Function of the Pancreas Flashcards
Exocrine functions of the pancreas
85%
Glands-ducts-duodenum
Secrete digestive enzymes
Endocrine functions of the pancreas
Islets of langerhans
Secrete peptide hormones into the blood (insulin and glucagon)
2 types of pancreatitis
Acute and chronic
Clincial features of acute pancreatitis
Emergency
Sudden onset of severe abdo pain radiating to the back
nausea and vomiting
Prognosis of acute pancreatitis
May be mild (recovery within 5-7 days) or serious with high mortality
Lab tests for acute pancreatitis
Raised serum amylase/lipase Hypocalcaemia (fatty acids bind calcium ions) Hyperglycaemia Abscess formation Pseudocysts
Causes of acute pancreatitis
Gallstones (50%)
Alcohol (25%)
Rare causes (vascular insufficiency, viral infections-mumps, coxsackie B,hypercalcaemia, ERCP)
Idiopathic
Mild pancreatitis
Swollen gland with fat necrosis
Severe pancreatitis
Swollen, necrotic gland with fat necrosis and haemorrhage
Sign indicating haemorrhage into the subcutaneous tissues of the flank in acute pancreatitis
Grey Turner’s sign
Sign to show periumbilicus in acute pancreatitis
Cullen’s sign
Complications of acute pancreatitis
Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts
Collections of pancreatic juice secondary to duct rupture
Pseudocysts
Chronic pancreatitis
Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.
Chronic pancreatitis is irreversible destruction of which tissue first
Exocrine first
Complications of chronic pancreatitis
Malnutrition and diabetes
Risk factors for chronic pancreatitis
Toxic- alcohol, smoking Genetic Obstruction of the main duct-cancer scarring Recurrent acute pancreatitis Autoimmune Idiopathic
Main genetic mutations associated with chronic pancreatitis
CFTR, PRSS1, SPINK1 mutations
Clinical presentation of chronic pancreatitis
Intermittent abdo pain, back pain and weight loss
Histlogy of chronic pancreatitis
Can mimic carcinoma macroscopically and microscopically
Complications of chronic pancreatitis
Malabsorption of fat
Diabetes
Pseudocysts
Stenosis of common bile duct/duodenum
Prognosis of chronic pancreatitis
Nearly 50% with 20-25 years of disease onset
Pathology of chronic pancreatitis
Localised, irregular involvement of the gland early on, later global atrophy Dilated and distorted ducts Calculi est in alcohol induced Fatty replacement Pseudocyst formation
Most common type of pancreatic cancer (up to 90%)
Pancreatic adenocarcinoma (ductal adenocarcinoma)
Prognosis of pancreatic cancer
5 year survival 4%
Risk factor for pancreatic adenocarcinoma
60-80yrs, rare before 40 years
Men
Smoking
Heavy alcohol intake, diet, obesity, hereditary, chronic pancreatitis
Which part of the pancreas is most commonly affected by pancreatic adenocarcinoma?
60-70% head of pancreas
Clinical symptoms of pancreatic adenocarcinoma
Non specific symptoms
Epigastric pain, radiating to back
Weight loss, painless jaundice, pruritis and nausea
Trausseau’s syndrome (migratory thrombophlebility)
Courvoisier’s sign (palpable gallbladder without pain)
Distat metastases
Diabetes
Inflammation of the veins because of the blood clots
Thrombophlebitis
HNPCC is a hereditary cancer syndrome with a mutation in what gene
DNA mismatch repair
Familial breast cancer is a hereditary cancer syndrome with a mutation in what gene
BRCA2
Ataxia telangiectasis is a hereditary cancer syndrome with a mutation in what gene
ATM
Von Hippel Lindau is a hereditary cancer syndrome with a mutation in what gene
VHL
Familial pancreatitis is a hereditary cancer syndrome with a mutation in what gene
Cationic trypsinogen, SPINK1
Peutz Jeghers is a hereditary cancer syndrome with a mutation in what gene
LKB1/STK11
second most common pancreatic cancer
Pancreatic neuroendocrine tumour
What genetic mutations predispose you to pancreatic neuroendocrine tumours?
MEN1
Von Hippel Lindau
Pancreatic cancer with a specturm of malignancy from benign to malignant
Pancreatic neuroendocrine tumour
2 types of neuroendocrine tumours
Well differentiated
Poorly differentiated
Rare Females 40-75 years Advanced disease at presentation Prognosis without treatment 1-2 months, with chemotherapy up to 50 months
Poorly differentiated neuroendocrine carcinomas
Uncommon 1-2% all pancreatic neoplasms Any age, rare in children 7-13% multiple (MEN-1) 15-35% non-functioning Single tumours often produce multiple hormones but usually single hyperfunctional syndrome
Well-differentiated neuroendocrine tumour
Benign pancreati cancer
Insulinoma
Clinical findings of gastrinoma
Peptic ulcer
Diarrhoea
