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Digestive System > Pancreatic & Gall Bladder Pathology > Flashcards

Pancreatic & Gall Bladder Pathology Flashcards

1
Q

Is the pancreas usually palpable? What does this mean for symptoms?

A

No. It is ‘hidden’, sits deep, tucked behind duodenum. Therefore symptoms are late & nonspecific

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2
Q

How is the pancreas a dual function organ?

A

It has both exocrine (80-90%) and endocrine (10-20%) components.

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3
Q

Exocrine function of the pancreas…

A
  • Acinar cells and ducts
  • Acini contain Zymogen granules
  • release proenzymes that are activated by trypsin
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4
Q

Zymogens are? what are they for?

A

Inactive precursor enzymes (travel in zymogen granules) for trypsin, chymotrypsin, amylase, lipase, elastase

Prevent digestion of pancreas&raquo_space; inflammatory response

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5
Q

Endocrine function of pancreas?

A

Islets of langerhans secrete insulin, glucagon

Involved in diabetes mellitus

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6
Q

The main pathologies of the pancreas?

A

1) Acute & chronic pancreatitis (inflamm/infect)
2) Pancreatic Adenocarcinoma (malignant)
3) Cystic Fibrosis (genetic)

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7
Q

What is acute pancreatitis, how is it classified?

A

Inflammation of the pancreas

Mild: 60-70% (low mortility rates)
Severe: 30-40% (20-30% mortility) due to multiorgan failure

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8
Q

Etiology of Pancreatitis

A

Mainly (80-90% due to these)
Alcohol (metabolic)
Gallstones (mechanical)

also
shock/vasculitis

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9
Q

What happens in pancreatitis?

A
  • autodigestion by pancreatic enzymes (damaged cells release enzymes > further damage)
  • This lead to a 2’ inflammatory response (cytokines)
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10
Q

What are the consequences of inappropriate pancreatic enzyme release?

A

Protease: proteolysis of acini, ducts, islets
Lipase: fat necrosis in pancreas + other sites
Elastase: BV destruction&raquo_space; haemorrhage

Cell injury response&raquo_space; inflammation, oedema, impaird blood flow, ischaemia

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11
Q

Key triggers of ACUTE pancreatitis

A

1) Obstruction : gall stones, ductal concentrations, ampullary obstruction, alcholism.
obstruction > High intrapancreatic ductal pressure > accumulation of enzyme rich fluid > fat necrosis > oedema/ inflammation > impaired BF > ischemia > acinar cell injury

2) Direct injury to acinar cells: enzyme release

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12
Q

Clinical symptoms/features of ACUTE pancreatitis?

A
  • acute abdo pain (epigastric)
  • nausea & vomiting
  • Fever, tachycardia (inflammatory response)
  • marked abdo tenderness (ileus or shock)
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13
Q

How can we diagnose ACUTE pancreatitis?

A
  • Elevated WBC count (non-specific)
  • Elevated serum amylase or lipase (non-specific)
  • CT scan - oedema, necrosis, pseudocysts
  • Rarely laparotomy
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14
Q

Management and treatment of pancreatitis…

A

“REST THE PANCREAS” (decrease stimulation/secretions)

  • IV fluids (no food = no secretions)
  • NG suction (remove gastric/ duodenal )
  • Anaglasia
  • Monitoring
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15
Q

Define CHRONIC pancreatitis

A

“repeated bouts of pancreatic inflammation with loss of pancreatic parenchyma and replacement by fibrous tissue)

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16
Q

If you were looking at chronic pancreatitis in a microscopic slide, what would you see?

A

Macrophagal tissue, necrosis, scarring

17
Q

Etiology/causes of CHRONIC pancreatitis

A

-60-70% due to heavy alcohol intake (damage to pancreatic tissue)
also
-previous acute pancreatitis
-severe malnutrtion

18
Q

Pathology of CHRONIC pancreatitis

A
  • Fibrotic (can be rock hard)
  • Atrophy of exocrine, but endocrine relatively spared (low risk of diabetes)
  • Often calcified (seen in CT scan)
19
Q

Clinical symptoms/ features of CHRONIC pancreatitis

A
  • repeated attacks of abdominal pain, brought on by ALCOHOL
  • persistent pain can also occur

if its ongoing you can see

  • loss of exocrine function (rarely endocrine > diabetes)
  • pseudocysts (scarring > cavities formed)
20
Q

Diagnose CHRONIC pancreatitis by

A 
serum amylase (not as prominant as acute)
CT imaging
21
Q

Pancreatic Carcinoma is

A 
4th most common form of cancer death
M>F
most 50+ years, (peak 60-80)
-poor prognosis (due to late presentation)
-
22
Q

Risk factors of adenocarcenoma

A
  • smoking
  • rare hereditary cases
  • alcohol & coffee
  • High BMI
23
Q

% of adenocarcinoma

A

60-70% head
5-10% body
10-15% tail
20% diffuse

24
Q

carcinoma of the head of pancreas

A
  • invade ampulla, bilary obstruction (jaundice, pale stool, dark urine)
  • Body and tail: remain silent, spreads to nodes, adjacent organs, liver, bones, lungs
25
Q

Clinical features/symptoms of pancreatic andenocarcinoma

A 
obstructive jaundice
pain
weight loss
pancreatitis
Thrombosis (SF veins) & venous thrombosis (deep veins)

DIAGNOSIS USUALLY MADE ON IMAGING

26
Q

What increases the risk of Venous thrombosis?

A

cancer

27
Q

Can pancreatic endocrine tumors occur?

If so what are their symptoms

A

Occasionally. These are rare.

  • elaborate pancreatic hormones
    eg) insulinoma: hypoglycaemia, most are benign (10%) malignant, treated with resection

Digestive System (27 decks)

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