Histopathology - Pancreatic Disease Flashcards
(50 cards)
What is the role of the pancreas?
- Produces 2L a day of enzymic HCO3- rich fluid, stimulated by secretin + CCK
- Exocrine pancreas composed of ducts and acinar cells
Where is secretin produced and what does it do?
- Produced by s-cells of duodenum
- Controls gastric acid secretion + buffering with HCO3-
Where is CCK produced and what does it do?
- Made by I-cells in duodenum
- Responsible for stimulating digestion of fat + protein
- Causes release of digestive enzymes
What is the function of the exocrine pancreas and its secretions?
Function:
- Digestive
- Proteases, lipases + amylase
Secretions:
- Secretes products into ducts (digestive enzymes)
What is the function of the endocrine pancreas and its secretions?
Function:
- Endocrine
Secretions:
- Secrets products into bloodstream (e.g. hormones)
What are the Islets of Langerhans within the endocrine pancreas and what are their features?
Α cells:
- Glucagon increases blood glucose
Β cells:
- Insulin decreases blood glucose
Delta cells:
- Somatostatin regulates Α + Β cells
D1:
- Vasoactive peptide
- Stimulates secretion of H20 into pancreatic system
PP:
- Pancreatic polypeptide
- Self regulates secretion activities
What is a metabolic syndrome and its features?
Collection of conditions that increase risk of IHD
- Fasting hyperglycaemia >6mmol/L
- BP >140/90
- Central obesity
- Dyslipidaemia (decreased HDL cholesterol + increased TGs)
- Microalbuminaemia
How is diabetes mellitus diagnosed?
- Fasting glucose >7mmol/L
OR - Random plasma glucose >11.1mmol/L
OR
HBA1c >48mmol/L
What is the pathogenesis of T1DM and some features?
- Autoimmune destruction of β cells by CD4+ + CD8+ T lymphocytes
- May present with DKA
- Insulin dependent
What is T2DM strongly related to?
- Obesity
- Insulin resistance
What are some macrovascular complications of diabetes?
- Cardiac (IHD)
- PVD (Claudication, change in colour/temp, poor healing ulcers)
- Cerebral (CVA)
What are some microvascular complications of diabetes?
- Glomerulonephritis (renal)
- Ulcers (peripheral neuropathy)
- Diabetic retinopathy (ocular)
How is acute pancreatitis scored?
GLASGOW Scale
- >=3 = severe pancreatitis
What are the causes of acute pancreatitis?
I GET SMASHED
- I: Idiopathic
- G: Gallstones
- E: Ethanol
- T: Trauma
- S: Steroids
- M: Mumps
- A: Autoimmune
- S: Scorpion venom
- H: Hyperlipidaemia
- E: ERCP
- D: Drugs (e.g. thiazides)
What are the most common causes of acute pancreatitis?
- Gallstones
- Ethanol
How does acute pancreatitis present?
- Severe epigastric (central) pain radiating to back
- Pain relieved by sitting forward
- Vomiting prominent
What is seen on blood tests for acute pancreatitis?
- Amylase transiently increase
- Serum lipase big increase (more sensitive)
What are some complications of acute pancreatitis?
- Formation of pseudocyst (pathological collection of fluid)
- Shock
- Hypoglycaemia
- Hypocalcaemia
What is seen on histology for acute pancreatitis?
Coagulative necrosis
What is the pattern of damage in acute pancreatitis?
Periductal damage: is necrosis of acinar cells near ducts, leading to obstructive causes
Perilobular damage: is necrosis at the edge of th elobules leading to ischaemic causes
Panlobular damage: is a combination of periductal and perilobular damage
What are some causes of chronic pancreatitis and which is most common?
- Alcoholism (most common)
- Cystic fibrosis
- Hereditary
- Pancreatic duct obstruction (e.g. stones/tumour)
- Autoimmune (IgG4 produced by plasma cells)
How does chronic pancreatitis present?
- Epigastric pain radiating to back
- Malabsorption (weight loss + steatorrhoea)
- Secondary DM (malabsorption due to lack of enzymes to digest food)
What is seen on histology of chronic pancreatitis?
- Fibrosis
- Loss of exocrine tissue parenchyma
- Duct dilatation with thick secretions
- Calcification
- Similar to pancreatic cancer
What are some complications of chronic pancreatitis?
- Pseudocysts
- Diabetes
- Pancreatic cancer
