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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
Describe the epidemiology of pancreatic carcinoma
85% of pancreatic malignancies, more common in males, average age of onset 60 years
26
What is the most common site of pancreatic carcinoma?
Head of the pancreas
27
State 3 risk factors for pancreatic carcinoma
Smoking, diet, FAP, Lynch syndrome
28
Describe the clinical features of pancreatic carcinoma
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
Name the tumour marker for pancreatic carcinoma
CA19-9 (>70IU/ml)
30
Describe the management of pancreatic carcinoma
If possible, Whipple's procedure (surgical resection of pancreatic head) If not, palliative chemotherapy with 5-fluorouracil
31
Describe the histology of islet cell tumours
Cells arranged in nests or trabeculae with granular cytoplasm. Range from benign to malignant
32
Where do islet cell tumours usually occur?
Body or tail of pancreas
33
Describe the presentation of functional islet cell tumours
Insulinomas: hypoglycaemic attacks Gastrinomas: Zollinger-Ellison syndrome (recurrent ulceration) VIPoma: diarrhoea Glucagonoma: necrolytic migrating erythema
34
Describe the features of multiple endocrine neoplasia 1 (MEN1)
Parathyroid hyperplasia/adenoma, pancreatic endocrine tumour, pituitary adenoma
35
Describe the features of multiple endocrine neoplasia 2a (MEN2a)
Parathyroid hyperplasia/ adenoma, thyroid cancer, phaeochromocytoma
36
Describe the features of multiple endocrine neoplasia 2b (MEN2b)
Medullary thyroid cancer, phaeochromocytoma, neuroma, Marfanoid phenotype
37
Name three pancreatic malformations
Ectopic pancreas, pancreas divisum, annular pancreas
38
How does an annular pancreas present?
With duodenal obstruction at around 1y of age
39
Where are the 2 most common locations for an ectopic pancreas
Stomach, small intestine
40
What is pancreas divisum?
Failure of fusion of dorsal and ventral buds, leading to an increased risk of pancreatitis

Histopathology (30 decks)

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