Pancreatic Diseases

Question 1

What is the role of the pancreas

Answer 1

Serves vital exocrine digestive functions and acts as the site of production of the endocrine hormones, insulin and glucagon, controlling glucose homeostasis

Question 2

How is self-digestion prevented

Answer 2

By a carefully balanced suppressor system: disruption of that system by a variety of causes can result in pancreatic inflammation called pancreatitis

Question 3

What can pancreatitis cause

Answer 3

scarring and destruction of pancreatic tissue with resultant loss of exocrine / endocrine function

Question 4

What do pancreatic lobules consist of

Answer 4

connective tissue surrounding alveoli or pouches that are filled with secretory cells

Question 5

What are the names of the islands of connective tissue between the alveoli

Answer 5

The islets of Langerhan

Question 6

What types of cells are contained within the Islets of Langerhan

Answer 6

A and B cells

Question 7

What are the role of the A and B cells in the islets of Langerhan

Answer 7

they produce the endocrine secretios of the pancreas involved in flucose homeostasis

Question 8

What are the 3 parts of the pancreas

Answer 8

Head, body and tail

Question 9

Where does the pancreatic duct commence

Answer 9

In the tail of the pancreas where the small duct from the pancreatic lobules join

Question 10

What does the dorsal part of the pancreas form

Answer 10

Part of the head, the body and tail

Question 11

What does the ventral part of the pancreas form

Answer 11

The rest of the head and uncinate process

Question 12

Where does the pancreas lie initially in embryology

Answer 12

Intraperitoneally between the two layers of the dorsal mesogastrium

Question 13

Where does the pancreas lie initially in embryology

Answer 13

Intraperitoneally between the two layers of the dorsal mesogastrium

Question 14

What is released in response to a meal

Answer 14

Release of of cholecystokinin

Question 15

Name 4 digestive enzymes produced in the pancreas

Answer 15

Amylase (carbs)
Lipase (fats)
Proteases (proteins)
Nucleases (DNA and RNA)

Question 16

how does amylase work

Answer 16

It hydrolyses polysaccharides in starch and glycogen to maltose and other small oligosaccharides which can then be celaved to glucose by brush border enzymes in the small intestinal mucosa

Question 17

Where else in the body is amylase produced

Answer 17

Salivary glands

Question 18

What is the function of Co-lipase

Answer 18

T prevent bile salts from inhibiting the liplysis of triglycerides

Question 19

Where is trypsin secreted from and as what

Answer 19

The acinar cells as trypsinogen

Question 20

What is activated trypsin important in

Answer 20

As the common activator of other pancreatic enzymes such as more trypsinogen, chymotrypsinogen, proelastase, procarbosypeptidases and prophospholipase

Question 21

How does trypsin act

Answer 21

To hydrolyse peptide bonds within the polypeptide chain of proteins

Question 22

Pancreatic enzymes require a neutral pH to function. How is this environment promoted?

Answer 22

By the secretion of Sodium bicarbonate by pancreatic duct cells to neutralise the gastric acid which enters the duodenum

Question 23

What is the main association with in chronic pancreatitis

Answer 23

Alcohol abuse

Question 24

What are the 3 main features of chornic pancreatitis

Answer 24

Pain - epigastric (radiates to back)
Maldigestion - due to glandular destruction - daily exocrine and endocrine requirements cannot be met
Diabetes - pancreatic endocrine insufficiency results in flucose introlerance as insulin production drop below requirements

Question 25

Why is the diagnosis of chronic pancreatitis often difficult

Answer 25

amylase and lipase levels are frequently normal

Question 26

How is endocrine dysfunction tested for

Answer 26

Fasting glucose and glucose tolerance testing if indicated

Question 27

How is exocrine function tested

Answer 27

using faecal elastase

reduced levels indicating reduced exocrine function

Question 28

What provides the best means of assessing the degree of calcification of the pancreas

Answer 28

CT scan

Question 29

What is the management for chronic pancreatitis

Answer 29

Largely symptomatic and aimed at managing pain and exocrine and endocrine insufficiency as well as nutritional support
Avoidance of alcohol and smoking

Question 30

Aggressive glucose management should be reserved for who

Answer 30

Patients with good compliance and cessation of alcohol

Question 31

What are the majority of pancreatic cancer

Answer 31

Adenocarcinomas

Question 32

Pancreatic carcinoma is twice as common in men compared to women. True or false

Answer 32

True

Question 33

At what age do pancreatic carcinomas appear

Answer 33

55

Question 34

What are some of the clinical features of pancreatic carcinoma

Answer 34

Severe abdominal pain (radiating to back)
weight loss
obstructive jaundice
potentially splenomegaly
diabetes (due to glandular destruction by the tumour)

Question 35

What is found in the investigations for Pancreatic carcinoma

Answer 35

Elevated ALP

elevated bilirubin

Question 36

What are the 2 preferred imaging tests

Answer 36

CT or MRCP

Question 37

What is the overall survival rate for pancreatic cancer

Question 38

What is the only chance of curing pancreatic cancer

Answer 38

Total resection of the tumour

Question 39

What is cystadenocarcinoma

Answer 39

A rare adenomatous tumour that results from malignant degeneration of a mucous cystadenoma

Question 40

Is the tumour in cystadnocarcinoma fast or slow growing

Answer 40

Slow

Question 41

Who is most likely to get an intraductal papillary mucinous tumour

Answer 41

Females

Question 42

What does the tumour do in intraductal papillary mucinous

Answer 42

It over-secretes mucin, causing pain and recurrent bouts of pancreatitis

Question 43

What is the typical appearance seen on ERCP

Answer 43

Fish eye