Pancreas

Question 1

where in the pancreas is the CTFR gene expressed

Answer 1

intralobular duct epithelial cells

Question 2

cells in this region of the pancreas are involved in endocrine functions. secrete SS, insulin an glucagon. small cells, vast numbers. secreted into bloodstream.

Answer 2

islets of langerhans

Question 3

exocrine region of the pancreas involved in production of digestive enzymes.
enzymes are formed as proenzymes in granules - secreted into ducts.

Answer 3

pancreatic acinar cells - large ducts and acini

Question 4

acute inflammation caused by aberrant release of proteolytic enzymes, histology shows increased infiltration by neutrophil polymorphs.

Answer 4

Acute pancreatitis

Question 5

main cause of acute pancreatitis

Answer 5

gallstones (50%)
alcohol (30%)
idiopathic (15%)

Question 6

I GET SMASHED

Answer 6

idiopathic
gallstones
ethanol
trauma
steroids
mumps 
autoimmune
scorpion
hyperlipidaemia
ercp
drugs - thiazides

Question 7

acute pancreatitis with periductal pattern of injury, necrosis of acini near ducts.

Answer 7

ductal obstruction

Question 8

perilobular pattern of injury with acute panceatitis

Answer 8

decreased blood supply

Question 9

panlobular pattern of pancreatic injury in acute panc

Answer 9

ductal obstruction and decreased blood supply can both cause

Question 10

damage caused by lipase release during acute pancreatitis

Answer 10

fat necrosis - calcium ions bind fatty acids and form yellow white foci on pancreas

Question 11

damage caused by elastases in acute panc

Answer 11

blood vessel damage and haemorrhage

Question 12

macroscopic Histology of acute panceratitis

Answer 12

macroscopic: can range from mild stromal oedeoma to severe haemorrhagic necrosis.

Question 13

how does alcohol cause AP

Answer 13

spasm of sphincter of Oddi causes formation of protein-rich fluid which obstructs the pancreatic duct.

Question 14

localised complications of AP

Answer 14

pseudocyst formation
these are cysts without epithelium which are liable to become infected, causing abcess, shock and hypocalcaemia.
Abcesses

Question 15

systemic complications of acute pancreatitis

Answer 15

shock, hypocalcaemia, hypoglycaemia, death. mortality 50% with severe haemorrhage

Question 16

sensitive marker for AP

Answer 16

lipase

amylase only transiently raised

Question 17

presentation of acute pancreatitis

Answer 17

severe epigastric pain, radiates to the back, relieved by sitting forward. lots of vomiting.

Question 18

causes of chronic pancreatitis

Answer 18

alcoholism, CF, heredita1. metabolic/toxic - alcohol (80%), haemochromatosis

2. duct obstruction - gallstones, CF, anatomical
3. idiopathic/autimmune

Question 19

marker for autoimmune pacreatitis (chronic)

Answer 19

IgG4+ sclerosing disease. characterised by a large number of IgG4+ plasma cells

Question 20

Histology of chronic pancreatitis - macroscopic and microscopic

Answer 20

macroscopic - pale, scarred, fibrotic. parenchymal loss. may see calcification on Xray
microscopic: dilated ducts with calcified stones in them

Question 21

Late stage histological changes in chronic pancreatitis

Answer 21

• loss of langerhans cells

calcification of body of pancreas

Question 22

bronzed diabetes

Answer 22

caused by haemochromatisis - iron overload

Question 23

most common form of pancreatic cancer

Answer 23

ductal (adeno)carcinoma (85%)

Question 24

risk factors for ductal adenocarcinoma of pancreas

Answer 24

smoking, high BMI, chronic pancreatitis, diabetes.

coffee is protective against fibrosis

Question 25

presentation of ductal adenoca

Answer 25

oftne present late as needs to get large before sx occur FLAWS cachexia especially upper abdo and back pain - chronic persistent and severe painless jaundice, pruritis and steatorrhoea

Question 26

complications of ductal adenoca

Answer 26

1. chronic pancreatitis | 2. venous thrombosis - secretion of mucin can trigger coag cascade and lead to a migratory thrombophlebitis

Question 27

macroscopic histology of ductal adenoca

Answer 27

grey, gritty, invasion into other retroperitoneal structures | NB - head of panc ca present earlier due to block of CBD

Question 28

microscopic histology of ducta adenoca

Answer 28

mucin secreting glands in desmoplastic (fibrotic) storma

Question 29

Rarer pancreatic cance,r seen in older adults, often presents with enzyme production by neoplastic cells. non specific sx, abdo pain wt loss and D/V. can get fat necrosis or polyarthralgia.

Answer 29

Acinar cell carcinoma

Question 30

histology of acinar cell carcinoma

Answer 30

neoplastic epithelial cells eosinophilic granular cytoplasm positve immunoreactivity for: lipase, trypsin and chymotrypsin

Question 31

main sites of ductal adenoca

Answer 31

``` head (60% body tail diffuse NB - opposite for neuroendocrine ```

Question 32

serous cystadenoma and mucinous cystic neoplasms are what form of pancreatic tumour

Answer 32

``` cystic neoplasms of the glandular tissue mucinous = Multilocular serous = Single locular often contain mucin/serous-secreting epithelium often benign NB - locular means CYST ```

Question 33

what is chromogranin

Answer 33

a neuroendocrine marker that you can look for in tissue/blood to determine if an endocrine neoplasm exists

Question 34

which genetic condition are endocrine neoplasms of the pancreas associated with

Answer 34

MEN-1

Question 35

tumours derived from B-pancreatic cells that secrete insulin, causing hypoglycaemia

Answer 35

Insulinoma

Question 36

most common site of insulinoma

Answer 36

tail

Question 37

GALLSTONES - risk factors

Answer 37

female, forty, fat, fertile. western populations, native americans, hereditary, drugs - OCP, rapid weight loss

Question 38

two types of gallstone

Answer 38

cholesterol - often radiolucent. singular | pigment - contain Ca and unconj bili - occur in sickle etc. multiple, radio-opaque

Question 39

Rokitansky Aschkoff sinuses

Answer 39

chronic cholecystitis - diverticuli form on bile ducts

Question 40

commonest cause of gallbladder ca (adenocarcinoma)(

Answer 40

gallstones (90%)

Question 41

Zollinger-Ellison sydrome

Answer 41

Gastrinoma causing high acid output, recurrent ulceration

Question 42

MEN-1

Answer 42

PPP parathyroid pancreatic endocrine tumor (phaeo) pit adenoma

Question 43

MEN-2a

Answer 43

parathyroid, thyroid and phaeo

Question 44

MEN-2b

Answer 44

neuroma, medullary thyroid, phaeo. marfanoid