159b/160b - Pathology and Clinical Features of Pancreatic Disorders Flashcards
What inflammatory cells will dominante in acute pancreatitis?
Neutrophils
What is the “typical” presentation of chronic pancreatitis?
There isn’t really one
May have:
- Fat malabsorption (Exocrine insufficiency)
- Diabetes mellitus (Endocrine insufficienty)
- Abdominal pain
- Neuropathic pain
- Also may be asymptomatic
Is tobacco use a risk factor for chronic pancreatitis?
Yes
(Previously unrecognized, but highlighted as important in the lecture)
Note: also increses risk of acute pancreatitis
What causes acute pancreatitis?
Autodigestion of the pancreas; premature activation of trypsin
Caused by:
- Duct obstruction (Gallstone)
- Acinar cell injury
- Alcohol, drugs, ischemia
- Defective intracellular transport
Which pancreatic cystic neoplasms are benign?
When would they need to be removed?
- Retention cyst
- Pseudocyst
- Serous cystadenoma
None have malignant potential :)
Remove if symptomatic, rapidly growing, or unsure if it might be MCN
How is acute pancreatitis diagnosed?
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
Compare the histology of acute and chronic pancreatitis
- Acute
- Inflammation (neutrophils)
- Fat necrosis
- Chronic
- Chronic inflammation (lymphocytes)
- Fibrotic stroma
What is the most common cause of chronic pancreatitis?
Long term alcohol use
What are the most commonly mutated genes in pancreatic ductal adenocarcinoma? (4)
(In the tumor; not necessarily hereditary)
- KRAS (oncogene)
- P16 aka CDKN2a (Tumor suppressor - cell cycle regulator)
- P53 (Tumor suppressor - responds to DNA damage)
- SMAD4 (involved in TGF-beta pathway
What are the two most common causes of acute pancreatitis?
Gallstone (more common in women w/pancreatitis)
Alcohol use (more common in men w/pancreatitis)
Which pancreatic cystic neoplasms have malignant potential and should be resected? (2)
- Mucinous cystic neoplasm
- Ovarian-like stroma
- Intraductal papillary mucinous neoplasm
What are the 2 types of acute pancreatitis?
Interstitial edamatous pancreatitis
Necrotizing pancreatitis
Only difference = necrosis in necrotizing
List 3 symptoms of acute pancreatitis
- Acute epigastric pain - may radieate to the back
- Nausea
- Vomiting
How is acute pancreatitis managed?
Goal = improve blood flow and reduce inflammation
- Supportive treatment
- Early hydration
- Avoid parenteral nutrition if possible
- Analgesia
- Prevent infection
If autoimmune-mediated, give steroids
What is the most common pancreatic tumor?
Pancreatic ductal adenocarcinoma