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PANCREAS DISEASES (Normal Anatomy & Physiology (. (Exocrine Panceas…

- - - - Diseases
        
        Carcinoma
        
        Pacreatitis
        (Acute vs. Chronic)
        
        Congenital Abnormalities
        (ex: Cystic Fibrosis)
  - - - Diseases
        
        Diabetes
        
        Tumors
      - Islets of Langerhans Cells
        
        20% Alpha Cells --> glucagon
        
        3-5% Gamma Cells --> somatostatin
        
        75% Beta Cells --> Insulin
        
        <2% F Cells = PP cells --> pancreatic polypeptide
- - - - (20%) Alcoholism
        
        mechanism unknown
      - Other
        
        shock
        
        mumps virus
        
        hypothermia
        -trauma
      - (50%) Choledocholithiasis
        
        Gall Stones obstructing the bile ducts
        --> distal to the hepatic and pancreatic duct junction
        
        forces bile back up to the main pancreatic duct
        --> causes damage to acinar cells
    - - 2/3 Rules for acute pancreatitis
        - pancreatic lipase
        --> more specific than serum amylase
        
        raised serum amylase (key marker)
        --> amylase made in the salivary glands, but mostly from the pancreas
      - presentation of acute pancreatitis
        
        WRETCHING epigastric pain
        --> radiates to the back
        --> rapid onset
        
        vomiting
        
        guarding upper abdomen
      - *pancreatitis Complications
        
        pseudocyst formation
        --> this is a key protection effect from the pancreas trying to wall off the activated zymogens
        --> recall the definition of pancreatitis = pancreas enzymes digesting itself
        
        *pseudocyst formation
        --> this is a key protection effect from the pancreas trying to wall off the activated zymogens
        --> recall the definition of pancreatitis = pancreas enzymes digesting itself
      - Pathophysiology of acute pancreatitis
        
        trypsinogen is trapped in main pancreatic duct
        --> activated prematurely into trypsin (peptic enzyme)
        --> trypsin activates all other zymogens
        --> destruction of exocrine cells (duct and acinar)
        
        will see focal fat necrosis --> due to lipase digesting pancreatic fat
- - - - Rare (1%) Pancreatic Islet Cell tumours
        
        most common = insulinoma
        --> from Beta cells
        (recall Beta cells are 75% of Islets)
        --> 5% are malignant
      - Risk Factors
        
        smoking
        
        high fat/meat intake
        
        history of gastrectomy or pancreatitis
      - Location
        
        20% diffuse
        
        60% head
        
        10% tail
        
        10% body
      - Signs and Symptoms
        
        weight loss
        
        jaundice
      - (99%) Adenocarcinoma
        
        since 80% of pancreas is
        exocrine and rest is endocrine
        --> glandular secreting cells --> adeno-
    - - *Whipple procedure surgery
        
        Whipple procedure = removing the head of the pancreas and body where the adeno CA is
        --> plus remove the GB
    - - *SPECIFIC signs of pancreas adeno CA
        
        Trousseau Syndrome
        --> migratory thromboplebitis = clotting
        
        Courvoisier Sign
        --> obstructive jaundice with NON-tender PALPABLE GB
        
        *Trousseau Syndrome = pancreas ADENO CA
        
        migratory thromboplebitis = clotting
        
        *Courvoisier Sign = pancreas ADENO CA
        
        obstructive jaundice with NON-tender PALPABLE GB