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31 Cards in this Set
- Front
- Back
The main pancreatic duct joins at the _______ and drains into the _________.
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Main pancreatic duct joins common bile duct at ampulla of Vater where it drains into duodenum of major papilla (of Vater).
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The accessory duct drains into the __________ through______.
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Accessory duct of Santorini drains into duodenum through minor papilla
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Pancreas divisum:
What is it? Clinical consequences? |
Most common clin sig anomaly of pancreas (3-10% incidence)
Occurs when fetal duct system of pancreatic primordia fail to fuse. Main panc duct is short and drains only a small portion of pancreas Bulk is drained through minor sphincter |
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Annular pancreas:
What is it? Clinical consequences? |
Uncommon; ring of pancreas encircles duodenum
Causes duodenal obstruction |
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Ectopic pancreas:
What is it? Clinical consequnces? |
2% of populn; favored sites in stomach, duod, jejunum, Meckel's diverticulum, ileum
Usually incidental but can cause pain |
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Pancreatic acini:
Role |
Produce proenzymes and store them in zymogen granules
Note: amylase, lipase not proenzymes! |
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Pancreatic ductuules:
Role |
Secrete bicarb rich fluid
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What pancreatic enzymes are not released as zymogens?
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Amylase, lipase
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How does the pancreas protect itself from autodigestion?
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Synthesis of proenzymes and their sequestration in zymogen granules; activation occurs in duodenum by enterokinase
Produces trypsin inhibitors: SPINKI (serine protease inhibitor Kazal I) and PSTI (pancreatic secretory trypsin inhibitor) Acinar cells remarkably resistant to actions of enzymes |
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Pancreatitis:
Acute vs Chronic (General) |
Acute: Reversible pancreatic parenchymal injury assocd w/inflammn
Chronic: inflammn w/irreveresible destruction of exocrine parenchyma, fibrosis |
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Acute pancreatitis:
Causes |
Biliary tract dz--Gall Stones
EtOH |
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Hereditary pancreatitis:
Pathophys |
Inherited genes encoding inhibitors of pancreatic enzymes; and in genes encoding panc prots.
Most causes caused by mutation of trypsinogen gene PRSS1 |
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PRSS1
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PRSS1: gene encoding trypsinogen
Mutation associated with hereditary pancreatitis; allowing small amts of trypsin inappropriately act'd to set off cascade of actvtn of other zymogens. Autosomal dominant |
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SPINK1
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Serine protease inhibitor Kazal type 1: encodes for protein that inhibits trypsin.
If undergoes inactivating mutation-->hereditary pancreatitis Autosomal recessive |
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Effects of duct obstruction.
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Duct obstruction-->inc'd intrapanc ductal pressure via accumuln of enzyme rich fluid
Lipase (secreted in active form)-->fat necrosis Injured tissue-->inflammn, edema (can eventually lead to vasc insuff and ischemia) |
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Acinar cell injury:
Causes |
Pancreatitis--mech unsure
Mumps! As well as drugs and direct trauma following ischemia, shock. Defective intracell transport of proenzymes |
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Chronic pancreatitis:
Causes |
Most common cause is alcohol abuse
May present as repeated bouts of acute pancreatitis |
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Pancreatitis:
Clinical presentation Lab features |
Abdominal pain, anorexia, nausea, vomiting
Marked elevation of serum amylase within first 24 hrs, followed with high serum lipase w/in 72-96 hours Hypocalcemia!!! resultsing form ppt of Ca in fat necrosis |
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Chronic pancreatitis:
Pathophys |
Ductal obstruction due to protein plugs--esp in EtOHism
EtOH exerts direct toxic effect EtOH and oxidative stress-->fusion of lysosomes and zymogen granules-->necrosis Chemokines released. |
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Lymphoplasmacytic sclerosis pancreatitis:
Pathophys Treatment |
Autoimmune!
Characterized by inflammatory cell infiltrate and inc'd numbers of plasma cells producing IgG4!!! Can mimic pancreatic cancer Responds to steroids |
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This form of pancreatitis can mimic pancreatic cancer.
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Lymphoplasmacytic sclerosis pancreatitis
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What defines a pseudocyst?
When do they arise? |
Localized collection of necrotic/hemorrhagic material lacking epithelial lining
75% of cysts in pancreas! Arise in acute and chronic pancreatitis as well as trauma |
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Serous cystadenoma:
Benign/Malignant Histology Treatment |
Cystic neoplasm almost always benign
Clear cuboidal cells filled with glycogen surrounding MICROCYSTS Surgery is curative |
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Mucinous cystadenoma:
Benign/Malignant Histology |
Can be assocd w/adenoca--needs path assessment
Filled with thick mucin and lined by columnar mucin producing epithelium |
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This cyst contains an ovarian-like stroma.
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Mucinous cystadenoma
also tends to affect women more |
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Intraductal Papillary Mucinous Neoplasms:
Benign/Malignant Histology |
May be invasive, must be path assessed
Mucin producing with columnar cells Involve pancreatic duct (mucinous neoplasms don't connect) |
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This cyst is commonly found at the head of the pancreas.
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IPMN
(mucinous cystadenomas can be found there too) |
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Pancreatic carcinoma:
Clinical features Associated mutations |
Remains silent until invades adjacent structures; pain is first symptom, then obstructive jaundice, DM, weight loss
Assocd mutations: KRAS p16 inactivated (tumor suppressor) SMAD4 inactivated (tumor suppressor) p53 inactivated (cell cycle regulation, induces apoptosis) |
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Pancreatic Intraepithelial Neoplasia:
What is it? |
Precursor lesion to pancreatic carcinoma
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______ often grows along adjacent nerves.
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Pancreatic carcinoma
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Acinar cell carcinoma:
Histology Features |
Acinar cell differentiation with formation of zymogen granules
Can develop metastatic fat necrosis by release of lipase into circulation |