Pancreatitis and Pancreatic Tumours Flashcards
What are the two types of functioning cells in the pancreas?
- Exocrine - acinar cells secrete pancreatic enzymes
- Endocrine - islets of Langerhans secrete hormones into the blood
What are the 4 cell types in the pancreas?
- Beta cells - secrete insulin
- Alpha cells - secrete glucagon
- Delta cells - secrete somatostatin
- PP cells - secrete polypeptides
In relation to the pancreas function only, what impact does somatostatin have?
Suppression of pancreatic hormones and also the exocrine function of the pancreas
What is the purpose of pancreatic polypeptides released from PP cells?
It is a self-regulatory mechanism to limit the secretions from the pancreas
Besides pancreatic polypeptides, which other factors can control pancreatic secretions?
- Vagus nerve
- Parasympathetic activity
What is the function of proteases?
Break down proteins from polypeptides to peptides
What is the function of pancreatic lipase?
Break down fat
Which two sources in the body does pancreatic lipsase come from?
- Saliva
- Pancreas
What does amylase in the body function to do?
Break down dietary starch and complex carbohydrates into di and trisaccharides
(additional enzymes can complete the breakdown process to form glucose)
Where is pancreatic lipase released?
Small intestine
Pancreatitis can be one of two things depending on the length of onset, what are these?
- Acute
- Chronic
What is the aetiology of acute pancreatitits?
I GET SMASHED
I - Idiopathic
G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion bites
H - Hyperlipidaemia, hyperparathyroidism, hypercalcaemia
E - ERCP
D - Drugs - azathioprine
What causes trypsin in the pancreas to be prematurely activated?
Damage to acinar cells
Blockage or occulsion preventing drainage out of the main pancreatic duct into the ampulla of Vater
Potentiall high levels of intracellular calcium
Which may cause high levels of intracellular calcium leadign to pancreatitits?
- Disruption in calcium homeostasis from alcohol consumption
- Duct hypertension from occulsion
Where will pain present in acute pancreatitis?
Epigastrium
What may be found on clinical examination in patient with pancreatitits?
- Fullness and pain in epigastrium
- Diffuse upper abdominal tenderness
- Soft
- Normal
- Tachycardia
- Hypotension
- Oliguric (very low urine output)
- Cullen’s, Grey-Turner’s signs and erythema ab igne
Which blood tests are required for acute pancreatitis?
- Serum amylase - may be normal, but can be high
- Serum lipase - remains elevated for longer than serum amylase
- CRP - can assess severity of inflammation
- Others
When would serum amylase levels be diagnostic of pancreatitits?
When they are raised 3 fold
Why may urinary amylase be useful?
It remains elevated for longer than serum amylase
ERCP can be used as a method to diagnose pancreatitis
True or false?
False
Name one method which can be used to assess the severity of pancreatitis?
The Glasgow Criteria
What are the components of the Glasgow criteria?
- PaO2 < 8kPa (60mmhg)
- Age > 55 years
- Neutrophils: (WBC >15 x109/l
- Calcium < 2mmol/l
- Renal function: (Urea > 16mmol/l)
- Enzymes: (AST/ALT > 200 iu/L or LDH > 600 iu/L)
- Albumin < 32g/l
- Sugar: (Glucose >10mmol/L)
How often are patients rescored for the severity of their pancreatitis?
After 24 hours
What are pseudocysts?
Cystic lesions lacking epithelial or endothelial cells - they are cmposed of a pocket of pancreatic fluid between pancreatic and fibrous/granular tissue
How are pseudocysts treated?
- Endoscopic drainage
- Stent insertion to compress cysts
Why must abscesses be drained?
They can potentially lead to sepsis
How is pancreatic necrosis assessed and treated?
Assessed by CT
Fine needle aspiration can allow for investigation of tissue
Percutaneous drainage can remove some tissue
Necrosectomy by endoscopy and lavage can remove infected tissue
What are common causes for chronic pancreatitis?
Alcohol is the main cause
Smoking and medication
What is often found on examination for chronic pancreatitis?
Masses, ascites, jaundice
What is the full aetiology for chronic pancreatitis?
CAT And PIG
- Congenital and acquired
- Alcohol
- Tropical countries
- Autoimmune
- Pancreatic duct obstruction
- Idiopathic
- Genetics – cystic fibrosis
Pancreatic stones are indicative of which type of chronic pancreatitis?
Tropical pancreatitis
What are the main symtoms for chronic pancreatitits?
- Bloating
- Pain
- Loose fatty stools
- Weight loss
- Increased stool frequency
How can chronic pancreatitis be treated?
CREON - enzyme replacement therapy
Pseudocyts can cause what types of obstruction in relation to the pancreas?
- Biliary obstruction
- Gastric outflow obstruction
What are the two main classes of pancreatic tumours based on cell types affected?
- Exocrine
- Endocrine
Almost all exocrine tumours will be what type of tumour?
Adenocarcinoma
What are risk factors for exocrine tumours of the pancreas?
- Smoking
- Alcohol excess
- High coffee intake
- Use of aspirin
Give examples of endocrine tumours and the effects they will have
Gastrinoma - produces gastrin - increases acid
Insulinoma - produces insulin - causes hypoglycaemia
Glucagonoma - produces glucagon - cause hyperglycaemia
Vasoactive intestinal peptide tumour (VIPoma) - VIP produced causing severe secretory diarrhoea
Somatostatinoma - can cause diabetes, gallstones and steatorrhoea
Endocrine tumours may present with signs such as what?
- Jaundice
- Loose pale stools
- Dark urine
- Weight loss
- Back pain
What are the risk factors for endocrine pancreatic tumours?
- Heavy smokers
- Charred meat
- Obesity
- Diabetes (types I and II)
How may pancreatic tumours be treated?
- ERCP or PTC (percutaneous transhepatic cholangiograhy) and stent instertion
- Surgery
