60b Pancreatic pathology Flashcards

1
Q

Which enzymes does the exocrine pancreas secrete? (5)

A
Trypsin
Lipase
Phospholipase
Elastase
Amylase
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2
Q

How does acute pancreatitis present? (3)

A

Severe abdo pain radiating to lower back.
N + V.
Raised serum amylase/lipase.

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3
Q

What is the aetiology of acute pancreatitis? (6)

A
Gallstones (50%)
Alcohol (25%)
Rare: Vascular insufficiency
Viral: mumps, coxsackie B
Hypercalcaemia
ERCP (iatrogenic)
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4
Q

Pathology in mild acute pancreatitis? (2)
Severe? (2)
Signs of severe acute pancreatitis? (2)

A

Swollen gland, fat necrosis.
Necrosis + haemorrhage.
Cullen’s sign: haemorrhage into periumbilicus.
Grey Turner’s sign: haemorrhage into subcutaneous flank.

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5
Q

How does pancreatitis change calcium and glucose levels in the blood?

A

Hypocalcaemia.

Hyperglycaemia.

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6
Q

What are the complications of acute pancreatitis? (4)

A

Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts (pancreatic juice collection)

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7
Q

Why are pseudocysts not true cysts?

A

No epithelial lining.

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8
Q

What is chronic pancreatitis?

What does it lead to?

A

Progressive inflammation with parenchyma destruction and fibrosis.
Destroys exocrine first, then endocrine.
Malnutrition + diabetes.

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9
Q

What are the causes of chronic pancreatitis?

A
TIGARO
Toxic: alcohol, cigarettes, high Ca, HPT
Idiopathic
Genetic: CFTR, PRSS1, SPINK 1 
Autoimmune
Recurrent acute pancreatitis
Obstruction of main duct
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10
Q

What are the complications of chronic pancreatitis? (4)

A

Fat malabsorption: steatorrhea, low vit ADEK, diarrhoea, weight loss, cachexia.
Diabetes (late feature)
Pseudocysts
Stenosis of common bile duct/duodenum

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11
Q

What is the most common pancreatic cancer?

A

Pancreatic adenocarcinoma.

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12
Q

What are the risk factors for pancreatic adenocarcinoma? (7)

A
M>F
Cigarette smoking
Alcohol intake
Red meat
Obesity
Hereditary (10%)
Chronic pancreatitis
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13
Q

How does pancreatic adenocarcinoma present? (5)

A

After a decade of growth.
Non specific: epigastric pain radiating to back.
Weight loss, painless jaundice, puritis, nausea.
Trousseau’s syndrome (migratory thrombophlebitis)
Courvoisier’s sign (palpable gallbladder without pain).

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14
Q

What is the prognosis for pancreatic adenocarcinoma?

A

4% 5 year survival.
Mean survival is 3-5 months.
Extends to 10-20 with surgery (only 10% eligible).

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15
Q

Which hereditary cancer syndrome is p16/cdkn2A involved in?

A

FAMMM.

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16
Q

Who gets pancreatic neuroendocrine tumours?

Increased risk? (2)

A

20-60 years
M=F
MEN 1, von Hippel Lindau

17
Q

How common are poorly differentiated neuroendocrine carcinomas of the pancreas?

A

Rare - 2-3% of pancreatic neuroendocrine tumours.

18
Q

Who gets poorly differentiated neuroendocrine carcinomas of the pancreas?
Presentation?

A

Males > Females
40-75 years
Advanced disease.

19
Q

What is the only neuroendocrine tumour of the pancreas that is considered to be benign?

A

Insulinoma.

20
Q

Which cell does a glucagonoma occur in?

Clinical findings? (4)

A

α cell

Stomatitis, rash, diabetes, weight loss.

21
Q

Which cell does a gastrinoma occur in?
Syndrome?
Clinical findings? (2)

A

G cell.
Zollinger-Ellison.
Peptic ulcer, diarrhoea.

22
Q

Which cell does a somatostatinoma occur in?

Clinical findings? (3)

A

δ cell (delta).

Diabetes, gallstones, hypochlorhydria.

23
Q

Which syndrome results from a VIPoma?

Clinical findings? (3)

A

Verner-Morrison.

Diarrhoea, hypokalaemia, achlorhydria.