Pancreatic Pathology

Question 1

Structure of pancreas

Answer 1

Question 2

What is the functional unit of the exocrine pancreas?

Answer 2

acinar cell

Question 3

What % of the pancreas does the exocrine part make up?

Answer 3

85%

Question 4

Function of acinar cells?

Answer 4

Synthesise, store and secrete digestive enzymes

Question 5

Which digestive enzymes do acinar cells secrete?

Answer 5

• trypsin
• lipase
• phospholipase
• elastase
• amylase

Question 6

Which digestive enzyme can be used as a marker of pancreatic inflammation?

Answer 6

amylase

Question 7

Digestive enzymes are secreted as enzymatically inert. What do they require for activation?

Answer 7

Requires conversion of trypsinogen to trypsin in the duodenum

Question 8

What is present in the acinar and ductal cells to prevent activation of digestive enzymes?

Answer 8

Trypsin inhibitors (e.g. SPINK-1)

Question 9

What is the functional unit of the endocrine pancreas?

Answer 9

islet of Langerhans

Question 10

What do the islets of langerhans secrete?

Answer 10

Secrete peptide hormones into blood (e.g. insulin and glucagon)

Question 11

What is pancreatitis?

Answer 11

Inflammation of the pancreas

Question 12

Is pancreatitis associated with injury to the endocrine or exocrine portion?

Answer 12

Exocrine

Question 13

What are the 2 major causes of acute pancreatitis?

Answer 13

1) Gallstones (50%)
2) Alcohol (25%)

Question 14

Rarer causes of acute pancreatitis;

Answer 14

• Vascular insufficiency
• Viral infections – mumps, coxsackie B
• Hypercalcaemia
• ERCP
• Inherited causes

Question 15

How does acute pancreatitis typically present?

Answer 15

• Sudden onset of severe abdominal pain radiating to back
• Nausea and vomiting

Question 16

Prognosis of acute pancreatitis?

Answer 16

May be mild (recovery within 5-7 days) but can be serious with high mortality

Question 17

Which digestive enzymes will be raised in acute pancreatitis

Answer 17

amylase/lipase (>3x normal)

Question 18

How can serum calcium levels be used as a prognostic sign of pancreatitis?

Answer 18

Persistent hypocalcaemia is a poor prognostic sign

Question 19

How do gallstones lead to pancreatitis?

Answer 19

• Gallstones getting trapped at the end of the biliary system (ampulla of Vater), blocking the flow of bile and pancreatic juice into the duodenum.
• The reflux of bile into the pancreatic duct, and the prevention of pancreatic juice containing enzymes from being secreted, results in inflammation in the pancreas.