60 - Pancreatic Pathology Flashcards Preview

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Flashcards in 60 - Pancreatic Pathology Deck (25):
1

Exocrine function of pancreas

85% of pancreatic tissue
secrete digestive enzymes: trypsin, lipase, phospholipase, elastase, amylase, which are markers for pancreatic inflammation and require activation

2

Endocrine function of pancreas

Islets of Langerhans
Secrete peptide hormones into blood (e.g. insulin and glucagon)

3

Acute pancreatitis - clinical presentation

Usually emergency
Sudden onset of severe abdo pain radiating to back
Nausea and vomiting
May be mild (recover within 5-7days) but has a high mortality as well

4

Acute pancreatitis - investigations

Raised serum amylase/lipase (3x normal)

5

Acute pancreatitis - aetiology

Gallstones (50%)
Alcohol (25%)
Rare causes: vascular insufficiency, viral infections (mumps, Coxsackie B), hypercalcaemia, ERCP
Idiopathic (10%)

6

Acute pancreatitis - pathogenesis

Leakage and activation of pancreatic enzymes
Amylase into blood

7

Acute pancreatitis - mild

Swollen gland with fat necrosis

8

Acute pancreatitis - severe

Swollen, necrotic gland with fat necrosis and haemorrhage

Showing Grey Turner's sign and Cullen's sign

Hypocalcaemia (fatty acids bind calcium ions), hyperglycaemia, abscess formation, pseudocysts

9

Acute pancreatitis - Grey Turner's sign

Haemorrhage into sub cut tissues of flank

10

Acute pancreatitis - Cullen's sign

Haemorrhage into sub cut tissues of periumbilicus

11

Acute pancreatitis - complications

Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts (collections of pancreatic juice secondary to duct rupture)

12

Chronic pancreatitis -

Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.

Irreversible dmg to exocrine then to endocrine

13

Chronic pancreatitis - clinical presentation

malnutrition and diabetes

14

Chronic pancreatitis - causes

Toxic - -OH, smoking, drugs, hypercalcaemia, HPTism, infections
Genetic CFTR, PRSS1, SPINK1 mutation
Obstruction of main duct - cancer, scarring
Recurrent acute
Autoimmune
Idiopathic

15

Chronic pancreatitis - main causes

95% are alcohol or idiopathic

16

Chronic pancreatitis - complications

Malabsorption of fat (lack of lipases) - steatorrhoea, impairment of fat soluble vit absorption (A,D,E,K), diarrhoea, weight loss and cachexia

Diabetes (last feature)
Pseudocysts
Stenosis of common bile duct / duodenum

17

Chronic pancreatitis - mortality

nearly 50% within 20-25 yrs of onset

18

Pancreatic adenocarcinoma -

Most common type - 90% of pancreatic neoplasms

4% 5 yr survival rate

19

Pancreatic adenocarcinoma - who?

60-80 yrs (rare before 40)
1.3M:1F
Smoking (2-3x risk), drops with abstinence
Heavy alcohol
Red meats
Obesity
Hereditary (10%)
Chronic pancreatitis

20

Pancreatic adenocarcinoma - clinical presentation

Present for at least a decade before detected
Non-specific symptoms
Epigastric pain, radiating to back
Weight loss, painless jaundice, pruritis and nausea
Trousseau's syndrome
Courvoisier's sign
Distant mets (liver, peritoneum, lung)
Diabetes

21

Pancreatic adenocarcinoma - Trousseau's sign

Migratory thrombophlebitis

22

Pancreatic adenocarcinoma - Courvoisier's sign

Palpable gall bladder w/o pain

23

Pancreatic adenocarcinoma - poor prognosis factors

Extension of tumour outside pancreas
Met spread to local lymph nodes
Vascular and perineural invasion
Grade of differentiation

24

Pancreatic neuroendocrine tumours -

Uncommon

25

Pancreatic neuroendocrine tumours - clinical presentation

Autopsy studies- higher incidence (up to 10%)
20-60 yrs
M=F
Increased risk MEN 1, von Hippel Lindau

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