INSTRUCTORS ONLY

GI Path Lab 5

Areas of Concentration

• Gallbladder diseases

• Pancreatic diseases (non-endocrine)

Upon completion of this exercise, you should be able to:

1. Identify the gross and histologic features of chronic inflammation of gallbladder and pancreas and carcinoma of the pancreas.

2. Correlate the histologic and clinical features of inflammations of the pancreas, including the pancreas in cystic fibrosis.

3. Know what gallstones look like, why they occur, and how much they cost the medical care system.

Slide 100 [WebScope] [ImageScope]

Chronic Cholecystitis

1. What are the histologic differences between this gallbladder and a normal one?

2. What caused this disease?

3. With what other gallbladder condition is this almost always associated?

4. Why is the muscle thick?

5. What are the clinical features of this condition as given in lecture?

6. Why was the gallbladder resected? Was it because the inflammation produced significant symptoms?

Slide 101 [WebScope] [ImageScope]

Cystic Fibrosis

Believe it or not, this is pancreas. Recognizable islets are evident, embedded within adipose tissue or loose scar. The exocrine parenchyma consists only of dilated ducts, the acini long since having disappeared. Many of the smaller ducts contain thick mucin in their lumens. Compare this slide with Slide 104. They both have much of the same features, but they differ in degree. This section clearly demonstrates why this disease is called “cystic fibrosis.”

1. How do you account for the atrophy and disappearance of the acini?

2. What would be the likely clinical manifestations of exocrine parenchymal loss?

3. What symptoms did this child have?

4. Why do you think he died?

5. What are the other morphologic manifestations of cystic fibrosis?

6. How is this disease usually first manifested?

7. What biochemical test may confirm the diagnosis?

Slide 67 [WebScope] [ImageScope]

Lung: Bronchiectasis (Review)

Lung disease is a significant cause of morbidity and mortality in cystic fibrosis. In fact, these days, bronchiectasis is most often secondary to cystic fibrosis.

Slide 104 [WebScope] [ImageScope]

Chronic Pancreatitis

1. What are the features of chronicity and of inflammation?

   Note the dilated ducts.

2. Do the duct and acinar changes have anything to do with each other?

3. If you were to produce this histologic picture, how would you manipulate the pancreas?

Slide 7 [WebScope] [ImageScope]

Pancreas: Acute Pancreatitis with Enzymatic Fat Necrosis (Review)

1. Does this process have any relation to the chronic pancreatitis in Slide 104?

2. Where is most of the damage occurring? The acini? The ducts? The islets? The peripancreatic adipose tissue?

3. What were this patient’s complaints?

Slide 103 [WebScope] [ImageScope]

Carcinoma of the Pancreas

This slide comes from the duodenal wall and the adjacent head of the pancreas. The adenocarcinoma has several different patterns of growth. In some places, well-developed tubules are formed. In other places, there are only cords of undifferentiated cells, and, in still other areas, single neoplastic cells are found within the stroma. Note also the intense fibrosis around the tumor cells, tubules and nests. This fibrosis is referred to as “desmoplasia.” In some sections, residual islands of pancreatic parenchyma are present with a few ducts, islets, and scattered residual normal acini. The carcinoma also invades the muscularis propria of the duodenum and extends into the adjacent adipose tissue.

1. What symptoms might such a carcinoma in this specific site produce?

2. What is the best way to determine if a patient with the above symptoms has pancreatic carcinoma? Are any laboratory tests specific for this neoplasm?

3. What is the screening program currently in vogue to detect early pancreatic cancer?

4. What is the usual outcome for a patient with pancreatic carcinoma?

The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'