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Path: Liver 5 - Liver, Pancreas, Biliary tract (ii) (Pancreatic carc…
Path: Liver 5 - Liver, Pancreas, Biliary tract (ii)
Pancreas
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2 components, embryologically distinct
98% exocrine: composed of glandular acini grouped into lobules, make digestive enzymes
exocrine secretions drain via ducts, honing to form pancreatic duct, when enters duodenum @ ampulla of Vater (surrounded by sphnicter of Oddi) along with the CBD in 75% of people (hence ERCP could trigger acute pancreatitis - auto digestion)
enzymes secreted in inactive form, require activation by gut enzymes
endocrine: islets of Langerhans, hormones (insulin, glucagon) secreted into blood
normal histology: small pancreatic duct surrounded of exocrine pancreatic glandular acini, islet cells stain paler
Pancreatic tumours
exocrine
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other less common tumours (sometimes cystic) may be benign or have intermediate behaviour (some recognised as precursors to pancreatic carc)
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Pancreatic carc
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60-70% from head, rest from body + tail
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symptoms
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vague abdo pain, may radiate to back (Ns involved)
rarely: palpable mass, thrombotic tendency (migratory thrombophlebitis = Trousseau's sign - also in lung cancer)
Dx
CA (cancer antigen) 19-9 serum marker for pancreatic-biliary cancer not useful in dx, used for response/relapse management
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prognosis
5 yr survival < 3%, most die within 1 yr
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Drugs + the liver
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admin of 1 drug may induce/inhibit liver enzymes + after metabolism of another drug - check drug interactions
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drug hx NB: incl OTC, herbal, recreational
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DILI
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type 2
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e.g. NSAIDs, antibiotics, statins
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hepatocellular damage
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Antibiotics, NSAIDs, statins, anti-epileptics, isoniazid (anti-TB)
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cholestatic reactions (acute or chronic) can be caused by erythromycin, chlorpromazine, augmentin, OCP
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