60b Pancreatic pathology

Question 1

Which enzymes does the exocrine pancreas secrete? (5)

Answer 1

Trypsin
Lipase
Phospholipase
Elastase
Amylase

Question 2

How does acute pancreatitis present? (3)

Answer 2

Severe abdo pain radiating to lower back.
N + V.
Raised serum amylase/lipase.

Question 3

What is the aetiology of acute pancreatitis? (6)

Answer 3

Gallstones (50%)
Alcohol (25%)
Rare: Vascular insufficiency
Viral: mumps, coxsackie B
Hypercalcaemia
ERCP (iatrogenic)

Question 4

Pathology in mild acute pancreatitis? (2)
Severe? (2)
Signs of severe acute pancreatitis? (2)

Answer 4

Swollen gland, fat necrosis.
Necrosis + haemorrhage.
Cullen’s sign: haemorrhage into periumbilicus.
Grey Turner’s sign: haemorrhage into subcutaneous flank.

Question 5

How does pancreatitis change calcium and glucose levels in the blood?

Answer 5

Hypocalcaemia.

Hyperglycaemia.

Question 6

What are the complications of acute pancreatitis? (4)

Answer 6

Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts (pancreatic juice collection)

Question 7

Why are pseudocysts not true cysts?

Answer 7

No epithelial lining.

Question 8

What is chronic pancreatitis?

What does it lead to?

Answer 8

Progressive inflammation with parenchyma destruction and fibrosis.
Destroys exocrine first, then endocrine.
Malnutrition + diabetes.

Question 9

What are the causes of chronic pancreatitis?

Answer 9

TIGARO
Toxic: alcohol, cigarettes, high Ca, HPT
Idiopathic
Genetic: CFTR, PRSS1, SPINK 1 
Autoimmune
Recurrent acute pancreatitis
Obstruction of main duct

Question 10

What are the complications of chronic pancreatitis? (4)

Answer 10

Fat malabsorption: steatorrhea, low vit ADEK, diarrhoea, weight loss, cachexia.
Diabetes (late feature)
Pseudocysts
Stenosis of common bile duct/duodenum

Question 11

What is the most common pancreatic cancer?

Answer 11

Pancreatic adenocarcinoma.

Question 12

What are the risk factors for pancreatic adenocarcinoma? (7)

Answer 12

M>F
Cigarette smoking
Alcohol intake
Red meat
Obesity
Hereditary (10%)
Chronic pancreatitis

Question 13

How does pancreatic adenocarcinoma present? (5)

Answer 13

After a decade of growth.
Non specific: epigastric pain radiating to back.
Weight loss, painless jaundice, puritis, nausea.
Trousseau’s syndrome (migratory thrombophlebitis)
Courvoisier’s sign (palpable gallbladder without pain).

Question 14

What is the prognosis for pancreatic adenocarcinoma?

Answer 14

4% 5 year survival.
Mean survival is 3-5 months.
Extends to 10-20 with surgery (only 10% eligible).

Question 15

Which hereditary cancer syndrome is p16/cdkn2A involved in?

Answer 15

FAMMM.

Question 16

Who gets pancreatic neuroendocrine tumours?

Increased risk? (2)

Answer 16

20-60 years
M=F
MEN 1, von Hippel Lindau

Question 17

How common are poorly differentiated neuroendocrine carcinomas of the pancreas?

Answer 17

Rare - 2-3% of pancreatic neuroendocrine tumours.

Question 18

Who gets poorly differentiated neuroendocrine carcinomas of the pancreas?
Presentation?

Answer 18

Males > Females
40-75 years
Advanced disease.

Question 19

What is the only neuroendocrine tumour of the pancreas that is considered to be benign?

Answer 19

Insulinoma.

Question 20

Which cell does a glucagonoma occur in?

Clinical findings? (4)

Answer 20

α cell

Stomatitis, rash, diabetes, weight loss.

Question 21

Which cell does a gastrinoma occur in?
Syndrome?
Clinical findings? (2)

Answer 21

G cell.
Zollinger-Ellison.
Peptic ulcer, diarrhoea.

Question 22

Which cell does a somatostatinoma occur in?

Clinical findings? (3)

Answer 22

δ cell (delta).

Diabetes, gallstones, hypochlorhydria.

Question 23

Which syndrome results from a VIPoma?

Clinical findings? (3)

Answer 23

Verner-Morrison.

Diarrhoea, hypokalaemia, achlorhydria.