Function of the Pancreas

Question 1

Exocrine functions of the pancreas

Answer 1

85%
Glands-ducts-duodenum
Secrete digestive enzymes

Question 2

Endocrine functions of the pancreas

Answer 2

Islets of langerhans

Secrete peptide hormones into the blood (insulin and glucagon)

Question 3

2 types of pancreatitis

Answer 3

Acute and chronic

Question 4

Clincial features of acute pancreatitis

Answer 4

Emergency
Sudden onset of severe abdo pain radiating to the back
nausea and vomiting

Question 5

Prognosis of acute pancreatitis

Answer 5

May be mild (recovery within 5-7 days) or serious with high mortality

Question 6

Lab tests for acute pancreatitis

Answer 6

Raised serum amylase/lipase
Hypocalcaemia (fatty acids bind calcium ions)
Hyperglycaemia
Abscess formation
Pseudocysts

Question 7

Causes of acute pancreatitis

Answer 7

Gallstones (50%)
Alcohol (25%)
Rare causes (vascular insufficiency, viral infections-mumps, coxsackie B,hypercalcaemia, ERCP)
Idiopathic

Question 8

Mild pancreatitis

Answer 8

Swollen gland with fat necrosis

Question 9

Severe pancreatitis

Answer 9

Swollen, necrotic gland with fat necrosis and haemorrhage

Question 10

Sign indicating haemorrhage into the subcutaneous tissues of the flank in acute pancreatitis

Answer 10

Grey Turner’s sign

Question 11

Sign to show periumbilicus in acute pancreatitis

Answer 11

Cullen’s sign

Question 12

Complications of acute pancreatitis

Answer 12

Shock
Intravascular coagulopathy
Haemorrhage
Pseudocysts

Question 13

Collections of pancreatic juice secondary to duct rupture

Answer 13

Pseudocysts

Question 14

Chronic pancreatitis

Answer 14

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

Question 15

Chronic pancreatitis is irreversible destruction of which tissue first

Answer 15

Exocrine first

Question 16

Complications of chronic pancreatitis

Answer 16

Malnutrition and diabetes

Question 17

Risk factors for chronic pancreatitis

Answer 17

Toxic- alcohol, smoking
Genetic
Obstruction of the main duct-cancer scarring
Recurrent acute pancreatitis
Autoimmune
Idiopathic

Question 18

Main genetic mutations associated with chronic pancreatitis

Answer 18

CFTR, PRSS1, SPINK1 mutations

Question 19

Clinical presentation of chronic pancreatitis

Answer 19

Intermittent abdo pain, back pain and weight loss

Question 20

Histlogy of chronic pancreatitis

Answer 20

Can mimic carcinoma macroscopically and microscopically

Question 21

Complications of chronic pancreatitis

Answer 21

Malabsorption of fat
Diabetes
Pseudocysts
Stenosis of common bile duct/duodenum

Question 22

Prognosis of chronic pancreatitis

Answer 22

Nearly 50% with 20-25 years of disease onset

Question 23

Pathology of chronic pancreatitis

Answer 23

Localised, irregular involvement of the gland early on, later global atrophy
Dilated and distorted ducts
Calculi est in alcohol induced
Fatty replacement
Pseudocyst formation

Question 24

Most common type of pancreatic cancer (up to 90%)

Answer 24

Pancreatic adenocarcinoma (ductal adenocarcinoma)

Question 25

Prognosis of pancreatic cancer

Answer 25

5 year survival 4%

Question 26

Risk factor for pancreatic adenocarcinoma

Answer 26

60-80yrs, rare before 40 years Men Smoking Heavy alcohol intake, diet, obesity, hereditary, chronic pancreatitis

Question 27

Which part of the pancreas is most commonly affected by pancreatic adenocarcinoma?

Answer 27

60-70% head of pancreas

Question 28

Clinical symptoms of pancreatic adenocarcinoma

Answer 28

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

Question 29

Inflammation of the veins because of the blood clots

Answer 29

Thrombophlebitis

Question 30

HNPCC is a hereditary cancer syndrome with a mutation in what gene

Answer 30

DNA mismatch repair

Question 31

Familial breast cancer is a hereditary cancer syndrome with a mutation in what gene

Answer 31

BRCA2

Question 32

Ataxia telangiectasis is a hereditary cancer syndrome with a mutation in what gene

Answer 32

ATM

Question 33

Von Hippel Lindau is a hereditary cancer syndrome with a mutation in what gene

Answer 33

VHL

Question 34

Familial pancreatitis is a hereditary cancer syndrome with a mutation in what gene

Answer 34

Cationic trypsinogen, SPINK1

Question 35

Peutz Jeghers is a hereditary cancer syndrome with a mutation in what gene

Answer 35

LKB1/STK11

Question 36

second most common pancreatic cancer

Answer 36

Pancreatic neuroendocrine tumour

Question 37

What genetic mutations predispose you to pancreatic neuroendocrine tumours?

Answer 37

MEN1 | Von Hippel Lindau

Question 38

Pancreatic cancer with a specturm of malignancy from benign to malignant

Answer 38

Pancreatic neuroendocrine tumour

Question 39

2 types of neuroendocrine tumours

Answer 39

Well differentiated | Poorly differentiated

Question 40

``` Rare Females 40-75 years Advanced disease at presentation Prognosis without treatment 1-2 months, with chemotherapy up to 50 months ```

Answer 40

Poorly differentiated neuroendocrine carcinomas

Question 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 ```

Answer 41

Well-differentiated neuroendocrine tumour

Question 42

Benign pancreati cancer

Answer 42

Insulinoma

Question 43

Clinical findings of gastrinoma

Answer 43

Peptic ulcer | Diarrhoea