Pancreatic Histopath

Question 1

Role of the pancreas

Answer 1

Production of 2L a day of enzymic HCO3 rich fluid, stimulated by secretin & CCK

Question 2

Role of secretin (2) & produced by which cells

Answer 2

Produced by s-cells of duodenum - in response to acid chyme from stomach Stimulates HCO3- release from pancreas (centroacinar cells)

Inhibits gastric acid secretion from parietal cells

Question 3

Role of CCK (2) & produced by which cells

Answer 3

Produced by I-cells of duodenum (in response to food in duodenum)

Stimulates digestion of fat & protein by causing release of digestive enzymes (from acinar cells)

Stimulates gallbladder contraction > release bile

Question 4

Function of alpha cells, beta cells, delta cells,

Answer 4

alpha - glucagon beta - insulin delta - somatostatin (endocrine cyanide)

Question 5

Function of D1 cells &

pancretic polypeptide cells

Answer 5

D1 cells - a vasoactive intestinal peptide (VIP) that stimulates secretion of H2O

PP cells - secrete PP, which stimulates secretion of gastric & intestinal enzymes, whilst reducing intestinal motility. Self regulates secretion activities

Question 6

Criteria of metabolic syndrome (5)

Answer 6

Dyslipidaemia - HDL 2mmol/l

Fasting blood sugar > 6mmol/l

BP > 140/90

Central obesity > 94 cm in M, > 80 cm in F

Microalbuminaemia

Question 7

Diagnosis of DM

Answer 7

fasting plasma glucose > 7 mmol/l

Random blood glucose > 11.1 mmol/l

Question 8

Symptoms of DM (3)

Answer 8

Polyuria

Polydipsia

Recurrent infections

Question 9

Macrovascular complications of diabetes (3)

Answer 9

Cardiac - MI

REnal - GN or pyelonephritis

Cerebral - CVA

Question 10

Microvascular complications of diabetes (2)

Answer 10

Ocular - diabetic retinopathy

PVS - claudication,

poor healing ulcer

Question 11

Causes of Acute pancreatitis (11)

Answer 11

I - idiopathic, G - gallstones, E - ETOH, T - trauma, S- steroids, M - mumps, A - autoimmune, S - scorpion venom, H - Hyperlipidaemia, E - ERCP, D - Drugs e.g. thiazides

Question 12

Presentation of acute pancreatitis (3)

Answer 12

Severe epigastric pain - relieved by leaning forward

Vomiting Pain radiates to back

Question 13

Histology of acute pancreatitis (1)

Answer 13

Coagulative necrosis

Question 14

Complication of acute pancreatitis (1)

Answer 14

formation of pseudocyst

Question 15

Ix of acute pancreatitis (1)

Answer 15

serum LIPASE (amylase on transiently increased)

Question 16

Causes of chronic pancreatitis (5)

Answer 16

Alcoholism

Pancreatic duct obstruction e.g. stone

Autoimmune

CF

Hereditary

Question 17

Presentation of chronic pancreatitis (3)

Answer 17

epigastric pain radiating to back

Malabsorption results in weight loss & steatorrhea secondary DM - due to lack of enzymes to digest food

Question 18

Histology of chronic pancreatitis (3)

Answer 18

Fibrosis + loss of exocrine tissue

Duct dilatation with thick secretions

calcification

Question 19

Acinar cell carcinoma presentation (4)

Answer 19

A rare cancer seen in eldery,

get enzyme secretion by neoplastic cells

Presentation - non specific weight loss, abdo pain, nause & vomiting

10% get multi-focal fat necrosis & polyarthralgia - due to lipase

Question 20

Histolopath of acinar cell carcinoma (3)

Answer 20

neoplastic epithelial cells with eosinophilic granular cytoplasm positive immunoreactivity for lipase, trypsin, chymotrypsin

Question 21

Prognosis of acinar cell carcinoma

Answer 21

Poor - median survival 18 months, 5 yr

Question 22

Ductal adenocarcionma of pancreas epidemiology - age group, gender & site

Answer 22

85% of all pancreatic cancers

Age > 60

M> F

Head of pancreas - Causes obstruction of bile duct > jaundice

Question 23

Ductal adenocarcionma of pancreas risk factors (3)

Answer 23

Smoking

diet

Genetic e.g. HNPCC & FAP

Question 24

Clinical features of Ductal adenocarcionma of pancreas (8)

Answer 24

Cachexia & anorexia

Epigastric + back pain - chronic & severe

Jaundice (PAINLESS), pruritis, steatorrhea

Ascites

Abdo mass

Virchow’s node

Trousseau’s syndrome (25%) - recurrent superficial thrombophlebitis

Courvoisier’s sign

Question 25

Investigations of Ductal adenocarcionma of pancreas (3)

Answer 25

Bloods - low Hb, high Br, high Ca2+

CT/MRI/ERCP

CA19.9 > 701 (low spec & sens - only used after diagnosis established)

Question 26

Management of Ductal adenocarcionma of pancreas (3)

Answer 26

Chemo is palliative 5-FU

Surgery - Whipple’s procedure

Poor prognosis - 5 yr survival

Question 27

Where are neuroendocrine tumours usually found? (2)

Answer 27

Body or tail of pancreas

Question 28

neuroendocrine tumours lie on a spectrum (benign > malignant) can be functional give examples (3)

Answer 28

Insulinoma - _hypoglycaemic attack_s

Gastrinoma - Zollinger-Ellison syndrome - recurrent ulceration due to high acid output

Glucagonoma - Necrolytic migrating erythema

VIPoma - diarrhoea

Question 29

Non functional neuroendocrine tumours

Answer 29

incidental finding on imaging or when large enough to produce symptoms

Question 30

Ix & Rx of neuroendocrine tumours

Answer 30

CT/ MRI

Surgery

Question 31

MEN-1 (3)

Answer 31

PPP

Pancreatic endocrine tumour (often a phaeo)

Parathyroid

Pituitary adenoma

Question 32

MEN 2A (3)

Answer 32

Parathyroid

Thyroid

Phaeo

Question 33

MEN 2B (3)

Answer 33

Medullary thyroid

Phaeo

Neuroma MARFINOID PHENOTYPE

Question 34

Pancreatic malformations (3)

Answer 34

Ectopic pancreas - esp stomach/ small intestine

Pancreas divisum - failure of fusion of dorsal + ventral buds; increased risk of pancreatitis

Annular pancreas - can present with duodenal obstruction (1 yr)