6.3 Heapto-pancreatic-biliaary System

Question 1

Congenital Abnormalities of Pancreas

Answer 1

1. Annular Pancreas - 2nd part of duodenum surrounded by pancreatic tissue
2. Pancreatic Divisum - ventral and dorsal buds of pancreas fail to fuse (mainly drain through minor papilla)

Question 2

Acute Pancreatitis Pathogenesis

Answer 2

• Auto-digestion of pancreatic tissue by own enzymes
• Premature activation of trypsinogen to trysin

Question 3

Factors of importance in the premature activation of trypsinogen to trypsin (trypsin in turn activates the other pancreatic enzymes):

Answer 3

1. Obstruction to flow of pancreatic juice resulting in ductal hypertension
2. Direct damage to pancreatic ductal epithelium from ischaemia, drugs, toxins, trauma or viral infection.
3. Inhibition of cellular mechanisms that prevent premature enzyme activation.

Question 4

Causes of Acute Pancreatitis

Answer 4

(I GET SMASHED)
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidemia/Hypercalcemia
ERCP
Drugs

Question 5

Chronic pancreatitis pathogenesis

Answer 5

• Inflam of pancreas
• pancreas become fibrotic
• loss of exocrine and endocrine gland mass (acini + langerhans)

Question 6

Chronic pancreatitis aetiology

Answer 6

• Toxic/Metabolic (alcohol, diet, calcium)
• Idiopathic
• genetic (mutations of trypsinogen)
• Autoimmune
• Recurrent
• Obstructive

Question 7

Chronic pancreatitis complications

Answer 7

• Leakage of pancreatic juice (Pseudocysts, Pancreatic Ascites)
• Exocrine + endocrine dys
• pain
• obstruction (fibrosis)

Question 8

Tumour of pancreas pathogenesis and risk factors

Answer 8

Origin - tubular /. Acinar epithelium of exocrine pancreas
RF - smoking, obesity, chronic pancreatitis

Question 9

Peri-ampullary carcinoma origin

Answer 9

• Ampulla of Vater
• Distal bile duct
• 2nd part of duodenum

Question 10

In patients with obstructive jaundice as a result of a primary malignant lesion in the vicinity of the head of the pancreas:

Answer 10

± 80% have adenocarcinoma of the head of the pancreas and ± 20% have peri-ampullary carcinoma

Question 11

Prognosis of Peri-papillary carcinoma

Answer 11

i) Inherently slower growth rate

ii) More orderly spread via gastro-duodenal lymphatics

iii) Earlier presentation with obstructive jaundice

Question 12

Cystic pancreatic tumours

Answer 12

• Serous cystic neoplasm
• Mucinous cystic neoplasm

Question 13

Pancreatic neuro-endocrine tumors origin and 2 different types

Answer 13

Origin - islet cells
- Non- func- incidentally diagnosed, metastatic
- Functional - insulinoma, glucagonoma, gastrinoma