124b Pancreas Disease

Question 1

pancreas - location in abdomen?

consists of what?

Answer 1

retroperitoneal

exocrine (majority) - acini + ducts AND
endocrine - islets of Langerhans

Question 2

histo appearance of exocrine pancreas?

Answer 2

acinar - pink

triangular cell, basal nucleus

apical - dense pink granules (zymogen)

extensive basal ER for making/transporting granules

Question 3

Normal ductal anatomy vs pancreatic divisum in pancreas?

Answer 3

normal - duct of wirsung to main pancreatic duct with smaller duct of santorini

divisum -separate branches (no duct of wirsung)

Question 4

what occurs in acute pancreatitis?

Answer 4

autodigestive and inflammation

Question 5

what causes acute pancreatitis in women? men?

Answer 5

gallstones (women) - mechanical

alcohol (men) - metabolic

+ other things

Question 6

what are 3 protections against autodigestion in pancreas?

Answer 6

inactive precrusors (zymogens) are secreted

duodenum enterokinase (in brush border) activates trypsinogen to trypsin which activates everything else

protease inhibitors in acinar cells in case of premature activation

Question 7

what do duct cells produce in pancreas?

Answer 7

bicarbonate and mucin

Question 8

what is the key step leading to autodigestion in pancreatitis?

Answer 8

activation of trypsin

Question 9

Pathogenesis of gallstones leading to acute pancreatisi?

Answer 9

Blockage ampulla of vater –> bile into pancreas

increased ductal P –> damages acinar cells/duct

Question 10

alcohol - pancreatitis pathogenesis (4 ways)?

Answer 10

spasm/relaxation of sphincter of Oddi

Acinar cells sensitized to CCK –> zymogen activation

Alcohol metabolism in pancreas

Increased protein secretion plugs ducts

Question 11

symptoms of acute pancreatitis?

Answer 11

rapid onset of severe, persistent pain to back
nausea and vomiting
low grade fever
hypotension

Question 12

pathology appearace of acute pancreatisi?

Answer 12

microvascular leakage --> swollen gland
lipases --> fat necrosis --> white
extensive hemorrhage --> brown 
proteolytic activation --> loss of parenchyma
inflammatory cells

Question 13

lab tests for acute pancreatitis?

Answer 13

increase serum lipase (more specific)

increase serum/urine amylase

increase WBC

Question 14

what is and what causes chronic pancreatitis?

Answer 14

chronic inflammatory process with fibrosis, loss of structure (exocrine then endocrine) from repeat acute from booze

Question 15

pancreatic pseudocyst - what causes it? what is it made of?

Answer 15

acute and chronic pancreatitis

fibrotic wall (no epithelial) filled with fluid and inflammatory cells

Question 16

what are the 3 types of chronic pancreatitis?

Answer 16

Calcified - fibrosis with stones and protein plugs from booze

Obstructive - tumor of main pancreatic duct

Inflammatory - autoimmune cause (Sjogren’s)

Question 17

clincial presenation from chornic panc

Answer 17

maldigestion from atrophy of acinar tissue

diabetes from loss of endocrine tissue

Pseudocyst

Question 18

what cell type are the most exocrine pancreatic tumors?

Answer 18

Ductal

Question 19

risks for pancreatic carcinoma?

Answer 19

smoking, alcohol, chronic pancreatitis

Question 20

pancreatic adenocarinoma genetics - frequent mutations

Answer 20

K-ras (12p) - most important/prevalent; early
p53 (17p)
BRCA2 (13q)
Rb gene
**cancers need multiple gene mutations**

Question 21

K-ras - role?

Answer 21

GTPase for signal transduction pathway

mutation makes it always active

Question 22

in what part of the pancreas does pancreatic cancer occur most often?

Answer 22

head with fibroblast proliferation -> obstructs common bile duct –> jaundice

Question 23

body vs head for pancreatic cancer presentation and spread

Answer 23

head - jaundice; liver, lungs, lymph nodes

body/tail - thromboembolism; subcutaneous, extensive mets

Question 24

stage if extension to peripancreatic tissue?

Answer 24

T3 (T4 celiac axis and unresectable)

Question 25

early diagnosis of pancreatic ca?

Answer 25

MRI - food early, but expensive
serum marker (CA 19-9) for advanced disease