer 24

exocrine

derived from the ducts

solid (rather than cystic)

MALIGNANT

functionally silent (not hormonally active)

Question 25

pancreas cancer ranks #___ of cancer deaths?

Answer 25

4

53k new case in the U.S. each year

Question 26

what are the clinical signs of pancreatic cancer?

Answer 26

vague signs:

weight loss

painless jaundice (tumor in head)

pain (tumor in tail)

Trousseau sign - migatory thrombophlebitis

Question 27

how do you dx pancreatic cancer?

Answer 27

ERCP - endoscopic retrograde cholangiopancreatorgraphy

aspiration cytology

Question 28

What’s the prognosis for ductal pancreatic carcinoma?

Answer 28

piss poor

overall 5 year survival - 3-5%

(slightly higher if resectable: 20-30%)

untreated 3 months

treated 10-20 months

Question 29

what indicators have a worse prognosis for a pancreatic endocrine neoplasm?

Answer 29

• size >3cm
• capsular/vascular invasion
• mitotic count >2/10 HPF
• produces a hormone other than insulin
• lack of progesterone receptors
• high proliferative index

Question 30

what % of the U.S. population is diabetic and what percentage don’t know it?

Answer 30

10%

25% (1/4) don’t know

Question 31

diabetes is the ____ leading cause of death

Answer 31

6th

Question 32

what two hormones are synthesized in the pancreatic islets?

Answer 32

insulin and glucagon

Question 33

what is the pathogenesis of diabetes?

Answer 33

deficiency of insulin, causing hyperglycemia

associated with cell starvation, osmotic diuresis, increased appetite, weight loss

Question 34

what is type 1 diabetes?

Answer 34

deficiency of insulin due to autoimmune destruction of the islets

(honeymoon period where there is still some insulin and no insulin treatment is required - short in children)

Question 35

Type 2 diabetes pathogenesis

Answer 35

obesity increases insulin resistance - weight loss improves diabetic control

genetic factor (90% concordance in twins)

Question 36

what time value is the most diagnostic in glucose tolerance testing?

Answer 36

2 hours

Question 37

A1C increases 1% for every ____mg/dL increase of serum of glucose

Answer 37

30