CP60 - Pancreatic Pathology

Question 1

what are the fucntions of pancreas?

Answer 1

exocrine - Secrete digestive enzymes

endocrine - islets of langerhans - secrete insulin and glucagon

Question 2

what are the clinical presentation of acute pancreatitis

Answer 2

Sudden onset of severe abdo pain radiating to back

nausea and vomiting

raised serum amylase/lipase (>3x normal)

Question 3

what is diagnostic for acute pancreatitis?

Answer 3

Raised serum amylase/lipase (>3x normal)

Question 4

what can cause acute pancreatitis?

Answer 4

Gallstones (50% cases)
Alcohol (25% cases)
idiopathic

Question 5

what is the pathogenesis of acute pancreatitis?

Answer 5

due to Leakage and activation of pancreatic enzymes which has been accumulated in the pancreas due to blocked pancreatic duct

Amylase released into blood

Mild pancreatitis – swollen gland with fat necrosis

Severe – swollen, necrotic gland with fat necrosis and haemorrhage(Grey Turner’s sign – haemorrhage into the subcutaneous tissues of flank, Cullen’s sign – periumbilicus).

Question 6

what are some complications for acute pancreatitis?

Answer 6

shock, IV coagulopathy, haemorrhage, pseudocyst (collections of pancreatic juice secondary to duct rupture & not lined by epithelium)

Question 7

what is chronic pancreatitis?

Answer 7

Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.

Irreversible destruction of the exocrine tissue, followed by destruction of the endocrine tissue

leads to malnutrition and diabetes

Question 8

what are some of the causes of chronic pancreatitis

Answer 8

TIAGOR

Toxic - alcohol, cigarette smoke, drugs, hypercalcaemia, hyperparathyroidism

idiopathic

autoimmune

Genetic

obstruction of main ducts - cancer/scaring

recurrent acute pancreatitis

Question 9

what can chronic pancreatitis have a resemblance of ?

Answer 9

Fibrosis of exocrine tissue – can mimic carcinoma macroscopically and microscopically

Question 10

what complications are present for chronic pancreatitis?

Answer 10

malabsorption of fat - lack of lipase from pancreatic juice - steatorrhoea (fatty stool), impairment of fat soluble Vit absorption - A,D,E,K , diarrhoea, weight loss and cachexia

diabetes (late features)
Pseudocysts
stenosis of common bile duct/duodenum

Question 11

what is another name for ductal adenocarcinoma?

Answer 11

pancreatic adenocarcinoma

Question 12

what is the most common type of pancreatic cancer?

Answer 12

ductal adenocarcinoma

Question 13

what is a major risk for pancreatic adenocarcinoma?

Answer 13

cigarette smoking

Question 14

where is the common place within the pancreas to have tumour present

Answer 14

head - 60-70%, body 5-15%, tail 10-15%, diffuse 5-15%

Question 15

what are some of the symptoms for pancreatic adenocarcinoma?

Answer 15

epigastric pain, radiating to the back, weight loss, painless jaundice, pruritis(severe itching of the skin), nausea

Trousseau’s syndrome (migratory thrombophlebitis)

Courvoisier’s sign (palpable gallbladder without pain)

distint metastasis - liver, peritoneum, lung

diabetes - increase risk and can be a presenting complication

Question 16

does pancreatic adenocarcinoma have a good prognoses ?

Answer 16

very poor, mortality rate almost equal to incidence rate

Question 17

what are some of the hereditary cancer syndrome which have a high risk for pancreatic cancer?

Answer 17

HNPCC, familial breast cancer, familial pancreatitis

Question 18

what is pancreatic neuroendocrine tumours

Answer 18

tumours arise from the endocrine cells of pancreas ie the islets of langerhans

production of specific hormones may cause distinct clinical syndrome

well-differentiated PET can progress to malignant but slow growing in nature

Question 19

what are the risk factors for pancreatic neuroendocrine tumours

Answer 19

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