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GI - 2 > 19-1 > Flashcards

19-1 Flashcards

1
Q

How does the pancreas normally arise during fetal development?

A

Fusion of ventral and dorsal outpouchings of the foregut

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2
Q

What are 2 common congenital anomalies of the pancreas?

A
  1. Pancreas Divisum

2. Annular Pancreas

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3
Q

Pancreas Divisum

A

Failure of fusion of ductal systems of dorsal and ventral pancreas

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4
Q

Failure of fusion of ductal systems of dorsal and ventral pancreas

A

Pancreas Divisum

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5
Q

With Pancreas Divisum, the majority of the pancreas is drained through what?

A

The Minor sphincter!

– Should be the papilla of vater/oddi

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6
Q

Those with Pancreas Divisum are at an increased risk for?

A

Chronic Pancreatitis

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7
Q

Annular Pancreas

A

Ring of pancreatic tissue that encircles the 2nd portion of duodenum

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8
Q

Ring of pancreatic tissue that encircles the 2nd portion of duodenum

A

Annular Pancreas

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9
Q

What does an Annular Pancreas usually result in?

A

Duodenal obstruction

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10
Q

What bud of the developing pancreas usually causes the Annular Pancreas?

A

Ventral bud

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11
Q

What can Ectopic Pancreatic Tissue cause?

A

Inflammation, damage, mucosal bleeding

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12
Q

Both Acute and Chronic Pancreatitis are initiated by?

A

Injuries that lead to autodigestion by its own enzymes

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13
Q

What are 3 protective factors that try to prevent autodigestion of the pancreas by its own enzymes?

A
  1. Most enzymes are synthesized as proenzymes (zymogens) and in granules
  2. Proenzymes are activated by Trypsin that is (+) by duodenal enteropeptidase in the duodenum
  3. Pancreatic cells secrete Trypsin (-) like SPINK1
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14
Q

What are 3 protective factors that try to prevent autodigestion of the pancreas by its own enzymes?

A
  1. Most enzymes are synthesized as proenzymes (zymogens) and in granules
  2. Proenzymes are activated by Trypsin that is (+) by duodenal enteropeptidase in the duodenum
  3. Pancreatic cells secrete Tyrpsin (-) like SPINK1
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15
Q

Pancreatitis occurs when the ______ are overwhelmed/disrupted

A

Protective factors

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16
Q

Etiologies of Acute Pancreatitis?

A 
Gallstones
Alcohol
Hypertriglyceridemia
Trauma
Meds
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17
Q

Etiologies of Chronic Pancreatitis?

A

TIGAR-O

  • Toxic metabolic = alcohol
  • Idiopathic = smoking
  • Genetic
  • Autoimmune = celiac/IgG
  • Recurrent acute pancreatitis
  • Obstructive
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18
Q

Acute vs. Chronic pancreatitis - reversible injury?

A 
Acute = reversible injury and inflammation
Chronic = Irreversible destruction
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19
Q

2/3 of these are needed to diagnose Acute Pancreatitis

A
  1. Epigastric pain that radiates to the back
  2. CT changes consistent wit pancreatitis
  3. Lipase (and amylase) elevated 3X the ULN
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20
Q

What physical things can be seen with Acute Pancreatitis on the abdomen?

A

Cullen sign

Grey Turner Sign

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21
Q

What electrolyte change can be seen with Acute Pancreatitis and what causes it?

A

Hypocalcemia due to saponification of necrotic fat

22
Q

What morphologic changes can be seen with Acute Pancreatitis?

A

Edema, fat necrosis, blood vessel destruction and hemorrhage

23
Q

What cytokines can (+) pancreatic stellate cells to deposit collagen and cause fibrosis with Chronic Pancreatitis?

A

TGF - beta

PDGF

24
Q

Autoimmune Pancreatitis can cause Chronic Pancreatitis. What will be seen with Autoimmune Pancreatitis?

A

Mass lesion at the pancreatic head

25
Q

Autoimmune Pancreatitis can cause Chronic Pancreatitis. What will be seen with Autoimmune Pancreatitis?

A

Mass lesion at the pancreatic head

26
Q

Symptoms/signs of Chronic Pancreatitis?

A

Intermittent epigastric pain
CALCIFICATIONS
Pancreatic insufficiency (steatorrhea and diabetes)

27
Q

What morphologic changes can be seen with Chronic Pancreatitis?

A

Fibrosis, atrophy and ductal dilation

28
Q

List 6 genes that cause predisposition to pancreatitis?

A

CFTR
PRSS1
SPINK1
CASR, CTRC, CPA1

29
Q

List 6 genes that cause predisposition to pancreatitis?

A

CFTR
PRSS1
SPINK1
CASR, CTRC, CPA1

30
Q

The genes that cause predisposition to pancreatitis all do so by stimulating activation of?

A

Trypsin

31
Q

Unilocular, thin-walled cysts lined with cuboidal epithelium

A

Congenital cysts

32
Q

Congenital cysts are thin-walled and lined with ____ epithelium

A

Cuboidal

33
Q

Congenital cysts may be associated with other conditions. What type of fluid are in these cysts?

A

Clear serous

34
Q

What causes Congenital cysts?

A

Incorrect pancreatic duct development

35
Q

Cysts that lack epithelial lining

A

Pseudocysts

36
Q

Pseudocysts lack _____

A

Epithelial lining

37
Q

What causes Pseudocysts?

A

Acute pancreatitis

- fat necrosis being walled off by fibrosis and granulation tissue

38
Q

Pseudocysts usually resolve or become?

A

Infected

39
Q

Pancreatic Carcinomas are _____ that (+) ______ reaction

A

Adenocarcinomas

(+) dense desmoplastic reaction

40
Q

A majority of Pancreatic Carcinomas arise from?

A

PanIN (pancreatic intraepithelial neoplasia)

41
Q

List a few risk factors for Pancreatic Carcinomas

A

Smoking
Chronic pancreatitis
Obesity and Diabetes

42
Q

Describe the PanIN progression along with the involved genes

A
  • Telomere shortening and KRAS activation
  • (-) CDKN2A
  • (-) TP53, SMAD4, BRCA2
43
Q

Describe the PanIN progression along with the involves genes

A
  • Telomere shortening and KRAS activation
  • (-) CDKN2A
  • (-) TP53, SMAD4, BRCA2
    = Invasive carcinoma
44
Q

What is a DNA abnormality that can cause (-) of CDKN2A with Pancreatic Carcinomas?

A

DNA methylation

45
Q

Most common location for Pancreatic Carcinomas?

A

Pancreatic head

46
Q

Pancreatic carcinomas are silent until they invade adjacent structures. What are the initial and nonspecific symptoms?

A

Pain, Weight loss, Weakness

47
Q

What are defining symptoms of Pancreatic Carcinoma?

A

Jaundice

New onset diabetes

48
Q

What tests will be (+) with Pancreatic Carcinoma?

A

Courvoisier sign
Trousseau sign of malignancy
CA 19-9

49
Q

Pancreatic Carcinomas tend to grow along ____

A

Nerves

50
Q

Most common distant metastases for Pancreatic Carcinomas?

A

Lung and liver

GI - 2 (61 decks)

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