Pancreas and Gall Bladder Pathology Flashcards
What is the role of the pancreas? How is this role stimulated?
Produces 2 litres of enzyme rich fluid, stimulated by secretin and CCK
Secretin: produced by s-cells of the duodenum
CCK: produced by the l-cells of the duodenum
What are the functions of the pancreas?
Exocrine:
- Digestive enzymes (proteases, lipases, amylases)
- Secretion into ducts
Endocrine:
- Hormones (alpha cells: glucagon; beta cells: insulin; delta cells: somatostatin)
- Secretion into bloodstream
What is metabolic syndrome?
- Hyperglycaemia (fasting >6)
- Hyperlipidaemia
- Hypertension
- Central adiposity
Describe diabetes mellitus and the types. What are the complications
Fasting glucose >7 or random glucose >11.1
Polyuria, polydipsia and hyperglycaemia
Type 1:
- No insulin
- Autoimmune T-cell destruction of beta cells
Type 2:
- Insulin resistance
Complications:
- Macrovascular (CVD, renal disease, CVA)
- Microvascular (retinopathy, vascular disease)
Describe gall stones. What are the types? What are the complications?
They affect 20 of those in the west, and affect females more than males. They are associated with hereditary genes, native Americans and some drugs
Types:
- Cholesterol (single and radiolucent)
- Pigment (multiple and radio-opaque)
Complications:
- Bile duct obstruction
- Pancreatitis
- Acute/chronic cholecystitis
- Gall bladder cancer
Describe acute and chronic cholecystitis and their causes
Acute:
- 90 have gall stones
- Inflammation
Chronic:
- 90 have gall stones
- Diverticulations (Rokitansky-Aschoff sinuses)
Describe the causes of acute pancreatitis, the presentation, and the histological features.
I GET SMASHED
- Idiopathic
- Gall stones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion venom
- Hyperlipidaemia
- ERCP
- Drugs (e.g. thiazides)
Presentation:
- Acute epigastric pain, relieved on sitting forward, vomiting
Histology:
- Coagulative necrosis
- Periductal (obstructive causes)
- Perilobular (reduced perfusion causes)
- Panlobular (extensive disease)
Describe the causes of chronic pancreatitis, the presentation and the histological features.
Causes:
- Alcoholism
- Cystic fibrosis
- Chronic obstruction
- Autoimmune (IgG4 mediated)
Presentation:
- Epigastric pain radiating to back
- Malabsorption
- Secondary DM
Histology:
- Fibrosis and loss of exocrine tissue
- Calcification
Describe gall bladder cancer
90 will have gall stones
- Commonest cholangiocarcinoma
- Higher incidence in south americans
Describe acinar cell carcinoma
Rare and found in older adults
Presentation:
- Non-specific symptoms
- Abdominal pain, weight loss, nausea
Histopathology:
- Neoplastic epithelial cells with granular cytoplasm
Prognosis:
- Mean survival is 18 months
Describe ductal carcinoma of the pancreas. What are the risk factors and clinical features? What are the investigations and management options?
These make up 85 of pancreatic cancers, many of which are a result of acino-ductal metaplasia. They affect older people, and men more than females; they are normally at the head of the pancreas.
Risk factors:
- Smoking
- Diet and BMI
- Chronic pancreatitis
Clinical features:
- Weight loss and epigastric pain
- Painless jaundice, pruritus, steatorrhea
- Ascites, DM
Investigations:
- Bilirubin, haemoglobin, calcium
- CT/MRI and ERCP
- Ca 19-9 will be over 70IU/ml
Management:
- Chemotherapy is palliative
- 5 percent survival at 5 years
Describe the neuroendocrine tumours of the pancreas
Normally in the body or tail, and usually non-functioning. They have very unpredictable behaviour. The functional tumours will present according to the hormone being released; non-functional will present once they are large enough to have mass related symptoms.
Investigated with CT
Managed with surgery
Describe multiple endocrine neoplasia in the area of pancreatic cancers
Pancreatic cancers are found in those with MEN 1
MEN 1: pituitary, parathyroid and pancreatic
Men 2A: parathyroid, phaeochromocytoma, medullary thyroid
Men 2B: phaeochromocytoma, medullary thyroid, marfanoid
