Pancreatic pathology

Question 1

Four major categories of pancreatitis

Answer 1

1. Metabolic; alcohol
2. Mechanical; gallstones, trauma
3. Vascular; shock vasculitis
4. Infection; mumps

Question 2

Pathology of pancreatitis

Answer 2

1. damage to acinar cells results in release of pancreatic enzymes
2. Cell injury response mediated by inflammatory cytokines

Question 3

Clinical features of pancreatitis

Answer 3

Acute epigastric abdo pain
Nausea and vomitng (closely associated with duodenum)
Fever, tachycardia (inflammatory response, release of cytokines)

Question 4

Clinical diagnosis of acute pancreatitis

Answer 4

1. Clinical signs and symptoms
2. High white cell count
3. Elevated serum amylase and lipase
4. CT scan, oedema, necrosis, pseudocysts

Question 5

Management

Answer 5

Rest the pancreas
IV fluids
NG suction (remove gastric/duodenal secretions)
Analgesia
Close monitoring

Question 6

Aetiology of chronic pancreatitis

Answer 6

60-70% heavy alcohol intake

Other causes include previous acute pancreatitis, malnutrition, cystic fibrosis

Question 7

Pathology of chronic pancreatitis

Answer 7

Fibrotic organ
Atrophy of exocrine components but endocrine maintained (relatively)
Calcification

Question 8

Diagnosis

Answer 8

Clinical suspicion
Amylase- may not be elevated
CT imaging
Pseudocysts

Question 9

Pancreatic carcinoma

Answer 9

4th most common cause of cancer death.
Late presentation (not until obstruction or big) so poor prognosis (

Question 10

Pathology

Answer 10

Adenocarcinoma.
Majority in head of pancreas
Can invade ampulla, biliary obstruction
Body and tail cancers remain silent and metastasise to adjacent organs

Question 11

Presentation of pancreatic cancer

Answer 11

Jaundice (obstructive), pain, weight loss, pancreatitis, thrombophlebitis,

Question 12

Diagnosis

Answer 12

Imaging, CT/ USS