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Histopath gastro > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

Enzymes which stimulate the pancreatic

A

Secretin and CCK

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2
Q

Produced by s-cells of the duodenum, controls gastric acid secretion and buffering with HCO3-

A

Secretin

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3
Q

Stimulates digestion of fat and protein. Made by I-cells in the duodenum. Causes release of digestive enzymes

A

CCK

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4
Q

Islets of langerhans - alpha cells

A

Secrete glucagon which increases blood glucose

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5
Q

Islets of Langerhans - beta cells

A

Secrete insulin which decreases blood glucose

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6
Q

Islets of Langerhans - delta cells

A

Secrete somatostatin which suppresses insulin and glucagon release

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7
Q

Islets of Langerhans - PP cells

A

PP cells contain a unique pancreatic polypeptide, VIP, that exerts several gastrointestinal effects, such as stimulation of secretion of gastric and intestinal enzymes and inhibi- tion of intestinal motility.

Pancreatic polypeptide is also secreted and regulates pancreatic secretion activities alongside effects on hepatic glycogen metabolism and GI secretions.

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8
Q

Metabolic syndrome

A

Pro-inflammatory state ?triggered by cytokine release from adipocytes.

Associated with:
Central obesity
Fasting hyperglycaemia (>6mmol/l)
BP > 140/90
Microalbuminaemia 
Dyslipidaemia (decreased HDL cholesterol <1mmol/L and increased triglycerides >2mmol/L)]
Hyper-coaguable state
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9
Q

Diagnosis of diabetes mellitus

A

Fasting plasma glucose >7mmol/L

Random plasma glucose >11.1mmol/L

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10
Q

T1DM pathophysiology

A

AI destruction of beta cells in the islets of Langerhans by CD4+ and CD8+ T lymphocytes.

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11
Q

T2DM pathophysiology

A

A combination of peripheral resistance to insulin action and an inadequate compensatory response of insulin secretion by the pancreatic beta cells (relative insulin deficiency).

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12
Q

Signs of diabetes

A

Polyuria (osmotic diuresis), polydipsia (raised plasma osmolality), hyperglycaemia predisposing to recurrent infections

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13
Q

Macrovascular complications of diabetes

A

Cardiac - MI
Renal - glomerulonephritis, pyelonephritis
Cerebral - CVA (cerebrovascular accident)

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14
Q

Microvascular complications of diabetes

A

Ocular - diabetic retinopahty

Peripheral vascular system - claudication, change in colour/temp, poor healing ulcer

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15
Q

Causes of acute pancreatitis

A 
I GET SMASHED 
Idiopathic 
Gallstones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion venom 
Hyperlipidaemia, hypercalcaemia, hypothermia 
ERCP 
Drugs (e.g. thiazides, steroids, sodium valproate)
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16
Q

Sudden severe epigastric pain radiating to back, relieved but sitting forward + vomiting

A

Acute pancreatitis

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17
Q

Periumbilical discolouration

A

Cullen’s sign in pancreatitis

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18
Q

Flank discolouration

A

Grey-turner’s sign in pancreatitis

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19
Q

Diagnosis of acute pancreatitis

A

Elevated serum lipase (more sensitive and specific than amylase, which is only raised for 1st 24 hours)

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20
Q

Histology in acute pancreatitis

A 
Overall: coagulative necrosis
Microvascular leakage - oedema 
Lipases - necrosis of fat 
Acute inflammatory reaction 
Proteolytic destruction of parenchyma 
Interstitial haemorrhage
21
Q

Causes of chronic pancreatitis

A

Alcoholism (80%), CF, hereditary, pancreatic duct obstruction (stones/tumour), autoimmune (IgG4 sclerosing)

22
Q

Chronic pancreatitis

A

Long-standing inflammation, fibrosis, and destruction of the exocrine pancreas. in its late stages, the endocrine parenchyma also is lost.

Irreversible impairment in function in chronic pancreatitis

23
Q

Presentation of chronic pancreatitis

A

Epigastric pain radiating to the back (typically worse 15-30min post meal)
Steatorrhoea: pancreatic insufficiency (5 - 25 years after the onset of pain)
Weight loss due to malabsorption
DM develops in the majority of patients. Usually >20 years after symptom onset
Jaundice

24
Q

Histology of chronic pancreatitis

A

Fibrosis and loss of exocrine tissue (acinar loss ubiquitous), duct dilation with thick secretions, calcification
Relative sparing of endocrine islets

25
Q

Investigations in chronic pancreatitis

A

CT may show calcifications in pancreas

Faecal elastase may assess exocrine function if imaging inconclusive

26
Q

Management of chronic pancreatitis

A

Pancreatic enzyme supplements and analgesia

27
Q

Pseudocysts, diabetes, pancreatic cancer

A

Complications of chronic pancreatitis

28
Q

Acinar cell carcinoma presentation

A

Non specific Sx; abdo pain, weight loss, nausea and diarrhoea.
10% get multifocal fat necrosis and polyarthragia due to lipase secretion

29
Q

Neoplastic epithelial cells with esoinophilic granular cytoplasm. Positive imunoreactivity for lipase, trypsin and chymotrypsin.

A

Histology of acinar cell carcinoma

30
Q

Schmid triad

A

Seen in acinar cell carcinoma

sc fat necrosis + eosinophilia + polyarthritis

31
Q

Prognosis for acinar cell carcinoma

A

Median survival 18m

<10% 5 year survival

32
Q 
A 19 year old American student with bronchiectasis is on inhaled tobramycin for chronic Pseudomonal infection. The mutation delta F508 is identified.
A. Carcinoma head of the pancreas
B. Pseudocysts
C. Gallstones
D. Renal tubular acidosis
E. Iatrogenic pancreatitis
F. Hypercalcaemia
G. Cystic fibrosis
H. Haemochromatosis
I. Insulinoma
J. Gallstone pancreatitis
K. VIPoma (Werner Morrison syndrome)
L. Chronic alcoholic pancreatitis
M. Vibrio cholerae infection
N. Carcinoma tail of the pancreas
A

Cystic fibrosis

33
Q 
A 68 year old smoker presents with jaundice and worsening abdominal and back pain. Scratch marks are seen on his arms and legs. He has lost 5kg in 2 months. Ultrasound shows dilated intrahepatic bile ducts.
A. Carcinoma head of the pancreas
B. Pseudocysts
C. Gallstones
D. Renal tubular acidosis
E. Iatrogenic pancreatitis
F. Hypercalcaemia
G. Cystic fibrosis
H. Haemochromatosis
I. Insulinoma
J. Gallstone pancreatitis
K. VIPoma (Werner Morrison syndrome)
L. Chronic alcoholic pancreatitis
M. Vibrio cholerae infection
N. Carcinoma tail of the pancreas
A

Carcinoma of head of pancreas

34
Q 
A 39 year old Nepalese man presents with severe watery diarrhoea. He is found to have hypokalaemia and, surprisingly, a metabolic acidosis. A RUQ mass is detected by contrast-enhanced spiral CT scanning. Stool bicarb is high and urine anion gap is negative.
A. Carcinoma head of the pancreas
B. Pseudocysts
C. Gallstones
D. Renal tubular acidosis
E. Iatrogenic pancreatitis
F. Hypercalcaemia
G. Cystic fibrosis
H. Haemochromatosis
I. Insulinoma
J. Gallstone pancreatitis
K. VIPoma (Werner Morrison syndrome)
L. Chronic alcoholic pancreatitis
M. Vibrio cholerae infection
N. Carcinoma tail of the pancreas
A

VIPoma (Werner Morrison syndrome)

35
Q 
A 59 year old widow complains of persistent back pain, loss of appetite and that she has dropped from dress size 18 to a size 14 in just 2 months. She was recently diagnosed with diabetes. A large central mass is palpable as well hepatosplenomegaly
A. Carcinoma head of the pancreas
B. Pseudocysts
C. Gallstones
D. Renal tubular acidosis
E. Iatrogenic pancreatitis
F. Hypercalcaemia
G. Cystic fibrosis
H. Haemochromatosis
I. Insulinoma
J. Gallstone pancreatitis
K. VIPoma (Werner Morrison syndrome)
L. Chronic alcoholic pancreatitis
M. Vibrio cholerae infection
N. Carcinoma tail of the pancreas
A

Carcinoma of tail of pancreas

36
Q 
A 47 year old lecturer is referred to hospital clinic from his GP with worsening abdominal pain. He has a poor diet and weight loss. He has previously been prescribed Thiamine.
A. Carcinoma head of the pancreas
B. Pseudocysts
C. Gallstones
D. Renal tubular acidosis
E. Iatrogenic pancreatitis
F. Hypercalcaemia
G. Cystic fibrosis
H. Haemochromatosis
I. Insulinoma
J. Gallstone pancreatitis
K. VIPoma (Werner Morrison syndrome)
L. Chronic alcoholic pancreatitis
M. Vibrio cholerae infection
N. Carcinoma tail of the pancreas
A

Chronic alcoholic pancreatitis

37
Q 
65 year old female with a large, cystic mass on tail of pancreas imaged using computed tomography. Further cytology reported the presence of epithelium
A. Hyperlipidaemia
B. Jaundice
C. Cystadenoma
D. Type 1 Diabetes
E. Pancreas Divisum
F. Agenesis
G. Cystic Fibrosis
H. Thrombophlebitis
I. Scorpion Sting
J. Pseudocyst
K. Alcoholism
L. Whipples' resection
M. Gall Bladder
N. Carcinoma of the Pancreas
O. Trousseau’s Syndrome
P. Pancreatitis
A

Cystadenoma

38
Q 
55 year old, diabetic, afro-Caribbean male presents with weight loss, poor diet and a gnawing pain in his back, which is sometimes felt ‘under his chest’
A. Hyperlipidaemia
B. Jaundice
C. Cystadenoma
D. Type 1 Diabetes
E. Pancreas Divisum
F. Agenesis
G. Cystic Fibrosis
H. Thrombophlebitis
I. Scorpion Sting
J. Pseudocyst
K. Alcoholism
L. Whipples' resection
M. Gall Bladder
N. Carcinoma of the Pancreas
O. Trousseau’s Syndrome
P. Pancreatitis
A

Carcinoma of the pancreas

39
Q 
The commonest cause of acute pancreatitis in the UK.
A. Hyperlipidaemia
B. Jaundice
C. Cystadenoma
D. Type 1 Diabetes
E. Pancreas Divisum
F. Agenesis
G. Cystic Fibrosis
H. Thrombophlebitis
I. Scorpion Sting
J. Pseudocyst
K. Alcoholism
L. Whipples' resection
M. Gall Bladder
N. Carcinoma of the Pancreas
O. Trousseau’s Syndrome
P. Pancreatitis
A

Alcoholism

40
Q 
Inflammatory condition of the exocrine pancreas that results in injury to acinar cells.
A. Hyperlipidaemia
B. Jaundice
C. Cystadenoma
D. Type 1 Diabetes
E. Pancreas Divisum
F. Agenesis
G. Cystic Fibrosis
H. Thrombophlebitis
I. Scorpion Sting
J. Pseudocyst
K. Alcoholism
L. Whipples' resection
M. Gall Bladder
N. Carcinoma of the Pancreas
O. Trousseau’s Syndrome
P. Pancreatitis
A

Pancreatitis

41
Q 
ERCP finding due to incomplete fusing of pancreatic buds.
A. Hyperlipidaemia
B. Jaundice
C. Cystadenoma
D. Type 1 Diabetes
E. Pancreas Divisum
F. Agenesis
G. Cystic Fibrosis
H. Thrombophlebitis
I. Scorpion Sting
J. Pseudocyst
K. Alcoholism
L. Whipples' resection
M. Gall Bladder
N. Carcinoma of the Pancreas
O. Trousseau’s Syndrome
P. Pancreatitis
A

Pancreas divisum

42
Q

Accounts for 85% of all pancreatic malignancies

A

Ductal adenocarcinoma of pancreas

43
Q

RFs for carcinoma of pancreas

A

Smoking, pancreatitis, diet, age, genetic (e.g.. FAP, HNPCC)

44
Q

Clinical features

A

Weight loss + anorexia = advanced disease
Upper abdo and back pain (chronic, persistent and severe)
Painless jaundice, pruritus, steatorrhoea (due to decreased exocrine function)
DM
Trousseau’s syndrome - superficial thrombophlebitis
Ascites
Abdominal mass
Virchow’s node
Courvoisier’s sign

45
Q

Trousseau’s syndrome

A

Superficial thrombophlebitis

46
Q

Investigations in suspected pancreatic cancer

A

High resolution CT modality of choice if diagnosis suspected
CT/MRI/ERCP
Bloods: increased bilirubin and calcium, decreased haemoglobin
Elevated CA19.9 (>70IU/ml) - not very sensitive or specific

47
Q

Management of pancreatic cancer

A 
Palliative chemotherapy (5-FU) 
Surgery (15% cases) - Whipple's procedure - surgical resection
ERCP + stenting = palliation
48
Q

Prognosis of ductal adenocarcinoma of the pancreas

A

<5% 5 year survival rate = very poor

Histopath gastro (2 decks)

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