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47 Cards in this Set
- Front
- Back
What is pancreas divisum?
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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 |
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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? |
Pancreas divisum
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major complication of annular pancreas?
what about pancreas divisum? |
annular- duodenal obstruction (annular pancreas is a ring of pancreatic tissue that encircles the duodenum)
divisum- chronic pancreatitis |
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for cystic fibrosis, please list the functional problem, genetics, group most commonly effected, and what generally happens (in the pancreas)
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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) |
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Activation of pancreatic proenzymes within the pancreas with autodigestion and inflammation is seen in what form of pancreatitis?
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Acute pancreatitis
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what happens in necrotizing acute pancreatitis?
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pancreatic fat is digested and saponification and calcification with necrosis
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2 major causes of acute pancreatitis?
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EtOH abuse
Gallstones |
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how do gallstones lead to pancreatitis?
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obstruction of the common bile duct can lead to release of pancreatic proezymes
also, bile backing up can cause this release |
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how does chronic alcohol consumption cause acute pancreatitis?
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EtOH thickens ductal secretions; increases exocrine secretions and constricts sphincter of Oddi; toxic to acinar cells
Only ~ 5% chronic alcoholics develop pancreatitis |
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pt presents with abdominal pain, nausea, vomiting, fever, and "acute abdomen" (increased WBC, hemolyisis, hypovolemia, hypoxia, ARDS)..what do they have?
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Acute pancreatitis
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What are Turner and Cullen's signs? associated with?
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flank (turner)
periumibilical (cullen) hemorrhage looks like a giant nasty bruise on the skin associated with acute pancreatitis |
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what is a pancreatic pseudocyst? why is this important?
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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 |
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if you do a Ranson's criteria for acute pancreatitis and the WBC >16,000 what should you be thinking (general)
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this is a worse prognosis for a pt
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is chronic pancreatitis reversible or no?
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NO
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most common cause of chronic pancreatitis?
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ALCOHOL
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sequelae of chronic pancreatitis?
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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) |
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what is Brittle Diabetes? associated with what?
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– loss of both insulin and glucagon
Very difficult to regulate blood glucose associated with Chronic Pancreatitis |
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just some notes to review for congenital cysts
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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 |
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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
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Serous Cystadenoma
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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?
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Mucinous Cystic Neoplasm
Female (F>>M 9:1) tend to find on body or tail > head |
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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?
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Intraductal papillary mucinous neoplasm (IPMN)
Male (M>F; 6th decade; appear to arise within large pancreatic duct) Head of pancreas >> tail |
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Pancreatic ductal carcinoma often affects what portion of the pancreas? Prognosis?
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Head
4th leading cause of cancer deaths in USA (behind lung, colon, and breast) One of highest mortality rates of any cancer |
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Genetic change associated with pancreatic ductal carcinoma?
**TEST |
K-RAS --> p16 --> p53 --> SMAD4 --> BRCA2
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pt presents with jaundice, abdominal pain, weight loss, and diabetes mellitus, and migratory thrombophlebitis...what do they have?
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ductal pancreatic cancer
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What is Trousseau's Sign? Associated with?
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(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 |
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increased conjugated bilirubin shows what?
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obstruction of the liver ducts
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Main duct:____ → most commonly drains via ampulla of Vater
» Joins common bile duct |
Wirsung
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Accessory duct:____ → most often drains into duodenum cranial to ampulla of Vater via a separate papilla
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Santorini
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______ contain inactive proenzymes
-What cells release these? |
Zymogen Granules released by Acinar Cells
(Note: Amylase and Lipase are ACTIVE enzymes released by acinar cells) |
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Exocrine Cells of Pancreas?
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Acinar Cells
Ductular Cells |
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Describe pain present with exocrine pancreas pathology
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**Pain**
– Epigastric, radiating to back • Exacerbated by eating, EtOH |
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Digestive symptoms related to exocrine pancrease pathology?
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Diarrhea
Steatorrhea Anorexia, sitophobia, weight loss |
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– Pancreas completely encircles the 2nd portion of the duodenum
– Duodenal obstruction and other congenital anomalies |
Annular (ring-like) Pancreas
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Heterotopic rests (patches) of pancras tissue in stomach, meckel diverticulum and small bowel
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Choristomas
**Usually clinically insignificant" |
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Caucasian male has abnormally viscous secretions (mucoviscidosis leading to pancreatic insufficiency and chronic pancreatitis)
Disease and common genetic mutation? |
Cystoc Fibrosis
Mutation of CTFR channel |
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How can hypertriglyceridemia lead to acute pancreatitis?
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Chylomicrons in blood obstruct pancreatic capillaries causing necrosis and ischemia
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Injury to the ductules or the acinar cells leads to the release of pancreatic enzymes. Lipase and proteases destroy tissue..
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Acute Pancreatitis
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Which lab test has a higher sensitivity and specificity for acute pancreatitis?
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Serum immunoreactive trypsin
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“Consumption” of free ionized Ca+2 in the process of enzymatic fat necrosis
(Sequelae of Acute Pancreatitis) |
Tetany
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When doing serum testing for acute pancreatitis, which enzyme level in serum is more reliable, amylase or lipase?
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Lipase!
Amylase is less specific because it is also released by salivary glands and has a shorter half life |
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What drug is useful in treating chronic pancreatitis because it decreases pancreatic enzyme secretions?
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Octreotide
(somatostatin analog) |
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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 |
Pseudocysts
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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 |
Congenital Cysts
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Dense “ovarian-type” stroma present in wall of cyst
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Mucinous cystic neoplasm
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Neoplasm that most commonly occurs in the head of pancreas and is associated with marked dilation of a large pancreatic duct
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Intraductal papillary mucinous neoplasm (IPMN)
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What is the most common kind of malignant neoplasm of the exocrine pancreas?
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Pancreatic Ductal Carcinoma
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Common risk factors for Pancreatic Ductal Carcinoma?
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Smoking
Chronic Pancreatitis Obesity Diet rich in meats and animal products |