Pancreatic disease Flashcards by Niamh Spence

Enzymes which stimulate the pancreatic

Secretin and CCK

How well did you know this?

Not at all

Perfectly

Produced by s-cells of the duodenum, controls gastric acid secretion and buffering with HCO3-

Secretin

How well did you know this?

Not at all

Perfectly

Stimulates digestion of fat and protein. Made by I-cells in the duodenum. Causes release of digestive enzymes

CCK

How well did you know this?

Not at all

Perfectly

Islets of langerhans - alpha cells

Secrete glucagon which increases blood glucose

How well did you know this?

Not at all

Perfectly

Islets of Langerhans - beta cells

Secrete insulin which decreases blood glucose

How well did you know this?

Not at all

Perfectly

Islets of Langerhans - delta cells

Secrete somatostatin which suppresses insulin and glucagon release

How well did you know this?

Not at all

Perfectly

Islets of Langerhans - PP cells

PP cells contain a unique pancreatic polypeptide, VIP, that exerts several gastrointestinal effects, such as stimulation of secretion of gastric and intestinal enzymes and inhibi- tion of intestinal motility.

Pancreatic polypeptide is also secreted and regulates pancreatic secretion activities alongside effects on hepatic glycogen metabolism and GI secretions.

How well did you know this?

Not at all

Perfectly

Metabolic syndrome

Pro-inflammatory state ?triggered by cytokine release from adipocytes.

Associated with:
Central obesity
Fasting hyperglycaemia (>6mmol/l)
BP > 140/90
Microalbuminaemia 
Dyslipidaemia (decreased HDL cholesterol <1mmol/L and increased triglycerides >2mmol/L)]
Hyper-coaguable state

How well did you know this?

Not at all

Perfectly

Diagnosis of diabetes mellitus

Fasting plasma glucose >7mmol/L

Random plasma glucose >11.1mmol/L

How well did you know this?

Not at all

Perfectly

T1DM pathophysiology

AI destruction of beta cells in the islets of Langerhans by CD4+ and CD8+ T lymphocytes.

How well did you know this?

Not at all

Perfectly

T2DM pathophysiology

A combination of peripheral resistance to insulin action and an inadequate compensatory response of insulin secretion by the pancreatic beta cells (relative insulin deficiency).

How well did you know this?

Not at all

Perfectly

Signs of diabetes

Polyuria (osmotic diuresis), polydipsia (raised plasma osmolality), hyperglycaemia predisposing to recurrent infections

How well did you know this?

Not at all

Perfectly

Macrovascular complications of diabetes

Cardiac - MI
Renal - glomerulonephritis, pyelonephritis
Cerebral - CVA (cerebrovascular accident)

How well did you know this?

Not at all

Perfectly

Microvascular complications of diabetes

Ocular - diabetic retinopahty

Peripheral vascular system - claudication, change in colour/temp, poor healing ulcer

How well did you know this?

Not at all

Perfectly

Causes of acute pancreatitis

I GET SMASHED 
Idiopathic 
Gallstones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion venom 
Hyperlipidaemia, hypercalcaemia, hypothermia 
ERCP 
Drugs (e.g. thiazides, steroids, sodium valproate)

How well did you know this?

Not at all

Perfectly

Sudden severe epigastric pain radiating to back, relieved but sitting forward + vomiting

Acute pancreatitis

How well did you know this?

Not at all

Perfectly

Periumbilical discolouration

Cullen’s sign in pancreatitis

How well did you know this?

Not at all

Perfectly

Flank discolouration

Grey-turner’s sign in pancreatitis

How well did you know this?

Not at all

Perfectly

Diagnosis of acute pancreatitis

Elevated serum lipase (more sensitive and specific than amylase, which is only raised for 1st 24 hours)

How well did you know this?

Not at all

Perfectly

Histology in acute pancreatitis

Study These Flashcards

Overall: coagulative necrosis
Microvascular leakage - oedema 
Lipases - necrosis of fat 
Acute inflammatory reaction 
Proteolytic destruction of parenchyma 
Interstitial haemorrhage

Causes of chronic pancreatitis

Study These Flashcards

Alcoholism (80%), CF, hereditary, pancreatic duct obstruction (stones/tumour), autoimmune (IgG4 sclerosing)

Chronic pancreatitis

Study These Flashcards

Long-standing inflammation, fibrosis, and destruction of the exocrine pancreas. in its late stages, the endocrine parenchyma also is lost.

Irreversible impairment in function in chronic pancreatitis

Presentation of chronic pancreatitis

Study These Flashcards

Epigastric pain radiating to the back (typically worse 15-30min post meal)
Steatorrhoea: pancreatic insufficiency (5 - 25 years after the onset of pain)
Weight loss due to malabsorption
DM develops in the majority of patients. Usually >20 years after symptom onset
Jaundice

Histology of chronic pancreatitis

Study These Flashcards

Fibrosis and loss of exocrine tissue (acinar loss ubiquitous), duct dilation with thick secretions, calcification
Relative sparing of endocrine islets

Investigations in chronic pancreatitis

CT may show calcifications in pancreas | Faecal elastase may assess exocrine function if imaging inconclusive

Management of chronic pancreatitis

Pancreatic enzyme supplements and analgesia

Pseudocysts, diabetes, pancreatic cancer

Complications of chronic pancreatitis

Acinar cell carcinoma presentation

Non specific Sx; abdo pain, weight loss, nausea and diarrhoea. 10% get multifocal fat necrosis and polyarthragia due to lipase secretion

Neoplastic epithelial cells with esoinophilic granular cytoplasm. Positive imunoreactivity for lipase, trypsin and chymotrypsin.

Histology of acinar cell carcinoma

Schmid triad

Seen in acinar cell carcinoma | sc fat necrosis + eosinophilia + polyarthritis

Prognosis for acinar cell carcinoma

Median survival 18m | <10% 5 year survival

``` A 19 year old American student with bronchiectasis is on inhaled tobramycin for chronic Pseudomonal infection. The mutation delta F508 is identified. A. Carcinoma head of the pancreas B. Pseudocysts C. Gallstones D. Renal tubular acidosis E. Iatrogenic pancreatitis F. Hypercalcaemia G. Cystic fibrosis H. Haemochromatosis I. Insulinoma J. Gallstone pancreatitis K. VIPoma (Werner Morrison syndrome) L. Chronic alcoholic pancreatitis M. Vibrio cholerae infection N. Carcinoma tail of the pancreas ```

Cystic fibrosis

``` A 68 year old smoker presents with jaundice and worsening abdominal and back pain. Scratch marks are seen on his arms and legs. He has lost 5kg in 2 months. Ultrasound shows dilated intrahepatic bile ducts. A. Carcinoma head of the pancreas B. Pseudocysts C. Gallstones D. Renal tubular acidosis E. Iatrogenic pancreatitis F. Hypercalcaemia G. Cystic fibrosis H. Haemochromatosis I. Insulinoma J. Gallstone pancreatitis K. VIPoma (Werner Morrison syndrome) L. Chronic alcoholic pancreatitis M. Vibrio cholerae infection N. Carcinoma tail of the pancreas ```

Carcinoma of head of pancreas

``` A 39 year old Nepalese man presents with severe watery diarrhoea. He is found to have hypokalaemia and, surprisingly, a metabolic acidosis. A RUQ mass is detected by contrast-enhanced spiral CT scanning. Stool bicarb is high and urine anion gap is negative. A. Carcinoma head of the pancreas B. Pseudocysts C. Gallstones D. Renal tubular acidosis E. Iatrogenic pancreatitis F. Hypercalcaemia G. Cystic fibrosis H. Haemochromatosis I. Insulinoma J. Gallstone pancreatitis K. VIPoma (Werner Morrison syndrome) L. Chronic alcoholic pancreatitis M. Vibrio cholerae infection N. Carcinoma tail of the pancreas ```

VIPoma (Werner Morrison syndrome)

``` A 59 year old widow complains of persistent back pain, loss of appetite and that she has dropped from dress size 18 to a size 14 in just 2 months. She was recently diagnosed with diabetes. A large central mass is palpable as well hepatosplenomegaly A. Carcinoma head of the pancreas B. Pseudocysts C. Gallstones D. Renal tubular acidosis E. Iatrogenic pancreatitis F. Hypercalcaemia G. Cystic fibrosis H. Haemochromatosis I. Insulinoma J. Gallstone pancreatitis K. VIPoma (Werner Morrison syndrome) L. Chronic alcoholic pancreatitis M. Vibrio cholerae infection N. Carcinoma tail of the pancreas ```

Carcinoma of tail of pancreas

``` A 47 year old lecturer is referred to hospital clinic from his GP with worsening abdominal pain. He has a poor diet and weight loss. He has previously been prescribed Thiamine. A. Carcinoma head of the pancreas B. Pseudocysts C. Gallstones D. Renal tubular acidosis E. Iatrogenic pancreatitis F. Hypercalcaemia G. Cystic fibrosis H. Haemochromatosis I. Insulinoma J. Gallstone pancreatitis K. VIPoma (Werner Morrison syndrome) L. Chronic alcoholic pancreatitis M. Vibrio cholerae infection N. Carcinoma tail of the pancreas ```

Chronic alcoholic pancreatitis

``` 65 year old female with a large, cystic mass on tail of pancreas imaged using computed tomography. Further cytology reported the presence of epithelium A. Hyperlipidaemia B. Jaundice C. Cystadenoma D. Type 1 Diabetes E. Pancreas Divisum F. Agenesis G. Cystic Fibrosis H. Thrombophlebitis I. Scorpion Sting J. Pseudocyst K. Alcoholism L. Whipples' resection M. Gall Bladder N. Carcinoma of the Pancreas O. Trousseau’s Syndrome P. Pancreatitis ```

Cystadenoma

``` 55 year old, diabetic, afro-Caribbean male presents with weight loss, poor diet and a gnawing pain in his back, which is sometimes felt ‘under his chest’ A. Hyperlipidaemia B. Jaundice C. Cystadenoma D. Type 1 Diabetes E. Pancreas Divisum F. Agenesis G. Cystic Fibrosis H. Thrombophlebitis I. Scorpion Sting J. Pseudocyst K. Alcoholism L. Whipples' resection M. Gall Bladder N. Carcinoma of the Pancreas O. Trousseau’s Syndrome P. Pancreatitis ```

Carcinoma of the pancreas

``` The commonest cause of acute pancreatitis in the UK. A. Hyperlipidaemia B. Jaundice C. Cystadenoma D. Type 1 Diabetes E. Pancreas Divisum F. Agenesis G. Cystic Fibrosis H. Thrombophlebitis I. Scorpion Sting J. Pseudocyst K. Alcoholism L. Whipples' resection M. Gall Bladder N. Carcinoma of the Pancreas O. Trousseau’s Syndrome P. Pancreatitis ```

Alcoholism

``` Inflammatory condition of the exocrine pancreas that results in injury to acinar cells. A. Hyperlipidaemia B. Jaundice C. Cystadenoma D. Type 1 Diabetes E. Pancreas Divisum F. Agenesis G. Cystic Fibrosis H. Thrombophlebitis I. Scorpion Sting J. Pseudocyst K. Alcoholism L. Whipples' resection M. Gall Bladder N. Carcinoma of the Pancreas O. Trousseau’s Syndrome P. Pancreatitis ```

Pancreatitis

``` ERCP finding due to incomplete fusing of pancreatic buds. A. Hyperlipidaemia B. Jaundice C. Cystadenoma D. Type 1 Diabetes E. Pancreas Divisum F. Agenesis G. Cystic Fibrosis H. Thrombophlebitis I. Scorpion Sting J. Pseudocyst K. Alcoholism L. Whipples' resection M. Gall Bladder N. Carcinoma of the Pancreas O. Trousseau’s Syndrome P. Pancreatitis ```

Pancreas divisum

Accounts for 85% of all pancreatic malignancies

Ductal adenocarcinoma of pancreas

RFs for carcinoma of pancreas

Smoking, pancreatitis, diet, age, genetic (e.g.. FAP, HNPCC)

Clinical features

Weight loss + anorexia = advanced disease Upper abdo and back pain (chronic, persistent and severe) Painless jaundice, pruritus, steatorrhoea (due to decreased exocrine function) DM Trousseau's syndrome - superficial thrombophlebitis Ascites Abdominal mass Virchow's node Courvoisier's sign

Trousseau's syndrome

Superficial thrombophlebitis

Investigations in suspected pancreatic cancer

High resolution CT modality of choice if diagnosis suspected CT/MRI/ERCP Bloods: increased bilirubin and calcium, decreased haemoglobin Elevated CA19.9 (>70IU/ml) - not very sensitive or specific

Management of pancreatic cancer

``` Palliative chemotherapy (5-FU) Surgery (15% cases) - Whipple's procedure - surgical resection ERCP + stenting = palliation ```

Prognosis of ductal adenocarcinoma of the pancreas

<5% 5 year survival rate = very poor

Pancreatic disease Flashcards

(48 cards)