Flashcards in Parcreatic pathology Deck (36):
What are the exocrine functions of the pancreas?
Most of pancreas (85%)
Secrete digestive enzymes
- amylase (marker of pancreatic inflammation) which require activation
What are the endocrine functions of the pancreas?
Islets of Langerhans
Secrete peptide hormones into blood (e.g. insulin and glucagon)
What are the clinical features of acute pancreatitis?
Usually presents as an emergency requiring admission to hospital
Sudden onset of severe abdo pain radiating to back
Nausea and vomiting
May be mild (recovery within 5-7 days) but can be serious with high mortality
Raised serum amylase/lipase (>3x normal)
What are the possible aetiologies of acute pancreatitis?
Gallstones (50% cases)
Alcohol (25% cases)
Rare causes (
What is the pathogenesis of acute pancreatitis?
Leakage and activation of pancreatic enzymes
Amylase released into blood
- swollen gland with fat necrosis
- necrotic gland with fat necrosis and haemorrhage
- Grey Turner’s sign
- Cullen’s sign
Hypocalcaemia (fatty acids bind calcium ions), hyperglycaemia, abscess formation, pseudocysts
What are the features of fat necrosis?
Chalky white material containing calcium salts which have been freed up by lipase mediated cleavage of fatty acids.
What is Grey Turner's sign?
Haemorrhage into the subcutaneous tissues of flank. Seen in severe acute pancreatitis.
What is Cullen's sign?
Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Seen in acute pancreatits.
Also in ruptured ectopic pregnancy.
What are the complications of acute pancreatitis?
Pseudocysts (collections of pancreatic juice secondary to duct rupture)
What is chronic pancreatitis?
Progressive inflammatory disorder in which parenchyma of pancreas is destroyed and replaced by fibrous tissue.
Irreversible destruction of the exocrine tissue, followed by destruction of the endocrine tissue
Leads to malnutrition and diabetes
What is the overlap between acute and chronic pancreatitis?
Recurrent acute can develop chronic pancreatitis
Overlap causative factors
Both genetic and environmental
Experimental protocols can be modified to induce each condition
What are the causes of chronic pancreatitis?
- cigarette smoke
- hyperparatyroidism infections
- SPINK 1 mutations
Obstruction of main duct
Recurrent acute pancreatitis
Excluding CF, what percentages of chronic pancreatitis is caused by alcohol consumption.
What percentage of alcoholics develop pancreatitis?
What is a strong independent risk factor for pancreatitis?
What are the complications of chronic pancreatitis?
Malabsorption of fat (lack of lipases)
- Impairment of fat soluble vit absorption –A,D, E and K
- Diarrhoea, weight loss and cachexia
Diabetes (late feature)
Stenosis of common bile duct/duodenum
Mortality rate - nearly 50% with 20-25years of disease onset
What are the gross and microscopic features of pancreatitis?
Localised, irregular involvement of the gland early on, later global atrophy.
Dilated and distorted ducts
Calculi, esp in alcohol induced
What is the most common type of pancreatic cancer?
Up to 90%
What is the 5-year-survival rate for pancreatic adenocarcinoma?
What is the typical age range for for pancreatic adenocarcinoma?
How much does smoking increase the risk of developing pancreatic adenocarcinoma?
Drops with abstinence
What are the other risk factors for pancreatic adenocarcinoma (other than smoking).
Heavy alcohol intake
Diet rich in red meats
What is the distribution of pancreatic adenocarcinoma about the pancreas?
60-70% head of pancreas
5-15% diffuse involvement
For how long is pancreatic adenocarcinoma present before it's detected?
At least a decade
What is Trousseau's syndrome?
What is Courvoisier's sign?
Palpable gallbladder without pain
What are the symptoms of pancreatic cancer?
Epigastric pain, radiating to back
Weight loss, painless jaundice, pruritis and nausea.
Trousseau’s syndrome and Courvoisier’s sign (palpable gallbladder without pain)
Distant metastases (liver, peritoneum, lung)
Diabetes – increases risk and can be a presenting complication
What is the prognosis for pancreatic adenocarcinoma?
Almost universally fatal (incidence nearly equals mortality)
Mean survival untreated is 3-5 months
10-20 months post- surgery but only 10-20% are resectable at the time of diagnosis.
What are the poor prognostic factors for pancreatic adenocarcinoma?
Extension of tumour outside the pancreas
Metastatic spread to local lymph nodes
Vascular and perineural invasion
Grade of differentiation
What hereditary cancer syndromes cause 5-10% of pancreatic adenocarcinoma?
- DNA mismatch repair
Familial breast cancer
Cationic trypsinogen, - SPINK1
How common are pancreatic neuroendocrine tumours?
What is the age range for pancreatic neuroendocrine tumours?
What conditions increase your risk of pancreatic neuroendocrine tumours?
von Hippel Lindau
What are the features of well-differentiated neuroendocrine tumours?
Uncommon 1-2% all pancreatic neoplasms
Any age, rare in children
7-13% multiple (MEN-1)
Single tumours often produce multiple hormones but usually single hyperfunctional syndrome
What are the features of poorly differentiated neuroendocrine carcinomas?
Advanced disease at presentation
Prognosis without treatment 1-2 months, with chemotherapy up to 50 months