Pancreatic Pathology

Question 1

What is the function of the pancreas?

Answer 1

Exocrine:
-acini secret digestive enzymes which go via ducts into duodenum.

Endocrine:
-Islets of Langerhans secrete peptide hormones into blood (e.g.insulin and glucagon)

Question 2

What are the symptoms of acute pancreatitis?

Answer 2

sudden onset abdo pain, radiating to back.

nausea, vomiting

Question 3

What are the clinical features of pancreatitis?

Answer 3

raised serum amylase and lipase

Question 4

What are the causes of acute pancreatitis?

Answer 4

• gallstones
• alcohol (metabolites of alcohol are toxic to pancreas)
• Rare causes = viral (mumps, cosackie B), hypercalcaemia

Question 5

What is the pathogenesis of acute pancreatitis?

Answer 5

Pancreatic enzymes leak into the blood and are activated.

This causes autodigestion of the pancreas&raquo_space;>necrosis

Question 6

swollen, necrotic gland with fat necrosis and haemorrhage is characteristic of …..

Answer 6

Acute Sever pancreatitis

Question 7

What are the complications of acute pancreatitis?

Answer 7

1) shock
2) Haemorrhage
3) Pseudocysts

Question 8

What is chronic pancreatitis?

Answer 8

progressive inflammatory disorder in which the parenchyma of the pancreas is destroyed and replaced by fibrous tissue.
-destruction of exocrine tissue occurs first then endocrine tissue.

Question 9

In chronic pancreatitis why is diabetes caused later than malnutrition?

Answer 9

Destruction of exocrine tissues occurs first - so no digestive enzyms are secreted into duodenum (malnutrition(

Then destruction of endocrine tissues occurs later so no secretion of insulin / glucagon&raquo_space;»diabetes

Question 10

what are the causes of chronic pancreatitis?

Answer 10

TIGARO

Toxic -alcohol, cigarette smoke
Idiopathic (sponataneous disease)
Autoimmune
Recurrent acute pancreatitis
Obstruction of main duct (cancer, scarring)
Genetics (CFTR cystic fibrosis)

Question 11

What are the complications of chronic pancreatitis?

Answer 11

Malabsorption of fat due to lack of lipase secretion leads to :

• steatorrhoea
• impaired absorption of fat soluble vitamins (A, D, E and K)
• Diabetes
• Pseudocysts
• Stenosis of common bile duct / duodenum

Question 12

What is the most common pancreatic tumour?

Answer 12

Pancreatic Adeno-carcinoma (ductal adenocarcinoma)

• it arises from the exocrine acini
• very aggressive
• rare
• affects more men than women

Question 13

What is a risk factor of pancreatic adenocarcinoma?

Answer 13

cigarette smoking

alcohol

Question 14

What is the most common site of pancreatic adenocarcinoma (ductal adenocarcinoma)?

Answer 14

Head of pancreas.

It is near many structures such as bile duct, duodenum and ampula

Question 15

What are the symptoms of pancreatic adenocarcinoma?

Answer 15

1) Troussaeus syndrome (migratory thrombophlebitis - blood clots causing inflammation of vessel)
2) Courvisier’s sign (enlarged gallbladder that is not painful on palpatation)
3) Weightloss
4) jaundice
5) prutitis (skin itching)
6) nausea
7) diabetes

Question 16

what are the key features of pancreatic neuroendocrine tumours?

Answer 16

(uncommon)
can be benign to very malignant
MEN1 and Von Hippel Lindau are risk factors

Question 17

What is an insulinoma?

Answer 17

insulinoma is a tumor of the pancreas that is derived from beta cells and secretes insulin. It is a rare form of a neuroendocrine tumor. Most insulinomas are benign in that they grow exclusively at their origin within the pancreas, but a minority metastasize.

Question 18

What is gastrinoma?

Answer 18

gastrinoma is a tumor in the pancreas or duodenum that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine. There is hypersecretion of the HCl acid into the duodenum, which causes the ulcers.

Question 19

What is Glucagonoma?

Answer 19

Glucagonoma is a rare tumor involving the pancreas. Glucagon is a hormone produced by the pancreas that works with insulin to control the amount of sugar in your blood. Glucagonoma tumor cells produce large amounts of glucagon&raquo_space;»»hyperglycaemia

Question 20

What is somatostatinoma?

Answer 20

Somatostatinoma is a malignant tumor of the delta cells of the endocrine pancreas that produces somatostatin. Increased levels of SOMATOSTATIN INHIBITS PANCREATIC HORMONES and gastrointestinal hormones. Thus somatostatinomas are associated with mild diabetes mellitus (due to inhibition of insulin release), steatorrhoea and gallstones (due to inhibition of cholecystokinin release), and achlorhydria (due to inhibition of gastrin release). Somatostatinomas are commonly found in head of pancreas.

Question 21

What is VIPoma?

Answer 21

Rare tumour originating from non-β islet cell of the pancreas, that produce vasoactive intestinal peptide (VIP).

The massive amounts of VIP in turn cause profound and chronic watery diarrhea and resultant dehydration,

Question 22

What are the symptoms of insulinoma?

Answer 22

Hypoglycaemia