Pancreas and GB Flashcards
what is the pancreas made up of
Two different glands mixed together
- EXOCRINE: bulk — ACINI
- ENDOCRINE — ISLETS OF LAGERHANS
What do the exocrine glands secrete
protease
lipase
amylase
what do endocrine glands secrete
insulin
glucagon
somatostatin
what is acute pancreatitis
acute inflammation of the pancreas
caused by aberrhant release of pancreatic enzymes
how can causes of acute pancreatitis be split
- Duct obstruction (gallstones, trauma, tumours)
- Metabolic / toxic (alcohol, drugs, hypercalcaemia, hyperlipidaemia)
- poor blood supply (shock, hypothermia)
- infection/inflamm
etc.
important becuse different causes have different mechanisms of injury
what is the method of injury of duct obstruction to the pancreas
obstruction causes reflux of bile up the pancreatic duct > damage to acini
how does alcohol cause pancreatitis
spasma/oedema of sphincter of oddi > formation of protein rich pancreatic fluid > obstructs the pancreatic duct
what is the pattern of damage in obstructive pan reatitis
PERIDUCTAL - necrosis of acinar cells near the ducts
what is the pattern of damage in ischaemia
Perilobular - necrosis at the edges of the lobukles, because they are the furthest away from blood supply
explain the process of SAPONIFICATION in pancreatitis
lipases are released from the inflamed pancreas
they cause fat necrosis
calcium binds to the free fatty acids
it forms soaps (YELLOW WHITE FOCI)
what are complications of acute pancreatitis
pancreatic: pseudocyst formation, abscess
Systemic: shock, HYPOcalcaemia, HYPOglycaemia
what is a pseudocyst
a collection of fluid without an epithelial lining
what is chronic pancreatitis
chronic inflammation with parencghymal fibrosis and loss of parenchyma
what are the causes of chronic pancreatitis
Metabolic: Alcohol (80%), haemochromatosis
Duct obstruction: gallstones, abnormal anatomy, CF
Other: tumour, AI
describe the injury in chronic pancreatitis
parenchymal fibrosis, loss of parenchyma
islets look bigger as acini disappear
duct strictures with calcified stones and secondary dilations
what is the cause of AI pancreatitis
IgG4 plasma cells
what is histology of AI pancreatitis
duct surrounded by lots of IgG4 expressing plasmna cells
What are the two types of pancreatic adenocarcinomas
Ductal (MOST COMMON)
acinar
How are pancreatic neuroendocrine tumours identifiable
contain neuroendocrine markeres
- chromogranin
- neurosecretory granules
what mutation is present pancreatic carcinoma
K-ras
What is the appearance of a ductal carcinoma
gritty, grey
what type of tumour is a pancreatic cancer
ADENOcardinoma
what ae pancreatic neuroendocrine tumours associated with
MEN1
what are the three types of gallsone
MIXED (most common)
cholesterol
pigment
what are cholesterol gallstones like on x ray
radiolucent = NOT visible on X tay
what are pigment gallstones like on x ray
radfio opque = VISIBLE
what is acute cholecystitis associated with
gallstones
explain histology of chronic cholecysttis
chronic inflamm
fibrosis of gallbladder > THICK waalls
what can chronic cholecystitis form
may form GALLBLADDER DIVERTICULA
as the gallbladder tried to cntract against the obstruction
what does endocrine mean
secretes the hormones without ducts, directly into bloodstream
What does exocrine mean
secretes hormones through ducts
What cells are in the islets of lagerhans and what do they secrete
alpha: glucagon
beta: insulin
delt: somatostatin
what are symptoms of pancreatic carcinoma
WL, anorexia, painless jaundice pruritus and staethorroea Trusseau's syndrome (recurrent superficial trhombophelbitis) Ascitis Abdominal mass Vichrows node Courvousiers sign
What surgery can you use for pancreatic carcinoma
Whipple proedure
