Pancreatic Diseases Flashcards
What is the role of the pancreas
Serves vital exocrine digestive functions and acts as the site of production of the endocrine hormones, insulin and glucagon, controlling glucose homeostasis
How is self-digestion prevented
By a carefully balanced suppressor system: disruption of that system by a variety of causes can result in pancreatic inflammation called pancreatitis
What can pancreatitis cause
scarring and destruction of pancreatic tissue with resultant loss of exocrine / endocrine function
What do pancreatic lobules consist of
connective tissue surrounding alveoli or pouches that are filled with secretory cells
What are the names of the islands of connective tissue between the alveoli
The islets of Langerhan
What types of cells are contained within the Islets of Langerhan
A and B cells
What are the role of the A and B cells in the islets of Langerhan
they produce the endocrine secretios of the pancreas involved in flucose homeostasis
What are the 3 parts of the pancreas
Head, body and tail
Where does the pancreatic duct commence
In the tail of the pancreas where the small duct from the pancreatic lobules join
What does the dorsal part of the pancreas form
Part of the head, the body and tail
What does the ventral part of the pancreas form
The rest of the head and uncinate process
Where does the pancreas lie initially in embryology
Intraperitoneally between the two layers of the dorsal mesogastrium
Where does the pancreas lie initially in embryology
Intraperitoneally between the two layers of the dorsal mesogastrium
What is released in response to a meal
Release of of cholecystokinin
Name 4 digestive enzymes produced in the pancreas
Amylase (carbs)
Lipase (fats)
Proteases (proteins)
Nucleases (DNA and RNA)
how does amylase work
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
Where else in the body is amylase produced
Salivary glands
What is the function of Co-lipase
T prevent bile salts from inhibiting the liplysis of triglycerides
Where is trypsin secreted from and as what
The acinar cells as trypsinogen
What is activated trypsin important in
As the common activator of other pancreatic enzymes such as more trypsinogen, chymotrypsinogen, proelastase, procarbosypeptidases and prophospholipase
How does trypsin act
To hydrolyse peptide bonds within the polypeptide chain of proteins
Pancreatic enzymes require a neutral pH to function. How is this environment promoted?
By the secretion of Sodium bicarbonate by pancreatic duct cells to neutralise the gastric acid which enters the duodenum
What is the main association with in chronic pancreatitis
Alcohol abuse
What are the 3 main features of chornic pancreatitis
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
Why is the diagnosis of chronic pancreatitis often difficult
amylase and lipase levels are frequently normal
How is endocrine dysfunction tested for
Fasting glucose and glucose tolerance testing if indicated
How is exocrine function tested
using faecal elastase
reduced levels indicating reduced exocrine function
What provides the best means of assessing the degree of calcification of the pancreas
CT scan
What is the management for chronic pancreatitis
Largely symptomatic and aimed at managing pain and exocrine and endocrine insufficiency as well as nutritional support
Avoidance of alcohol and smoking
Aggressive glucose management should be reserved for who
Patients with good compliance and cessation of alcohol
What are the majority of pancreatic cancer
Adenocarcinomas
Pancreatic carcinoma is twice as common in men compared to women. True or false
True
At what age do pancreatic carcinomas appear
55
What are some of the clinical features of pancreatic carcinoma
Severe abdominal pain (radiating to back)
weight loss
obstructive jaundice
potentially splenomegaly
diabetes (due to glandular destruction by the tumour)
What is found in the investigations for Pancreatic carcinoma
Elevated ALP
elevated bilirubin
What are the 2 preferred imaging tests
CT or MRCP
What is the overall survival rate for pancreatic cancer
What is the only chance of curing pancreatic cancer
Total resection of the tumour
What is cystadenocarcinoma
A rare adenomatous tumour that results from malignant degeneration of a mucous cystadenoma
Is the tumour in cystadnocarcinoma fast or slow growing
Slow
Who is most likely to get an intraductal papillary mucinous tumour
Females
What does the tumour do in intraductal papillary mucinous
It over-secretes mucin, causing pain and recurrent bouts of pancreatitis
What is the typical appearance seen on ERCP
Fish eye
