159b/160b - Pathology and Clinical Features of Pancreatic Disorders Flashcards

1
Q

What inflammatory cells will dominante in acute pancreatitis?

A

Neutrophils

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2
Q

What is the “typical” presentation of chronic pancreatitis?

A

There isn’t really one

May have:

  • Fat malabsorption (Exocrine insufficiency)
  • Diabetes mellitus (Endocrine insufficienty)
  • Abdominal pain
  • Neuropathic pain
  • Also may be asymptomatic
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3
Q

Is tobacco use a risk factor for chronic pancreatitis?

A

Yes

(Previously unrecognized, but highlighted as important in the lecture)

Note: also increses risk of acute pancreatitis

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4
Q

What causes acute pancreatitis?

A

Autodigestion of the pancreas; premature activation of trypsin

Caused by:

  • Duct obstruction (Gallstone)
  • Acinar cell injury
    • Alcohol, drugs, ischemia
  • Defective intracellular transport
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5
Q

Which pancreatic cystic neoplasms are benign?

When would they need to be removed?

A
  • Retention cyst
  • Pseudocyst
  • Serous cystadenoma

None have malignant potential :)

Remove if symptomatic, rapidly growing, or unsure if it might be MCN

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6
Q

How is acute pancreatitis diagnosed?

A

Must have 2/3 of:

  • Abdominal pain radiating to back
  • Elevated pancreatic enzymes (amylase or lipase x3 ULN)
  • Confirmed radiographic findings
    • Not needed if top 2 criteria are met
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7
Q

Compare the histology of acute and chronic pancreatitis

A
  • Acute
    • Inflammation (neutrophils)
    • Fat necrosis
  • Chronic
    • Chronic inflammation (lymphocytes)
    • Fibrotic stroma
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8
Q

What is the most common cause of chronic pancreatitis?

A

Long term alcohol use

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9
Q

What are the most commonly mutated genes in pancreatic ductal adenocarcinoma? (4)

(In the tumor; not necessarily hereditary)

A
  • KRAS (oncogene)
  • P16 aka CDKN2a (Tumor suppressor - cell cycle regulator)
  • P53 (Tumor suppressor - responds to DNA damage)
  • SMAD4 (involved in TGF-beta pathway
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10
Q

What are the two most common causes of acute pancreatitis?

A

Gallstone (more common in women w/pancreatitis)

Alcohol use (more common in men w/pancreatitis)

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11
Q

Which pancreatic cystic neoplasms have malignant potential and should be resected? (2)

A
  • Mucinous cystic neoplasm
    • Ovarian-like stroma
  • Intraductal papillary mucinous neoplasm
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12
Q

What are the 2 types of acute pancreatitis?

A

Interstitial edamatous pancreatitis

Necrotizing pancreatitis

Only difference = necrosis in necrotizing

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13
Q

List 3 symptoms of acute pancreatitis

A
  • Acute epigastric pain - may radieate to the back
  • Nausea
  • Vomiting
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14
Q

How is acute pancreatitis managed?

A

Goal = improve blood flow and reduce inflammation

  • Supportive treatment
    • Early hydration
    • Avoid parenteral nutrition if possible
    • Analgesia
  • Prevent infection

If autoimmune-mediated, give steroids

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15
Q

What is the most common pancreatic tumor?

A

Pancreatic ductal adenocarcinoma

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16
Q

What procedure increses one’s risk of acute pancreatitis?

How can this risk be reduced?

A

ERCP

(Use MRCP to evaluate patinet if pancreatitis is suspected)

To reduce risk:

  • Aggressive IV hydration to improve bloodflow
  • Stent in pancreas during procedure to allow drainage
    OR
  • Rectal indomethacin
17
Q

What genetic mutations predispose an individual to pancreatitis?

Which one is considered “hereditary pancreatits”?

A
  • PRSS1
    • Hereditary pancreatitis
  • STK11
    • Peutz-Jegher’s
  • CDKN2A
    • Familial atypical multiple melanoma

Note: Chronic pancreatitis increases risk of pancreatic cancer

=> All of these may be considered risk factors for pancreatic cancer

18
Q

What is the treatment for chronic pancreatitis?

A

Pancreatic enzyme replacement therapy

(This thing is def not meeting your enzymatic needs - fibrotic changes are irreversible!)

19
Q

What is the characteristic histologic finding of mucinous cystic neoplasms in the pancreas?

How would you manage this neoplasm?

A

Ovarian-like stroma

Remove! Has malignant potential (considered a precursor for pancreatic ductal adenocarcinoma)

20
Q

What hereditary genetic mutations predispose an individual to pancreatic adenocarcinoma?

A
  • STK11*
    • Peutz-Jegher’s
  • CDKN2A*
    • Familial atypical multiple melanoma
  • BRCA1, BRCA2
  • Lynch Syndrome

*Increased risk of pancreatitis - but it seems like increased cancer risk independent of pancreatitis risk?

21
Q

What are the precursor legions of pancreatic ductal adenocarcinoma? (3)

A
  • PanIN tumor
  • Intraductal papillary mucinous neoplasm (IPMN)
  • Mucinous cyst neoplasm (MCN)
22
Q

A patient is having an abdominal for some random reason and she is found to have a mass in her pancreas.

Biopsy reveasl “ovarian-like stroma”

How would you manage this patient?

A

Ovarian-like stroma = mucinous cystic neoplasm

  • Occurs almost exclusively in women, usually > 40 y/o
  • Remove immediately!
    • ​MCNs are precursor lesions for pancreatic ductal adenocarcinoma