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31 Cards in this Set

  • Front
  • Back
The main pancreatic duct joins at the _______ and drains into the _________.
Main pancreatic duct joins common bile duct at ampulla of Vater where it drains into duodenum of major papilla (of Vater).
The accessory duct drains into the __________ through______.
Accessory duct of Santorini drains into duodenum through minor papilla
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
Annular pancreas:
What is it?
Clinical consequences?
Uncommon; ring of pancreas encircles duodenum

Causes duodenal obstruction
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
Pancreatic acini:
Role
Produce proenzymes and store them in zymogen granules

Note: amylase, lipase not proenzymes!
Pancreatic ductuules:
Role
Secrete bicarb rich fluid
What pancreatic enzymes are not released as zymogens?
Amylase, lipase
How does the pancreas protect itself from autodigestion?
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
Pancreatitis:
Acute vs Chronic (General)
Acute: Reversible pancreatic parenchymal injury assocd w/inflammn

Chronic: inflammn w/irreveresible destruction of exocrine parenchyma, fibrosis
Acute pancreatitis:
Causes
Biliary tract dz--Gall Stones
EtOH
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
PRSS1
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
SPINK1
Serine protease inhibitor Kazal type 1: encodes for protein that inhibits trypsin.

If undergoes inactivating mutation-->hereditary pancreatitis

Autosomal recessive
Effects of duct obstruction.
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)
Acinar cell injury:
Causes
Pancreatitis--mech unsure

Mumps! As well as drugs and direct trauma following ischemia, shock.

Defective intracell transport of proenzymes
Chronic pancreatitis:
Causes
Most common cause is alcohol abuse

May present as repeated bouts of acute pancreatitis
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
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.
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
This form of pancreatitis can mimic pancreatic cancer.
Lymphoplasmacytic sclerosis pancreatitis
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
Serous cystadenoma:
Benign/Malignant
Histology
Treatment
Cystic neoplasm almost always benign

Clear cuboidal cells filled with glycogen surrounding MICROCYSTS

Surgery is curative
Mucinous cystadenoma:
Benign/Malignant
Histology
Can be assocd w/adenoca--needs path assessment

Filled with thick mucin and lined by columnar mucin producing epithelium
This cyst contains an ovarian-like stroma.
Mucinous cystadenoma

also tends to affect women more
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)
This cyst is commonly found at the head of the pancreas.
IPMN

(mucinous cystadenomas can be found there too)
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)
Pancreatic Intraepithelial Neoplasia:
What is it?
Precursor lesion to pancreatic carcinoma
______ often grows along adjacent nerves.
Pancreatic carcinoma
Acinar cell carcinoma:
Histology
Features
Acinar cell differentiation with formation of zymogen granules

Can develop metastatic fat necrosis by release of lipase into circulation