Diseases of the pancreas Flashcards
What are the causes of acute pancreatitis?
Gallstones
Alcohol - toxic to pancreas
Idiopathic
Rare causes: vascular insufficiency, virus, hypercalcaemia, endoscopic retrograde cholangiopancreatography
How does acute pancreatitis occur?
Leakage and activation of pancreatic enzymes
Breaks pancreas down = necrosis
What are the complications of acute pancreatitis?
Pseudocyst - cyst not lined by epithelium, causes by rupture of duct
Abscesses
DIC
Shock
How does acute pancreatitis present?
Severe abdo pain - radiates to the back Nausea/vomiting Hypocalcaemia Hyperglycaemua Raised serum amylase/lipase
How does the pancreas look in acute pancreatitis?
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
How does chronic pancreatitis come about?
Progressive inflammation
Parenchyme of pancreas is destroyed - irreversible, first exocrine then endocrine tissue
Replaced by fibrous tissue
What are the complications of chronic pancreatitis?
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
What can cause chronic pancreatitis?
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
What are the symptoms of chronic pancreatitis?
Intermittent abdominal pain
Back pain
Weight loss
How does the pancreas look in chronic pancreatitis?
Fibrosis - can mimic carcinoma Atrophy Dilated/distorted ducts Calculi Fatty replacement Pseudocysts
What is the most common type of pancreatic carcinoma?
Ductal adenocarcinoma
How does pancreatic ductal adenocarcinoma present?
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
What is the prognosis for pancreatic ductal adenocarcinoma?
Almost universally fatal
Maximum 20 months survival with surgery
What are the risk factors for developing pancreatic ductal adenocarcinoma?
Smoking Alcohol Red meat Obestity Chronic pancreatitis Diabetes
What part of the pancreas does carcinomas occur?
head of the pancreas
What is Trousseau’s syndrome?
Episodes of vessel inflammation due to blood clot (migratory thrombophlebitis)
What is Courvoisier’s sign?
Palpable gallbladder without pain
What are the factors that effect the poor prognosis of pancreatic adenocarcinomas?
Extension of tumour outside the pancreas
Metastatic spread to local lymph nodes
Vascular/perineural invasion
Grade of differentiation
What is the difference between pancreatic adenocarcinoma and pancreatic neuroendocrine tumours?
Pancreatic adenocarcinoma = EXOcrine
Pancreatic neuroendocrine tumour/islet cell tumours = ENDOcrine
Are pancreatic neuroendocrine tumours malignant or benign?
Can be either
Wide spectrum of behaviour
How are pancreatic neuroendocrine tumours categorised?
Well differentiated
Poorly differentiated
If a neuroendocrine tumour secretes insulinoma then is it malignant or benign?
benign
What hormones can be secreted from malignant pancreatic neuroendocrine tumours?
Glucagonoma Gastrinoma Somatostatinoma VIPoma PP-cell PEN
Due to hormone secretion, what can be the complications of neuroendocrine tumours?
Diabetes Rash Stomatitis - inflammation of the mucous membrane of the mouth Peptic ulcers Diarrhoea Gall stones Hypochlorhydria - low levels of hydrochloric acid Hypokalaemia
How do pancreatic neuroendocrine tumours appear macroscopically?
Well circumscribed
Sometimes encapsulated
Solid
