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CP > Diseases of the pancreas > Flashcards

Diseases of the pancreas Flashcards

1
Q

What are the causes of acute pancreatitis?

A

Gallstones
Alcohol - toxic to pancreas
Idiopathic
Rare causes: vascular insufficiency, virus, hypercalcaemia, endoscopic retrograde cholangiopancreatography

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2
Q

How does acute pancreatitis occur?

A

Leakage and activation of pancreatic enzymes

Breaks pancreas down = necrosis

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3
Q

What are the complications of acute pancreatitis?

A

Pseudocyst - cyst not lined by epithelium, causes by rupture of duct
Abscesses
DIC
Shock

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4
Q

How does acute pancreatitis present?

A 
Severe abdo pain - radiates to the back
Nausea/vomiting
Hypocalcaemia
Hyperglycaemua
Raised serum amylase/lipase
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5
Q

How does the pancreas look in acute pancreatitis?

A

Mild - swollen, fat necrosis (chalky)
Severe - swollen, necrosis (inc fat)
Grey Turner’s sign - haemorrhage into subcutaneous tissue of flank
Cullen’s sign - haemorrhage around the umbilicus

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6
Q

How does chronic pancreatitis come about?

A

Progressive inflammation
Parenchyme of pancreas is destroyed - irreversible, first exocrine then endocrine tissue
Replaced by fibrous tissue

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7
Q

What are the complications of chronic pancreatitis?

A 
Malnutrition - lack of absorption of fat soluble vitamins
Steatorrhoae
Diarrhoea
Weight loss
Cachexia - weakness/wasting of muscle
Diabetes
Pseudocysts
Stenosis of common bile duct/duodenem
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8
Q

What can cause chronic pancreatitis?

A 
Recurrent episodes of acute pancreatitis
Toxins - alcohol (can lead to calculi), smoking, drugs
Hypercalcaemia
Hyperparathyroidism
Genetics e.g. CFTR
Obstruction of the main duct e.g. cancer, scarring
Autoimmune
Idiopathic
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9
Q

What are the symptoms of chronic pancreatitis?

A

Intermittent abdominal pain
Back pain
Weight loss

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10
Q

How does the pancreas look in chronic pancreatitis?

A 
Fibrosis - can mimic carcinoma
Atrophy
Dilated/distorted ducts
Calculi
Fatty replacement
Pseudocysts
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11
Q

What is the most common type of pancreatic carcinoma?

A

Ductal adenocarcinoma

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12
Q

How does pancreatic ductal adenocarcinoma present?

A 
Late presenting
Epigastric pain - radiates to the back
Weight loss
Painless jaundice - earlier symptom
Pruritis - sevear itching
Nausea
Trousseau's syndrome - episodes of vessel inflammation due to blood clot (migratory thrombophlebitis)
Courvoisier's sign - palpable gallbladder without pain
Diabetes
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13
Q

What is the prognosis for pancreatic ductal adenocarcinoma?

A

Almost universally fatal

Maximum 20 months survival with surgery

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14
Q

What are the risk factors for developing pancreatic ductal adenocarcinoma?

A 
Smoking
Alcohol
Red meat
Obestity
Chronic pancreatitis
Diabetes
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15
Q

What part of the pancreas does carcinomas occur?

A

head of the pancreas

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16
Q

What is Trousseau’s syndrome?

A

Episodes of vessel inflammation due to blood clot (migratory thrombophlebitis)

17
Q

What is Courvoisier’s sign?

A

Palpable gallbladder without pain

18
Q

What are the factors that effect the poor prognosis of pancreatic adenocarcinomas?

A

Extension of tumour outside the pancreas
Metastatic spread to local lymph nodes
Vascular/perineural invasion
Grade of differentiation

19
Q

What is the difference between pancreatic adenocarcinoma and pancreatic neuroendocrine tumours?

A

Pancreatic adenocarcinoma = EXOcrine

Pancreatic neuroendocrine tumour/islet cell tumours = ENDOcrine

20
Q

Are pancreatic neuroendocrine tumours malignant or benign?

A

Can be either

Wide spectrum of behaviour

21
Q

How are pancreatic neuroendocrine tumours categorised?

A

Well differentiated

Poorly differentiated

22
Q

If a neuroendocrine tumour secretes insulinoma then is it malignant or benign?

A

benign

23
Q

What hormones can be secreted from malignant pancreatic neuroendocrine tumours?

A 
Glucagonoma
Gastrinoma
Somatostatinoma
VIPoma
PP-cell PEN
24
Q

Due to hormone secretion, what can be the complications of neuroendocrine tumours?

A 
Diabetes
Rash
Stomatitis - inflammation of the mucous membrane of the mouth
Peptic ulcers
Diarrhoea
Gall stones
Hypochlorhydria - low levels of hydrochloric acid
Hypokalaemia
25
Q

How do pancreatic neuroendocrine tumours appear macroscopically?

A

Well circumscribed
Sometimes encapsulated
Solid

CP (50 decks)

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