some study questions for the pathology lectures on the pancreas and gall bladder...
questions
acute pancreatitis...
1. what part of the pancreas is most commonly affected in acute pancreatitis?
2. describe the pancreatic destruction in more severe forms of acute pancreatitis.
3. what are the two most common causes of pancreatitis?
4. what are three general mechanisms for the pathogenesis of acute pancreatitis?
5. what are some morphological features of acute pancreatitis?
6. what is "chicken soup ascites"?
7. what are the lab tests used to diagnose acute pancreatitis?
8. what is a lab result that indicates a poor prognosis in acute pancreatitis?
9. what are the potential complications of acute pancreatitis?
chronic pancreatitis...
10. what is the etiology of chronic pancreatitis?
11. what is the morphology of chronic pancreatitis?
12. what is the basic clinical picture of chronic pancreatitis?
pseudocysts...
13. what are pseudocysts?
14. what are some potential complications of pseudocysts?
pancreatic carcinoma...
15. what is the prognosis of pancreatic carcinoma?
16. what are some risk factors for pancreatic carcinoma?
17. describe a typical patient with pancreatic carcinoma.
18. which pancreatic cells does carcinoma originate with?
19. what part of the pancreas is most affected by carcinoma?
20. what are complications of pancreatic carcinoma specific to body and tail lesions?
21. what is trousseau's syndrome?
22. what is courvosier's sign?
23. carcinoma is more likely to present with jaundice when involving what part of the pancreas?
gallstones...
24. what are some risk factors for gallstone formation?
25. what is the most common type of gallstone and how is it formed?
26. what are three etiological routes that can lead to gallstone formation?
27. what are the top three foods that cause biliary pain?
28. what is the morphology of cholesterol stones?
29. what is the morphology of bile pigment stones?
30. describe the clinical presentation of gallstones.
31. what are some complications of gallstones?
cholecystitis...
32. what is the etiology of acute calculous cholecystitis?
33. what is the clinical presentation of acute calculous cholecystitis?
34. what are some lab markers that are elevated in acute calculous cholecystitis?
35. what is the prognosis or course for acute calculous cholecystitis?
36. acute calculous cholecystitis plus diabetes can lead to what complication?
37. what is acute acalculous cholecystitis generally due to?
38. describe the typical patient who has acalculous cholecystitis.
39. what are complications for acute acalculous cholecystitis?
40. what are Rokitansky-Aschoff sinuses?
41. what is the "porcelain gallbladder" sign?
42. what is the HIDA scan?
43. what is an imaging test useful for discovering gallstones?
answers
1. exocrine pancreas; destruction of acinar cells.
2. fat necrosis and hemorrhage into parenchyma.
3. alcohol consumption
gallstones / sludge
4. duct obstruction, acinar cell injury, defective intracellular transport.
5. necrotic fat cells with debris and calcium
edema, inflammation
chicken soup ascites
pseudocyst
6. brown fluid filled with fat droplets.
7. serum/urinary amylase and lipase elevations.
8. hypocalcemia, which results from precipitation of calcium soaps in fat necrosis.
9. shock
renal failure
ARDS
duodenal obstruction
10. either severe alcoholism or repeated injury from pancreatitis.
11. loss of acinar cells
fibrous deposition
duct obstruction
calcifications
pseudocysts
[loss fiber obstruct calcium cyst] [chan park- lose the fiber, it's blocking your teeth with cysts]
12. chronic abdominal / back pain triggered by alcohol, overeating, drugs
steatorrhea
diabetes
mild jaundice
13. walled off pancreatic secretions from damaged ducts within the interstitial tissues.
14. pain, pancreatic abscess, peritonitis.
15. almost uniformly fatal- 3% 5 year survival rate.
16. smoking
alcohol
diabetes
chronic pancreatitis / cirrhosis
heavy meat / fat consumption
a-napthylamine / benzene exposure
partial gastrectomy
[SAD CHAP]
17. over 50 year old male, black, diabetic.
18. ductal cells.
19. 60% head of the pancreas.
20. impingement of vertebrae, retroperitoneal spaces.
21. migratory thrombophlebitis caused by elaboration of platelet aggregating factors.
22. acute, painless dilation of the gall bladder plus jaundice.
23. head of the pancreas.
24. female, fat, forty, fertile, fair, first nation (native americans)
25. cholesterol, via supersaturation of bile salts in cholesterol.
26. SAD: biliary stasis, decreased bile acid levels, high calorie diet.
27. tomatoes, pork, onions.
28. oval / round, pale yellow.
29. grey-white or black.
30. isolated episodes of severe RUQ pain, after rich meals or at night.
31. empyema
perforation
fistula
cholangitis
32. obstruction via a stone causes biliary stasis, which increases hydrolysis of lecithin to lysolecithin via mucosal phospholipases.
33. RUQ pain
low grade fever
anorexia
tachycardia, diaphoresis, nausea, vomiting
34. alk phos, ALP, GGT.
35. usually self limiting, resolves in 1-7 days.
36. gangrenous cholecystitis.
37. ischemia from surgery, trauma, severe infection, etc.
38. severely ill.
39. perforation and gangrene, as with calculous.
40. outpouchings of the mucosal epithelium through the wall. associated with chronic cholecystitis.
41. radiologic sign that indicates extensive calcifications. associated with chronic cholecystitis.
42. imaging with injection of hydroxy iminodiacetic acid to measure the ejection fraction of the gallbladder, useful in diagnosing gall bladder motility issues.
43. ERCP.
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