Pancreatic path Flashcards
what are the functions of the pancreas
exocrine - convert trypsinogen to trypsin in the duodenum, acing cells - pyramidal shaped epithelia around lumen
secretes trypsin, lipase, elastase, amylase
endocrine - islets of langerhans insulin (b) and glucagon (a)
what is an exocrine test for pancreatic inflammation
inert enzyme which require inflammation
describe pancreatitis
inflammation with injury to exocrine parenchyma - acute = gland reverts to normal
chronic = irreversible damage
describe hereditary pancreatitis
PRSS1 inherited mutation - AD cationic trypsinogen - resistant to cleavage
SPINK1 mutation AR - reduced trypsin inhibitor = auto digestion of the pancreas
describe acute pancreatitis, pathogenesis and complications
common - mainly due to gallstones and alcohol (may be viral)
severe abdominal pain, nausea/vomiting
raised serum amylase/lipase
fat necrosis and haemorrhage
hypocalcaemia and hypoxia = shock and DIC
which disease would you see grey tuners signs and cullens sign and what are they
grey turner = haemorrhage into the subcutaneous tissue of flank
cullens sign - periumbillicus
acute pancreatitis
describe the main features of chronic pancreatitis
progressive inflammation normal cells replaced by fibrous tissue
irreversible destruction of exocrine tissue followed by endocrine tissue = malnutrition and diabetes
what is the aetiology of chronic pancreatitis
TIGARO Toxic - alcohol, smoking, drugs, ^Ca Idiopathic Genetic: CF, PRSS1 SPINK1 Autoimmune Recurrent acute pancreatitis Obstruction of main duct
what are the complications of chronic pancreatitis
malabsorption diabetes severe chronic pain stenosis of bile duct or duodenum impairment of ADEK vitamins weight loss and diarrhoea
what is the most common type of pancreatic cancer
pancreatic adenocarcinoma
what do these disease have mutation in and what are they all associated with HNPCC FAMMM Familial breast cancer Ataxia-telangiectics Von-Hippe,-Lindau Familial pancreatitis Peutz jeghers
DNA mismatch repair p16/cdkn2a BRCA2 ATM VHL catatonic trypsinogen, SPINK1 LKB1/STK11
all associated with pancreatic cancer
describe the progression model of adenocarcinoma in the pancreas
MCN - body of pancreas
IPNN - intraductal
PanIN - most common precursor which starts in duct
KRAS mutations occur early = p16 inactivation - lack suppressor gene
what is pancreatic intraepithelial neoplasia and what does it lead to
PanIN head of pancreas invasive and poorly defined lots of fibroblasts and lymphocytes leads to pancreatic carcinoma
which disease would you see trousseaus syndrome, courvoisior signs Sister Mary joesph
pancreatic carcinoma
TS - migratory thrombophlebitis
CS - palpable gallbladder without pain
what are non-specific symptoms of pancreatic carcinoma
epigastric pain, radiating to back, weight loss and painless jaundice
