7. Pancreatic pathology

Question 1

pancreatic carcinomas are usually of what type and located where

Answer 1

• mostly adenocarcinomas

- 70% in head of pancreas

Question 2

what is the prognosis for pancreatic cancer

Answer 2

poor prognosis (20% 1yr survival, 3% 5yr survival) - present late and metastasise early

Question 3

what are the symptoms of pancreatic carcinoma

Answer 3

1- epigastric/back pain
2- anorexia and sig. weight loss
3- malaise and fatigue
4- jaundice
5- signs/symptoms of biliary tree obstruction due to head of pancreas compressing bile duct: dark urine, pale stools and pruritis

Question 4

what is pancreatitis

Answer 4

Proteases produced by pancreatic acinar cells (esp. trypsinogen) are prematurely activated in pancreatic ducts (instead of duodenum)… autodigest pancreas and retroperitoneum… inflammatiom and in severe cases, necrosis.

10% mortality

Question 5

name the 2 main causes of pancreatitis

Answer 5

1. GALLSTONES (biliary acute pancreatitis): pancreatic duct outflow obstruction and hypertension, with toxic effects of bile salts contributing to activation of pancreatic proteases
2. ALCOHOL: alters balance between proteolytic enzymes and protease inhibitors… enzyme activation

Question 6

list all the causes of acute pancreatitis

Answer 6

I GET SMASHED:

• idiopathic
• gallstones
• ethanol
• trauma
• steroids
• mumps
• autoimmune
• scorpion venom
• hypertriglyceridaemia and hypercalcaemia
• ERCP (endoscopic retrograde cholangiopancreatography)
• drugs (e.g. sodium valproate, metformin)

Question 7

what are the symptoms of acute pancreatitis

Answer 7

• severe epigastric pain that radiates to back

- nausea and vomiting

Question 8

which investigations indicate acute pancreatitis

Answer 8

• increase serum amylase or lipase

- CT scan (in moderate/severe cases): pancreatic necrosis or pseudocyst