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Histopathology > Pancreatic Pathology > Flashcards

Pancreatic Pathology Flashcards

1
Q

What is secretin?

A

A hormone produced by duodenal s-cells that controls gastric acid secretion and buffering with bicarbonate (HCO3 -) by stimulating bicarbonate-rich fluid release from the pancreas

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2
Q

What is CCK?

A

A hormone produced by duodenal I-cells that stimulates the digestion of fat and protein by causing the release of digestive enzymes from the pancreas

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3
Q

Describe the exocrine function of the pancreas

A

Secretion of digestive enzymes - proteases, lipases, and amylases - into ducts

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4
Q

Describe the endocrine function of the pancreas

A

Secretion of hormones into the bloodstream, including glucagon, insulin, somatostatin, D1, and pancreatic polypeptide (PP)

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5
Q

Describe the role of somatostatin

A

Regulating pancreatic alpha and beta cells

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6
Q

Describe the role of D1

A

Stimulating the secretion of water into the pancreatic system

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7
Q

Describe the role of pancreatic polypeptide (PP)

A

Self-regulation of pancreatic secretion activities

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8
Q

State the features of metabolic syndrome

A

Fasting hypoglycaemia >6mmol/l, resting blood pressure >140/90, central obesity (>80cm female, >94cm male), dyslipidaemia (HDL cholesterol <1mmol/l, triglycerides >2mmol/l), microalbuminaemia

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9
Q

State the diagnostic criteria of diabetes mellitus

A

Fasting plasma glucose >7mmol/l or random plasma glucose >11.1mmol/l

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10
Q

What is type 1 diabetes mellitus?

A

The autoimmune destruction of pancreatic beta cells by CD4 and CD8 T lymphocytes, causing an inability to produce insulin

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11
Q

How does diabetes mellitus present?

A

Polyuria, polydipsia, recurrent infections. T1DM may present with DKA. T2DM may present with HHS

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12
Q

State the macrovascular complications of diabetes

A

Myocardial infarction, glomerulonephritis, pyelonephritis, stroke

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13
Q

State the microvascular complications of diabetes

A

Diabetic retinopathy, peripheral neuropathy, peripheral vascular syndrome (claudication, cool, pale, poor healing ulcer)

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14
Q

State the causes of acute pancreatitis

A

I GET SMASHED: idiopathic, gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion venom, hyperlipidaemia, ERCP, drugs e.g. thiazides

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15
Q

How does acute pancreatitis present?

A

Severe epigastric or central abdominal pain radiating to the back, relieved by sitting forward, prominent vomiting

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16
Q

How is acute pancreatitis diagnosed?

A

Raised serum amylase or lipase

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17
Q

Describe the histology of acute pancreatitis

A

Coagulative necrosis

18
Q

State at least four causes of chronic pancreatitis

A

Alcoholism, cystic fibrosis, hereditary, pancreatic duct obstruction (e.g. gallstones, tumour), autoimmune (IgG4 sclerosing)

19
Q

How does chronic pancreatitis present?

A

Epigastric pain radiating to the back, weight loss, steatorrhoea, secondary diabetes mellitus

20
Q

Describe the histology of chronic pancreatitis

A

Fibrosis and loss of exocrine tissue, duct dilatation with thick secretions, calcification - very similar to pancreatic cancer

21
Q

State the three main complications of chronic pancreatitis

A

Pseudocysts, diabetes, pancreatic cancer

22
Q

How does acinar cell carcinoma present?

A

Non-specific symptoms: abdominal pain, weight loss, nausea, diarrhoea. 10% get multifocal fat necrosis and polyarthralgia from lipase secretion

23
Q

Describe the histology of acinar cell carcinoma

A

Neoplastic epithelial cells with eosinophilic granular cytoplasm. Positive immunoreactivity for lipase, trypsin, and chymotrypsin

24
Q

What is the median survival with acinar cell carcinoma?

A

18 months from diagnosis

25
Q

Describe the epidemiology of pancreatic carcinoma

A

85% of pancreatic malignancies, more common in males, average age of onset 60 years

26
Q

What is the most common site of pancreatic carcinoma?

A

Head of the pancreas

27
Q

State 3 risk factors for pancreatic carcinoma

A

Smoking, diet, FAP, Lynch syndrome

28
Q

Describe the clinical features of pancreatic carcinoma

A

Weight loss, anorexia, painless jaundice, pruritis, steatorrhoea, diabetes mellitus
Some get persistent, severe upper abdominal and back pain
25% get Trousseau’s syndrome - recurrent superficial thrombophlebitis
Ascites, abdominal mass, Virchow’s node, Courvoisier’s sign

29
Q

Name the tumour marker for pancreatic carcinoma

A

CA19-9 (>70IU/ml)

30
Q

Describe the management of pancreatic carcinoma

A

If possible, Whipple’s procedure (surgical resection of pancreatic head)
If not, palliative chemotherapy with 5-fluorouracil

31
Q

Describe the histology of islet cell tumours

A

Cells arranged in nests or trabeculae with granular cytoplasm. Range from benign to malignant

32
Q

Where do islet cell tumours usually occur?

A

Body or tail of pancreas

33
Q

Describe the presentation of functional islet cell tumours

A

Insulinomas: hypoglycaemic attacks
Gastrinomas: Zollinger-Ellison syndrome (recurrent ulceration)
VIPoma: diarrhoea
Glucagonoma: necrolytic migrating erythema

34
Q

Describe the features of multiple endocrine neoplasia 1 (MEN1)

A

Parathyroid hyperplasia/adenoma, pancreatic endocrine tumour, pituitary adenoma

35
Q

Describe the features of multiple endocrine neoplasia 2a (MEN2a)

A

Parathyroid hyperplasia/ adenoma, thyroid cancer, phaeochromocytoma

36
Q

Describe the features of multiple endocrine neoplasia 2b (MEN2b)

A

Medullary thyroid cancer, phaeochromocytoma, neuroma, Marfanoid phenotype

37
Q

Name three pancreatic malformations

A

Ectopic pancreas, pancreas divisum, annular pancreas

38
Q

How does an annular pancreas present?

A

With duodenal obstruction at around 1y of age

39
Q

Where are the 2 most common locations for an ectopic pancreas

A

Stomach, small intestine

40
Q

What is pancreas divisum?

A

Failure of fusion of dorsal and ventral buds, leading to an increased risk of pancreatitis

Histopathology (30 decks)

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