Imported: Gi_Test 2: Tol_Pathology Of Pancreas

Front 1

What is pancreas divisum?

Back 1

most common congenital anomaly

persistent separation of dorsal and ventral developmental anlages

the majority pancreatic secretions are trying to go through the smaller accessory duct of Santorini

this causes it to back up, and you autodigest your pancreas

can get chronic pancreatitis

Front 2

Majority of parenchyma drains exocrine secretions via the smaller accessory duct of Santorini through a small papilla → prone to impaired drainage and chronic pancreatitis

this describes?

Back 2

Pancreas divisum

Front 3

major complication of annular pancreas?

what about pancreas divisum?

Back 3

annular- duodenal obstruction (annular pancreas is a ring of pancreatic tissue that encircles the duodenum)

divisum- chronic pancreatitis

Front 4

for cystic fibrosis, please list the functional problem, genetics, group most commonly effected, and what generally happens (in the pancreas)

Back 4

Genetic mutation with abnormal function of epithelial ion (Cl-) channel protein: cystic fibrosis transmembrane conductance regulator (CFTR)

Autosomal Recessive

Seen in Caucasians (most common lethal genetic disorder)

Abnormally viscous secretions (mucoviscidosis leading to pancreatic insufficiency and chronic pancreatitis)

Front 5

Activation of pancreatic proenzymes within the pancreas with autodigestion and inflammation is seen in what form of pancreatitis?

Back 5

Acute pancreatitis

Front 6

what happens in necrotizing acute pancreatitis?

Back 6

pancreatic fat is digested and saponification and calcification with necrosis

Front 7

2 major causes of acute pancreatitis?

Back 7

EtOH abuse

Gallstones

Front 8

how do gallstones lead to pancreatitis?

Back 8

obstruction of the common bile duct can lead to release of pancreatic proezymes

also, bile backing up can cause this release

Front 9

how does chronic alcohol consumption cause acute pancreatitis?

Back 9

EtOH thickens ductal secretions; increases exocrine secretions and constricts sphincter of Oddi; toxic to acinar cells

Only ~ 5% chronic alcoholics develop pancreatitis

Front 10

pt presents with abdominal pain, nausea, vomiting, fever, and "acute abdomen" (increased WBC, hemolyisis, hypovolemia, hypoxia, ARDS)..what do they have?

Back 10

Acute pancreatitis

Front 11

What are Turner and Cullen's signs? associated with?

Back 11

flank (turner)
periumibilical (cullen)

hemorrhage

looks like a giant nasty bruise on the skin

associated with acute pancreatitis

Front 12

what is a pancreatic pseudocyst? why is this important?

Back 12

abdominal mass with

AMYLASE in the psuedocyst

this is associated with acute pancreatitis

this is important because when you see some growth on the pancreas you need to know if it is malignant or not, when you aspirate amylase that lets you know it is a pseudocyst and not a tumor

Front 13

if you do a Ranson's criteria for acute pancreatitis and the WBC >16,000 what should you be thinking (general)

Back 13

this is a worse prognosis for a pt

Front 14

is chronic pancreatitis reversible or no?

Back 14

NO

Front 15

most common cause of chronic pancreatitis?

Back 15

ALCOHOL

Front 16

sequelae of chronic pancreatitis?

Back 16

Malabsorption (leading to decreased exocrine fnx, steatorrhea, ect)

Type 1 Diabetes Mellatus (Brittle diabetes- – loss of both insulin and glucagon; hard to regulate blood glucose)

Front 17

what is Brittle Diabetes? associated with what?

Back 17

– loss of both insulin and glucagon
Very difficult to regulate blood glucose

associated with Chronic Pancreatitis

Front 18

just some notes to review for congenital cysts

Back 18

Dilatation of ducts

Polycystic diseases: cysts in kidneys, liver and other organs/tissues

ADPKD; von Hippel-Lindau disease

Unilocular, thin-walled; lined by attenuated (stretched and thinned) simple cuboidal epithelium

Front 19

this is a benign pancreatic tumor that has non-mucus fluid in it. It has a spongy look and affects F>M in 7th decade of life

Back 19

Serous Cystadenoma

Front 20

pt gets a CT and there is a growth on body and tail of the pancreas... what type of cyst do you think this is? What sex would you guess the pt to be?

**

Back 20

Mucinous Cystic Neoplasm

Female (F>>M 9:1)

tend to find on body or tail > head

Front 21

pt gets a CT and there is a tumor found on the head of the pancreas. What would you guess this to be? What sex would you guess your pt is?

**

Back 21

Intraductal papillary mucinous neoplasm (IPMN)

Male (M>F; 6th decade; appear to arise within large pancreatic duct)

Head of pancreas >> tail

Front 22

Pancreatic ductal carcinoma often affects what portion of the pancreas? Prognosis?

**

Back 22

Head

4th leading cause of cancer deaths in USA (behind lung, colon, and breast)
One of highest mortality rates of any cancer

Front 23

Genetic change associated with pancreatic ductal carcinoma?

**TEST

Back 23

K-RAS --> p16 --> p53 --> SMAD4 --> BRCA2

Front 24

pt presents with jaundice, abdominal pain, weight loss, and diabetes mellitus, and migratory thrombophlebitis...what do they have?

Back 24

ductal pancreatic cancer

Front 25

What is Trousseau's Sign? Associated with?

Back 25

(Also known as thrombophlebitis)

mucin associated with pancreatic carcinoma is prothrombotic, so when you have cancer cells gain access to the blood, those antigens that are associated with the mucin, you get blood clots

the seem to appear, then lyse in different places in the body

makes it look like blood clots are traveling throughout the body

associated with pancreatic ductal cancer

Front 26

increased conjugated bilirubin shows what?

Back 26

obstruction of the liver ducts

Front 27

Main duct:____ → most commonly drains via ampulla of Vater

» Joins common bile duct

Back 27

Wirsung

Front 28

Accessory duct:____ → most often drains into duodenum cranial to ampulla of Vater via a separate papilla

Back 28

Santorini

Front 29

______ contain inactive proenzymes

-What cells release these?

Back 29

Zymogen Granules released by Acinar Cells

(Note: Amylase and Lipase are ACTIVE enzymes released by acinar cells)

Front 30

Exocrine Cells of Pancreas?

Back 30

Acinar Cells

Ductular Cells

Front 31

Describe pain present with exocrine pancreas pathology

Back 31

**Pain**
– Epigastric, radiating to
back

• Exacerbated by eating,
EtOH

Front 32

Digestive symptoms related to exocrine pancrease pathology?

Back 32

Diarrhea

Steatorrhea

Anorexia, sitophobia,
weight loss

Front 33

– Pancreas completely encircles the 2nd portion of the duodenum

– Duodenal obstruction and other congenital anomalies

Back 33

Annular (ring-like) Pancreas

Front 34

Heterotopic rests (patches) of pancras tissue in stomach, meckel diverticulum and small bowel

Back 34

Choristomas

**Usually clinically insignificant"

Front 35

Caucasian male has abnormally viscous secretions (mucoviscidosis leading to pancreatic insufficiency and chronic pancreatitis)

Disease and common genetic mutation?

Back 35

Cystoc Fibrosis

Mutation of CTFR channel

Front 36

How can hypertriglyceridemia lead to acute pancreatitis?

Back 36

Chylomicrons in blood obstruct pancreatic capillaries causing necrosis and ischemia

Front 37

Injury to the ductules or the acinar cells leads to the release of pancreatic enzymes. Lipase and proteases destroy tissue..

Back 37

Acute Pancreatitis

Front 38

Which lab test has a higher sensitivity and specificity for acute pancreatitis?

Back 38

Serum immunoreactive trypsin

Front 39

“Consumption” of free ionized Ca+2 in the process of enzymatic fat necrosis

(Sequelae of Acute Pancreatitis)

Back 39

Tetany

Front 40

When doing serum testing for acute pancreatitis, which enzyme level in serum is more reliable, amylase or lipase?

Back 40

Lipase!

Amylase is less specific because it is also released by salivary glands and has a shorter half life

Front 41

What drug is useful in treating chronic pancreatitis because it decreases pancreatic enzyme secretions?

Back 41

Octreotide
(somatostatin analog)

Front 42

Non-neoplastic Pancreatic Cysts:

– Localized collection of fluid (hemorrhagic, necrotic)

– Rich in pancreatic enzymes (e.g., amylase)

– Lack epithelial lining (hence not a true cyst)

– Associated with acute pancreatitis; trauma

Back 42

Pseudocysts

Front 43

Non-neoplastic Pancreatic Cysts:

Dilatation of ducts

Polycystic diseases: cysts in kidneys, liver and other organs/tissues

ADPKD; von Hippel-Lindau disease

Unilocular, thin-walled; lined by attenuated (stretched and thinned) simple cuboidal epithelium

Back 43

Congenital Cysts

Front 44

Dense “ovarian-type” stroma present in wall of cyst

Back 44

Mucinous cystic neoplasm

Front 45

Neoplasm that most commonly occurs in the head of pancreas and is associated with marked dilation of a large pancreatic duct

Back 45

Intraductal papillary mucinous neoplasm (IPMN)

Front 46

What is the most common kind of malignant neoplasm of the exocrine pancreas?

Back 46

Pancreatic Ductal Carcinoma

Front 47

Common risk factors for Pancreatic Ductal Carcinoma?

Back 47

Smoking

Chronic Pancreatitis

Obesity

Diet rich in meats and animal products