Flashcards in Function of the Pancreas Deck (43):
1
Exocrine functions of the pancreas
85%
Glands-ducts-duodenum
Secrete digestive enzymes
2
Endocrine functions of the pancreas
Islets of langerhans
Secrete peptide hormones into the blood (insulin and glucagon)
3
2 types of pancreatitis
Acute and chronic
4
Clincial features of acute pancreatitis
Emergency
Sudden onset of severe abdo pain radiating to the back
nausea and vomiting
5
Prognosis of acute pancreatitis
May be mild (recovery within 5-7 days) or serious with high mortality
6
Lab tests for acute pancreatitis
Raised serum amylase/lipase
Hypocalcaemia (fatty acids bind calcium ions)
Hyperglycaemia
Abscess formation
Pseudocysts
7
Causes of acute pancreatitis
Gallstones (50%)
Alcohol (25%)
Rare causes (vascular insufficiency, viral infections-mumps, coxsackie B,hypercalcaemia, ERCP)
Idiopathic
8
Mild pancreatitis
Swollen gland with fat necrosis
9
Severe pancreatitis
Swollen, necrotic gland with fat necrosis and haemorrhage
10
Sign indicating haemorrhage into the subcutaneous tissues of the flank in acute pancreatitis
Grey Turner's sign
11
Sign to show periumbilicus in acute pancreatitis
Cullen's sign
12
Complications of acute pancreatitis
Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts
13
Collections of pancreatic juice secondary to duct rupture
Pseudocysts
14
Chronic pancreatitis
Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.
15
Chronic pancreatitis is irreversible destruction of which tissue first
Exocrine first
16
Complications of chronic pancreatitis
Malnutrition and diabetes
17
Risk factors for chronic pancreatitis
Toxic- alcohol, smoking
Genetic
Obstruction of the main duct-cancer scarring
Recurrent acute pancreatitis
Autoimmune
Idiopathic
18
Main genetic mutations associated with chronic pancreatitis
CFTR, PRSS1, SPINK1 mutations
19
Clinical presentation of chronic pancreatitis
Intermittent abdo pain, back pain and weight loss
20
Histlogy of chronic pancreatitis
Can mimic carcinoma macroscopically and microscopically
21
Complications of chronic pancreatitis
Malabsorption of fat
Diabetes
Pseudocysts
Stenosis of common bile duct/duodenum
22
Prognosis of chronic pancreatitis
Nearly 50% with 20-25 years of disease onset
23
Pathology of chronic pancreatitis
Localised, irregular involvement of the gland early on, later global atrophy
Dilated and distorted ducts
Calculi est in alcohol induced
Fatty replacement
Pseudocyst formation
24
Most common type of pancreatic cancer (up to 90%)
Pancreatic adenocarcinoma (ductal adenocarcinoma)
25
Prognosis of pancreatic cancer
5 year survival 4%
26
Risk factor for pancreatic adenocarcinoma
60-80yrs, rare before 40 years
Men
Smoking
Heavy alcohol intake, diet, obesity, hereditary, chronic pancreatitis
27
Which part of the pancreas is most commonly affected by pancreatic adenocarcinoma?
60-70% head of pancreas
28
Clinical symptoms of pancreatic adenocarcinoma
Non specific symptoms
Epigastric pain, radiating to back
Weight loss, painless jaundice, pruritis and nausea
Trausseau's syndrome (migratory thrombophlebility)
Courvoisier's sign (palpable gallbladder without pain)
Distat metastases
Diabetes
29
Inflammation of the veins because of the blood clots
Thrombophlebitis
30
HNPCC is a hereditary cancer syndrome with a mutation in what gene
DNA mismatch repair
31
Familial breast cancer is a hereditary cancer syndrome with a mutation in what gene
BRCA2
32
Ataxia telangiectasis is a hereditary cancer syndrome with a mutation in what gene
ATM
33
Von Hippel Lindau is a hereditary cancer syndrome with a mutation in what gene
VHL
34
Familial pancreatitis is a hereditary cancer syndrome with a mutation in what gene
Cationic trypsinogen, SPINK1
35
Peutz Jeghers is a hereditary cancer syndrome with a mutation in what gene
LKB1/STK11
36
second most common pancreatic cancer
Pancreatic neuroendocrine tumour
37
What genetic mutations predispose you to pancreatic neuroendocrine tumours?
MEN1
Von Hippel Lindau
38
Pancreatic cancer with a specturm of malignancy from benign to malignant
Pancreatic neuroendocrine tumour
39
2 types of neuroendocrine tumours
Well differentiated
Poorly differentiated
40
Rare
Females
40-75 years
Advanced disease at presentation
Prognosis without treatment 1-2 months, with chemotherapy up to 50 months
Poorly differentiated neuroendocrine carcinomas
41
Uncommon 1-2% all pancreatic neoplasms
Any age, rare in children
7-13% multiple (MEN-1)
15-35% non-functioning
Single tumours often produce multiple hormones but usually single hyperfunctional syndrome
Well-differentiated neuroendocrine tumour
42
Benign pancreati cancer
Insulinoma
43