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Pancreaticobiliary Lesions: DR Rofanda Bakeer

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C. Pancreatic pseudocyst is the most likely diagnosis given the history of chronic alcohol abuse and findings of a cystic pancreatic mass.

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Pancreaticobiliary Lesions: DR Rofanda Bakeer

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Kareem Dawood
54 views29 pages
C. Pancreatic pseudocyst is the most likely diagnosis given the history of chronic alcohol abuse and findings of a cystic pancreatic mass.

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C. Pancreatic pseudocyst is the most likely diagnosis given the history of chronic alcohol abuse and findings of a cystic pancreatic mass.

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54 views29 pages

Pancreaticobiliary Lesions: DR Rofanda Bakeer

Uploaded by

Kareem Dawood
C. Pancreatic pseudocyst is the most likely diagnosis given the history of chronic alcohol abuse and findings of a cystic pancreatic mass.

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Pancreaticobiliary Lesions

DR ROFANDA BAKEER
Objectives

 Recognize causes of acute and chronic cholecystitis.


 Define Cholelithiasis and types of stones.
 List common and uncommon causes of acute and
chronic pancreatitis.
 Outline biliary and pancreatic neoplasia.
Cholecystitis

 It’s the inflammation of the gall bladder.


 Its might be acute or chronic according to the onset
and duration of the disease
 The most common etiological factor for
cholecystitis is Gall stones.
 while the commonest risk factor for gallbladder
cancer is Polyps, that’s why removal of gall bladder
having polyps larger than 1 centimeter is
recommended because these are more likely to be
cancerous.
Cholecystitis

 Symptoms
Pain in the right hypochondrium
Spreading to the right shoulder
Nausea, vomiting
Fever in acute cases
 Signs
Tenderness of the right hypochondrium
Positive Murphy’s sign (pain with deep inspiration while
palpating the gall bladder )
Jaundice
Cholelithiasis (gallstones)

 Higher incidence in women


 Associated with obesity and multiple pregnancies.
 Stone types
a. Cholesterol stones (often solitary and large)
b. Pigment stones
Precipitation of unconjugated bilirubin.
Hemolytic anemia and bacterial infection.
c. Mixed stones(75% -80%).
Mixture of cholesterol and calcium salts.
Can often be visualized radiographically because of their
calcium content.
Grossly
Microscopically
 NB
 What is Rokitansky Aschoff Sinus?
 It is a depression due to hyperplasia of the epithelial
lining of the gallbladder getting to the deep
fibromuscular layer of its wall
Microscopically
Clinical picture

 Cholelithiasis is often silent and asymptomatic.


 Fatty food intolerance is characteristic.
Complications
 Biliary colic (impacted stone ).
 Obstructive jaundice (conjugated hyperbilirubinemia).
 Increased alkaline phosphatase and
Hypercholesterolemia
 Ascending cholangitis (2ry bacterial infection )
 Cholecystitis (acute or chronic) and Acute pancreatitis
 Gallstone ileus (intestinal obstruction ).
 Mucocele.
 Malignancy
Pancreatic Non-Neoplastic Lesions

 Pancreatic pseudocyst
A pseudocyst is a complication of chronic pancreatitis
seen most frequently in persons with a history of
chronic alcoholism. The pseudocyst is an area of
necrosis with a wall composed of granulation tissue.
Drainage of this pseudocyst is often needed as
treatment.
Morphology

 Grossly

 85% solitary, usually unilocular, in / near pancreas


 Thick, irregular wall, ragged inner surface, cloudy
intraluminal contents
 Microscopically
 No epithelial lining, cyst arises from drainage of
pancreatic secretions from damaged ducts into interstitial
tissue, which becomes walled off by fibrous tissue
 Cyst wall contains histiocytes, giant cells, granulation
tissue, rarely eosinophils
 Cyst may communicate with ductal system
 Fluid has high amylase content
Pancreatic cystic lesion. There was a 17-mm,
unilocular, well-encapsulated cystic lesion filled with
yellowish muddy material in the body of the
pancreas.
Neoplasia
Gall bladder Neoplasia

 Benign tumors of the gallbladder are rare.


 Adenocarcinoma: most common primary tumor,
often associated with gallstones.
 Adenocarcinoma of the extra hepatic biliary ducts
and the ampulla of Vater is less common.
 Progressive obstructive jaundice.
 Enlarged gallbladder. Tumors that obstruct the
common bile duct result in an enlarged, distended
gallbladder; obstructing stones do not (Courvoisier
law).
Grossly
Microscopically
Pancreatic Exocrine Tumors

 Adenocarcinoma of the pancreas is a common


tumor.
 More common in smokers.
 Obstructive jaundice.
Other types of tumors:
Serous cystic neoplasms
Mucinous cystic neoplasms
Solid pseudopapillary neoplasms
Pancreatoblastomas
Microscopically
arrow head =pancreatic adenocarcinoma
arrow=islets of Langerhans
CBL
Case 1

 A 36-year-old woman develops severe abdominal


pain over the past 24 hours. On physical
examination her abdominal musculature is rigid,
making palpation difficult because of severe
tenderness. Laboratory studies show her serum
lipase is 1165 U/L. Her total WBC count is 16,390/
microliter with 86% granulocytes. The gross
appearance of her disease process is shown here.
Which of the following is the most probable etiology
for this process?
A. Gallstones
B. Cytomegalovirus infection
C. Adenocarcinoma
D. Diabetes mellitus, type II
E. Cystic fibrosis
A. Gallstones
B. Cytomegalovirus infection
C. Adenocarcinoma
D. Diabetes mellitus, type II
E. Cystic fibrosis
Case 2

 A 50-year-old man gives a history of chronic alcohol abuse. He


has had bouts of abdominal pain in the past year. For the past
month, he has had more frequent and worsening abdominal pain.
Physical examination reveals right upper and left upper quadrant
pain with guarding. An abdominal plain film radiograph reveals
extensive peritoneal fluid collection along with dilated loops of
small bowel. An abdominal CT scan reveals a 7 to 8 cm cystic
mass in the tail of the pancreas. Which of the following is the
most likely diagnosis?
A. Pancreatic neuroendocrine tumor
B. Acute pancreatitis
C. Pancreatic pseudocyst
D. Metastatic carcinoma
E. Pancreatic adenocarcinoma
A. Pancreatic neuroendocrine tumor
B. Acute pancreatitis
C. Pancreatic pseudocyst
D. Metastatic carcinoma
E. Pancreatic adenocarcinoma

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