Ch 19 Robbins

Question 1

What is the exocrine pancreas composed of?

Answer 1

Acinar cells that secrete enzymes for digestion

Question 2

What is the endocrine pancreas composed of?

Answer 2

Islets of Langerhans

Question 3

What do the Islets of Langerhans secrete?

Answer 3

1) Insulin
2) Glucagon
3) Somatostatin

Question 4

What is the most common congenital anomaly of the pancreas?

Answer 4

Pancreas divisum

Question 5

Annular pancreas are band-like rings of normal pancreatic tissue that encircles the?

Answer 5

Second portion of the duodenum

Question 6

Pancreatic agenesis is due to homozygous mutation of?

Answer 6

PDX1

Question 7

Why is acute pancreatitis irreversible?

Answer 7

It is reversible

Question 8

What are three initiating events that lead to pancreatic autodigestion?

Answer 8

1) Duct obstruction
2) Primary acinar cell injury
3) Defective intracellular transport of proenzymes within acinar cells

Question 9

With pancreatic duct obstruction, lipase has potential for?

Answer 9

Local fat necrosis

Question 10

What is a shared feature of most forms of hereditary pancreatitis?

Answer 10

Defect that increases the activity of trypsin

Question 11

What does acute pancreatitis lead to morphologically?

Answer 11

1) Edema that leads to microvascular leakage
2) Fat necrosis
3) Destruction of pancreatic parenchyma
4) Interstitial hemorrhage

Question 12

What levels are increased with acute pancreatitis in the first 24 hours?

What are increased within 72-96 hours?

Answer 12

1) Amylase

2) Lipase

Question 13

Chronic pancreatitis is characterized as prolonged inflammation of the pancreas due to?

Answer 13

Irreversible destruction of exocrine and endocrine parenchyma

Question 14

What population is chronic pancreatitis most often seen it?

What is the most common cause of it?

Answer 14

1) Middle aged males

2) Long term alcohol abuse

Question 15

What fibrogenic inflammatory mediators are produced during chronic pancreatitis?

Answer 15

TGFβ and PDGF

Question 16

What does autoimmune pancreatitis respond well to?

Answer 16

Steroid therapy

Question 17

What are the most common pancreatic cysts?

Answer 17

Pseudocysts

Question 18

What are large, well-circumscribed malignant neoplasms with solid and cystic components filled with hemorrhagic debris?

Answer 18

Solid pseudopapillary neoplasm

Question 19

What mutation is associated with solid pseudopapillary neoplasm?

What does this mutation lead to?

Answer 19

1) CTNNB1 (β-catenin) oncogene mutation

2) Hyperactivation of WNT signaling

Question 20

What is the 4th leading cause of cancer death in the USA due to it being on the most aggressive of the solid malignancies?

Answer 20

Infiltrating ductal adenocarcinoma (pancreatic carcinoma)

Question 21

What is the strongest risk factor for infiltrating ductal adenocarcinoma?

Answer 21

Smoking

Question 22

Adenocarcinoma of the head of pancreas produces?

This causes an elevation predominantly of?

This all results in the classic finding of?

Answer 22

1) Extrahepatic biliary obstruction
2) Direct bilirubin and Alkaline phosphatase
3) Painless jaundice

Question 23

Where does infiltrating ductal adenocarcinoma metastasize to?

Answer 23

Liver and lungs

Question 24

What is the most frequently altered oncogene in pancreatic cancers found on Chr 12p?

What is the most frequently inactivated tumor suppressor gene in pancreatic cancer found on Chr 9p?

What is inactivated in 55% of pancreatic cancers and found on Chr 18q, but rarely mutated in other cancers?

Answer 24

1) KRAS
2) CDKN2A
3) SMAD4

Question 25

What is characterized by a syndrome of metastatic fat necrosis caused by the release of lipase into the circulation?

Answer 25

Acinar cell Carcinoma

Question 26

Squamous islands admixed with acinar cells is a distinct microscopic appearance of?

Answer 26

Pancreatoblastoma