Parcreatic pathology Flashcards Preview

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Flashcards in Parcreatic pathology Deck (36):
1

What are the exocrine functions of the pancreas?

Most of pancreas (85%)

Glands- ducts-duodenum

Secrete digestive enzymes
- trypsin
- lipase
- phospholipase
- elastase
- amylase (marker of pancreatic inflammation) which require activation

2

What are the endocrine functions of the pancreas?

Islets of Langerhans

Secrete peptide hormones into blood (e.g. insulin and glucagon)

3

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)

4

What are the possible aetiologies of acute pancreatitis?

Gallstones (50% cases)

Alcohol (25% cases)

Rare causes (

5

What is the pathogenesis of acute pancreatitis?

Leakage and activation of pancreatic enzymes

Amylase released into blood

Mild pancreatitis
- swollen gland with fat necrosis

Severe
- swollen
- necrotic gland with fat necrosis and haemorrhage
- Grey Turner’s sign
- Cullen’s sign

Hypocalcaemia (fatty acids bind calcium ions), hyperglycaemia, abscess formation, pseudocysts

6

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.

7

What is Grey Turner's sign?

Haemorrhage into the subcutaneous tissues of flank. Seen in severe acute pancreatitis.

8

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.

9

What are the complications of acute pancreatitis?

Shock

Intravascular coagulopathy

Haemorrhage

Pseudocysts (collections of pancreatic juice secondary to duct rupture)

10

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

11

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

12

What are the causes of chronic pancreatitis?

Toxic
- alcohol
- cigarette smoke
- drugs
- hypercalcaemia
- hyperparatyroidism infections

Genetic
- CFTR
- PRSS1
- SPINK 1 mutations
Obstruction of main duct
- cancer
- scarring

Recurrent acute pancreatitis

Autoimmune

Idiopathic

13

Excluding CF, what percentages of chronic pancreatitis is caused by alcohol consumption.

90-95%

14

What percentage of alcoholics develop pancreatitis?

10%

15

What is a strong independent risk factor for pancreatitis?

smoking

16

What are the complications of chronic pancreatitis?

Malabsorption of fat (lack of lipases)
- Steatorrhoea
- Impairment of fat soluble vit absorption –A,D, E and K
- Diarrhoea, weight loss and cachexia

Diabetes (late feature)

Pseudocysts

Stenosis of common bile duct/duodenum

Mortality rate - nearly 50% with 20-25years of disease onset

17

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

Fatty replacement

Pseudocyst formation

18

What is the most common type of pancreatic cancer?

Ductal adenocarcinoma

Up to 90%

19

What is the 5-year-survival rate for pancreatic adenocarcinoma?

4%

20

What is the typical age range for for pancreatic adenocarcinoma?

60-80 years

21

How much does smoking increase the risk of developing pancreatic adenocarcinoma?

2-3x

Drops with abstinence

22

What are the other risk factors for pancreatic adenocarcinoma (other than smoking).

Heavy alcohol intake

Diet rich in red meats

Obesity

Hereditary (10%)

Chronic pancreatitis

23

What is the distribution of pancreatic adenocarcinoma about the pancreas?

60-70% head of pancreas

5-15% body

10-15% tail

5-15% diffuse involvement

24

For how long is pancreatic adenocarcinoma present before it's detected?

At least a decade

25

What is Trousseau's syndrome?

Migratory thrombophlebitis

26

What is Courvoisier's sign?

Palpable gallbladder without pain

27

What are the symptoms of pancreatic cancer?

Non-specific

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

28

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.

29

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

30

What hereditary cancer syndromes cause 5-10% of pancreatic adenocarcinoma?

HNPCC
- DNA mismatch repair

FAMMM
- p16/cdkn2A

Familial breast cancer
- BRCA2

Ataxia-telangiectasis
- ATM

Von Hippel-Lindau
- VHL

Familial pancreatitis
Cationic trypsinogen, - SPINK1

Peutz-Jeghers
- LKB1/STK11

31

How common are pancreatic neuroendocrine tumours?

32

What is the age range for pancreatic neuroendocrine tumours?

20-60 years

33

What conditions increase your risk of pancreatic neuroendocrine tumours?

MEN1

von Hippel Lindau

34

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)

15-35% non-functioning

Single tumours often produce multiple hormones but usually single hyperfunctional syndrome

35

What are the features of poorly differentiated neuroendocrine carcinomas?

Rare

Females

40-75 years

Advanced disease at presentation

Prognosis without treatment 1-2 months, with chemotherapy up to 50 months

36

What are the macroscopic features of pancreatic neuroendocrine tumours?

Usually well circumscribed, sometimes encapsulated

Solid

10 - >50mm

Occur anywhere in pancreas

Can be multiple

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