60 - Pancreatic Pathology

Question 1

Exocrine function of pancreas

Answer 1

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

Question 2

Endocrine function of pancreas

Answer 2

Islets of Langerhans

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

Question 3

Acute pancreatitis - clinical presentation

Answer 3

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

Question 4

Acute pancreatitis - investigations

Answer 4

Raised serum amylase/lipase (3x normal)

Question 5

Acute pancreatitis - aetiology

Answer 5

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

Question 6

Acute pancreatitis - pathogenesis

Answer 6

Leakage and activation of pancreatic enzymes

Amylase into blood

Question 7

Acute pancreatitis - mild

Answer 7

Swollen gland with fat necrosis

Question 8

Acute pancreatitis - severe

Answer 8

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

Question 9

Acute pancreatitis - Grey Turner’s sign

Answer 9

Haemorrhage into sub cut tissues of flank

Question 10

Acute pancreatitis - Cullen’s sign

Answer 10

Haemorrhage into sub cut tissues of periumbilicus

Question 11

Acute pancreatitis - complications

Answer 11

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

Question 12

Chronic pancreatitis -

Answer 12

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

Irreversible dmg to exocrine then to endocrine

Question 13

Chronic pancreatitis - clinical presentation

Answer 13

malnutrition and diabetes

Question 14

Chronic pancreatitis - causes

Answer 14

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

Question 15

Chronic pancreatitis - main causes

Answer 15

95% are alcohol or idiopathic

Question 16

Chronic pancreatitis - complications

Answer 16

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

Question 17

Chronic pancreatitis - mortality

Answer 17

nearly 50% within 20-25 yrs of onset

Question 18

Pancreatic adenocarcinoma -

Answer 18

Most common type - 90% of pancreatic neoplasms

4% 5 yr survival rate

Question 19

Pancreatic adenocarcinoma - who?

Answer 19

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

Question 20

Pancreatic adenocarcinoma - clinical presentation

Answer 20

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

Question 21

Pancreatic adenocarcinoma - Trousseau’s sign

Answer 21

Migratory thrombophlebitis

Question 22

Pancreatic adenocarcinoma - Courvoisier’s sign

Answer 22

Palpable gall bladder w/o pain

Question 23

Pancreatic adenocarcinoma - poor prognosis factors

Answer 23

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

Question 24

Pancreatic neuroendocrine tumours -

Answer 24

Uncommon

Question 25

Pancreatic neuroendocrine tumours - clinical presentation

Answer 25

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