60b Pancreatic pathology Flashcards Preview

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Flashcards in 60b Pancreatic pathology Deck (23):
1

Which enzymes does the exocrine pancreas secrete? (5)

Trypsin
Lipase
Phospholipase
Elastase
Amylase

2

How does acute pancreatitis present? (3)

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

3

What is the aetiology of acute pancreatitis? (6)

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

4

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

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

5

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

Hypocalcaemia.
Hyperglycaemia.

6

What are the complications of acute pancreatitis? (4)

Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts (pancreatic juice collection)

7

Why are pseudocysts not true cysts?

No epithelial lining.

8

What is chronic pancreatitis?
What does it lead to?

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

9

What are the causes of chronic pancreatitis?

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

10

What are the complications of chronic pancreatitis? (4)

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

11

What is the most common pancreatic cancer?

Pancreatic adenocarcinoma.

12

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

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

13

How does pancreatic adenocarcinoma present? (5)

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).

14

What is the prognosis for pancreatic adenocarcinoma?

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

15

Which hereditary cancer syndrome is p16/cdkn2A involved in?

FAMMM.

16

Who gets pancreatic neuroendocrine tumours?
Increased risk? (2)

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

17

How common are poorly differentiated neuroendocrine carcinomas of the pancreas?

Rare - 2-3% of pancreatic neuroendocrine tumours.

18

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

Males > Females
40-75 years
Advanced disease.

19

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

Insulinoma.

20

Which cell does a glucagonoma occur in?
Clinical findings? (4)

α cell
Stomatitis, rash, diabetes, weight loss.

21

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

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

22

Which cell does a somatostatinoma occur in?
Clinical findings? (3)

δ cell (delta).
Diabetes, gallstones, hypochlorhydria.

23

Which syndrome results from a VIPoma?
Clinical findings? (3)

Verner-Morrison.
Diarrhoea, hypokalaemia, achlorhydria.

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