60 - Pancreatic Pathology Flashcards
Exocrine function of pancreas
85% of pancreatic tissue
secrete digestive enzymes: trypsin, lipase, phospholipase, elastase, amylase, which are markers for pancreatic inflammation and require activation
Endocrine function of pancreas
Islets of Langerhans
Secrete peptide hormones into blood (e.g. insulin and glucagon)
Acute pancreatitis - clinical presentation
Usually emergency
Sudden onset of severe abdo pain radiating to back
Nausea and vomiting
May be mild (recover within 5-7days) but has a high mortality as well
Acute pancreatitis - investigations
Raised serum amylase/lipase (3x normal)
Acute pancreatitis - aetiology
Gallstones (50%)
Alcohol (25%)
Rare causes: vascular insufficiency, viral infections (mumps, Coxsackie B), hypercalcaemia, ERCP
Idiopathic (10%)
Acute pancreatitis - pathogenesis
Leakage and activation of pancreatic enzymes
Amylase into blood
Acute pancreatitis - mild
Swollen gland with fat necrosis
Acute pancreatitis - severe
Swollen, necrotic gland with fat necrosis and haemorrhage
Showing Grey Turner’s sign and Cullen’s sign
Hypocalcaemia (fatty acids bind calcium ions), hyperglycaemia, abscess formation, pseudocysts
Acute pancreatitis - Grey Turner’s sign
Haemorrhage into sub cut tissues of flank
Acute pancreatitis - Cullen’s sign
Haemorrhage into sub cut tissues of periumbilicus
Acute pancreatitis - complications
Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts (collections of pancreatic juice secondary to duct rupture)
Chronic pancreatitis -
Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.
Irreversible dmg to exocrine then to endocrine
Chronic pancreatitis - clinical presentation
malnutrition and diabetes
Chronic pancreatitis - causes
Toxic - -OH, smoking, drugs, hypercalcaemia, HPTism, infections
Genetic CFTR, PRSS1, SPINK1 mutation
Obstruction of main duct - cancer, scarring
Recurrent acute
Autoimmune
Idiopathic
Chronic pancreatitis - main causes
95% are alcohol or idiopathic
Chronic pancreatitis - complications
Malabsorption of fat (lack of lipases) - steatorrhoea, impairment of fat soluble vit absorption (A,D,E,K), diarrhoea, weight loss and cachexia
Diabetes (last feature)
Pseudocysts
Stenosis of common bile duct / duodenum
Chronic pancreatitis - mortality
nearly 50% within 20-25 yrs of onset
Pancreatic adenocarcinoma -
Most common type - 90% of pancreatic neoplasms
4% 5 yr survival rate
Pancreatic adenocarcinoma - who?
60-80 yrs (rare before 40) 1.3M:1F Smoking (2-3x risk), drops with abstinence Heavy alcohol Red meats Obesity Hereditary (10%) Chronic pancreatitis
Pancreatic adenocarcinoma - clinical presentation
Present for at least a decade before detected Non-specific symptoms Epigastric pain, radiating to back Weight loss, painless jaundice, pruritis and nausea Trousseau's syndrome Courvoisier's sign Distant mets (liver, peritoneum, lung) Diabetes
Pancreatic adenocarcinoma - Trousseau’s sign
Migratory thrombophlebitis
Pancreatic adenocarcinoma - Courvoisier’s sign
Palpable gall bladder w/o pain
Pancreatic adenocarcinoma - poor prognosis factors
Extension of tumour outside pancreas
Met spread to local lymph nodes
Vascular and perineural invasion
Grade of differentiation
Pancreatic neuroendocrine tumours -
Uncommon
Pancreatic neuroendocrine tumours - clinical presentation
Autopsy studies- higher incidence (up to 10%)
20-60 yrs
M=F
Increased risk MEN 1, von Hippel Lindau
