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47 Cards in this Set
- Front
- Back
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Pancreas Divisum
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separation of dorsal & ventral developmental anlages
*most common congenital anomaly |
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Annular Pancreas
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band-like ring of normal pancreatic tissue that encircles the duodenum
presents symptoms of Duodenal (Small Bowel Obstruction) |
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Choristomas/heterotopic rests
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mass of normal tissue in an abnormal place
embryologic rests located in submucosa cause pain from localized infection |
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Pancreatitis
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inflammation in pancreas associated with injury to exocrine parenchyma
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Acute Pancreatitis
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reversible pancreatic parenchymal injury
associated w/ inflammation |
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Acute Pancreatitis -- causes
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Alcoholics >> Gallstones
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Acute Pancreatitis--morphology
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autodigestion of pancreatic substances
due to inappropriate ACTIVATION of pancreatic enzymes |
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Interstial Acute Pancreatitis
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mild inflammation
interstitial edema focal areas of Fat Necrosis |
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Hemorrhagic Acute Pancreatitis
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vascular injury leading to hemorrhage of glands
elastase = breaks down endothelin = vascular injury |
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Acute Pancreatitis -- clinical presentation
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SEVERE abdominal pain
referred pain radiates to BACK and Left SHOULDER Anorexia + Nausea + Vomiting + Fever Cullen & Grey-Turner signs |
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Acute Pancreatitis -- laboratory findings
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↑ serum Amylase (first 24-hours)
↑ Lipase level Glycosuria & Hypocalcemia |
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Acute Pancreatitis -- treatment
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NPO + IVF + pain relief
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Chronic Pancreatitis
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irreversible destruction of pancreas
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Chronic Pancreatitis
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repeated episodes of acute pancreatitis
results in loss of pancreatic parenchyma & fibrosis |
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Chronic Pancreatitis -- symptoms
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often asymptomatic until . . .
Pancreatic Insuffiency & diabetes develop |
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Chronic Pancreatitis --- histology
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↓ # acinar cells = parenchymal fibrosis
dilated ducts with eosinophils |
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Chronic Pancreatitis -- complications
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1. Secondary Diabetes Mellitus
2. ↑ risk of pancreatic carcinoma 3. Fat malabsorption = steatorrhea & ↓vitamin K 4. Other --pleural effusion, pain, pseudocyst, calcification and stones |
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Lympoplasmicytic Sclerosing Pancreatitis
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Autoimmune ---chronic pancreatitis
duct-centric inflammatory cells w/ plasma cells producing IgG4 mimics cancer but responds to STERIODS |
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Hereditary Pancreatitis
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begins in childhood w/o warning
mutated cationic Trypsinogen gene PRSS1 |
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Hereditary Pancreatitis --- mechanism
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inactivating mutation of serine protease inhibitor Kazal type I "SPINK-1"
loss of Trypsin inhibition = constant pancreatic enzyme activation = autodigestion |
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Acute Pancreatitis -- mechanism
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activation of Proteolytic enzymes
= Acinar cell injury = activates coagulation = inflame = Vascular injury |
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Chronic Panceatitis -- mechanism
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Ethonal or Oxidative Stress
=inflammation via TGF = collagen secretion = remodel |
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Pancreatic Carcinoma
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infiltrating ductal carcinoma
poor 5 year prognosis |
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Pancreatic Carcinoma - -risk factors
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1. Cigarette Smoking
2. Fat-rich diet 3. Chronic Pancreatitis 4. Diabetes Mellitus |
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Pancreatic Carcinoma
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" old fat Black lady"
60-80yrs African Americans Fatty-diet |
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PanIN
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Pancreatic Intraepithelial Neoplasia
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Pancreatic Intraepithelial Neoplasia
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precursor lesion to pancreatic cancer
usually mutations in KRAS and p16/CDKN2A genes |
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Pancreatic Carcinoma --- histology
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Ductal = Highly INVASIVE & Desmoplastic response
usually targets Head of Pancreas |
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Pancreatic Carcinoma -- presentation
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pancreas is silent until invades other structures
1. Pain 2. Obstructive Jaundice @ head 3. Weight loss + Anorexia + Malaise/weakness 4. Trousseau sign |
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Trousseau sign
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tender erythematous red rash
↑ platelet aggregation ↑ pro-coagulants |
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Increase risk of Pancreatic Cancer
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1. Breast/ovarian CA
2. Atypical Melanoma 3. family history (3+ relative w/ pancreatic CA) 4. Peutx-Jeghens syndrome |
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Cystic Pancreas Lesions
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1. Pseudocyst
2. Serous Cystadenoma 3. Mucinous Cystic Neoplasm 4. Intraductal Papillary Mucinous Neoplasm 5. Solid Pseudopapillary Neoplsam 6. Degenerative Cyst |
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Pseudocyst
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Chronic Pancreatitis no epithelium lining
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Solid Pseudopapillary Neoplasm
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Solid neoplasm no epithelium lining
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Serous Cystadenoma
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clear, cuboidal cells epithelium lining
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Mucinous Cystic Neoplasm
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mucin-filled, columnar epithelium lining
Spindle Stroma Separate from ducts |
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Intraductal Papillary Mucinous Neoplasm
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Mucin-filled, Columnar epithelial lining
Connected to Ducts |
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Pseudocyst -- histology
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no epithelial lining
formed by walling off areas of Pancreatic Hemorrhagic Fat Necrosis w/ fibrous tissue Necrotic center = Amylase & Lipase |
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Pseudocyst --cause
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after an Acute Pancreatitis episode
in the setting of Chronic ALCOHOLIC pancreatitis **most common cystic lesion of pancreas |
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Serous Cystadenoma -- histology
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BENIGN of body or tail
neoplasm of small cysts lined by uniform glycogen rich cuboidal epithelium produce watery fluid |
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Serous Cystadenoma -- presentation
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associated w/ VHL disease
Females age 70s EXCELLENT Prognosis |
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Mucinous Cystic Neoplasm -- presentation
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Females age 50s
Excellent prognosis w/o invasion * invasive = ductal adenocarcinoma |
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Mucinous Cystic Neoplasm -- histology
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columnar mucin-producing epithelium
supported by Ovarian-like Stroma slow-growing, noncommunicating |
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Intraductal Papillary Mucinous Neoplasm
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Men age 60-70s
communicates w/ main pancreatic duct |
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Solid Pseudopapillary Neoplasm
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Young Women age 40s
activating mutation B-catenin 95% cure rate after complete removal |
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Degenerative Cysts
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cysts associated with solid neoplasms
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Degenerative Cysts
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1. cystic endocrine neoplasm
2. ductal adenocarcinoma w/ cystic degeneration 3. acinar cell cystadenocarcinoma |
