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45 Cards in this Set
- Front
- Back
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What do acinar cells make?
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these make zymogen granules (eosinphilic ones)
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What shape do acinar cells have?
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these have a pyramidal shape, and are radially oriented about the lumen
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How does the pancreas not digest it self?
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all enzymes are in the inactive proenzyme form- and are sequesterd in the acinar cells.
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What is the first pancreatic enzyme activated?
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Trypsinogen- in the duodenum, which then activates all the rest
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what things degrade zymogen granules when secretion is impaired?
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lysosomal hydrolases
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What is pancreas divisum? complication?
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incomplete fusion of ducts-
so all secretions go through small stenosed duct- causes recurrent pancreatitis |
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What is an annular pancreas? complications?
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pancreas surrounds duodenum, may constrict it causing gastric distension and vomiting
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where are the common locations for a heterotopic pancreas?
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stomach
duodenum jejunum meckel |
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what is the morphology of acute pancreatitis?
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fat necrosis- chalky white material**
destruction of blood vessels acute inflammatory infiltrate |
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What is the morphology of acute necrotizing pancreatitis?
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necrosis of acinar, ductal, and islet cells
fat necrosis serous fluid in peritoneum hemorrhage into parenchyma |
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What is the pathogenesis of pancreatitis?
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enzymatic necrosis and autodigestion*
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How does the Kinin system cause damage in pancreatitis?
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this increases vascular permeability
leads to DIC activated complement |
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What three things can lead to the activation of pancreatic enzymes?
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Duct obstruction
Acinar cell injury (drugs, booze, ischemia) defective intracellular transport of zyomgens |
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What are the clinical signs of acute pancreatitis?
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sudden onset abdominal pain
refered to upper back systemic inflammatory response |
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What are the signs of acute hemorrhagic pancreatitis
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Turner-Grey signs- ecchymosis of the flanks
Cullen sign- periumbilical ecchymosis |
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What are the major possible complications of acute pancreatitis?
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ARDS
renal failure DIC HYPOcalcemia* duodenal obstruction pancreatic abscess/cyst necrotizing pancreatitis with infection |
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What is the course for acute pancreatitis?
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fully recovery
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how does surgery go with acute pancreatitis?
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VERY poorly
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how does the amylase rise in time?
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rises 2-12 hours after onset of symptoms
and is elevated for 3-5 days 5X elevation is specific for acute pancreatitis |
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What are the causes of elevated amylase other than pancreatitis?
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pesudocysts
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how is lipase affected in acute pancreatitis?
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elevated soon after amylase 72 hours
but stays elevated long 7-10 days |
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How is calcium affect in pancreatitis?
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hypocalcemia, due to low albumin
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What is the CT image like in acute pancreatitis?
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enlarged inflamed pancreas
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What are the main causes of chronic pancreatitis?
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alcohol- most common
persistent obstruction of pancreatic duct trauma tropical pancreatitis hereditary idiopathic |
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What is the morphology of chronic pancreatitis?
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patchy fibrosis
calcifciation of the pancreas pesudocyts obstruction of pancreatic ducts lymphoplasmacytic sclerosing pancreatitis |
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what is the presentation of chronic pancreatitis
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repeated attacks of abdominal pain, or persistant pain.
typically silent until- malaborption, diabetes mellitus |
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what things precipitate attacks of chronic pancreatitis?
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alcohol, overeating, opiates, mild fever
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what are the complications of chronic pancreatitis
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chronic pain
DM pseudocysts pancreatic insufficiency with malabsorption |
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What are the associations of true pancreas cysts
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either from polycystic kidney disease
or Von Hipple-Landau disease |
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what things produce pseudocysts?
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pancreatitis
traumatic injury |
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what are the clinical findings of pseudocysts?
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abdominal pain
elevated amylase mass in region of pancreas |
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whats the morphology of pseudocysts?
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no epithelial lining
has fibrous tissue and granulation tissue lining it |
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What are serous cystadenomas of the pancreas?
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these are benign, typically in older individuals/women
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What are mucinous cystadeomas?
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painless slow growing mass in tail/body of pancreas
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what is the survival rate of prancreatic carcinoma?
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less than 5% at 5 years
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How common is pancreatic carcinoma?
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this is increasing in frequency, currently 4th leading cancer death
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what is the genetic mutation in pancreatic cancer?
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K-RAS
p16 inactivaton SMAD4 suppressor |
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What is the ORDER of mutations in pancratic cancer/
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KRAS
p16 inactivation p53 inactivation, SMAD4, BRCA2 |
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What are the risk factors of pancreatic carcinoma?
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Smoking**
alcohol/high fat diet Chronic pancreatitis** Diabetes |
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What familial syndromes predispose someone to pancreatic cancer?
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Hereditary pancreatitis PRSS1
Peutz-Jeghers Syndrome SKT11 |
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what is the morphology of pancreatic cancer?
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Hard, stellate, gray-white-
obstructs biliary tree 60% arise in head of pancreas. |
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What is the most common kind of pancreatic cancer? arising from?
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Adenocarcinoma of the duct epithelial cells
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What is the presentation of pancreatic carcinoma?
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this is assocated with Trousseau syndrome
nonspecific weight loss very metastatic tumor (often goes to lung and liver, pleural effusion) |
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How many pancreatic cancers are rescetable at diagnosis?
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less than 20%
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What tumor marker is elevated in pancreatic carcinoma?
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Ca19-9
CEA may be elevated KRAS- CDKN2A detectable most common*** |
