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BHP II > Exocrine > Flashcards

Exocrine Flashcards

1
Q

blunt extension of the pancreatic head that projects from its left lateral aspect and hooks behind the mesenteric vessels (SMA/SMV)

A

uncinate process

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2
Q

lacks organ capsule and is majority located retroperitoneally

A

pancreas

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3
Q

secretes substances directly into the bloodstream

A

endocrine, pancreatic islets

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4
Q

secretes substances into ductal system to an epithelial surface

A

exocrine, acinar cells

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5
Q

inactive pro-enzyme digestive enzymes of the pancreas are stored here

A

zymogen granules of acinar cells

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6
Q

smaller duct epithelium are _____ and release _______

A

cuboidal, bicarbonate fluid

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7
Q

larger duct epithelium are _____ and release

A

columnar, mucin

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8
Q

pancreatic ducts express this protein which contributes to the viscosity of secretions

A

cystic fibrosis transmembrane conductance regulator

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9
Q

most common congenital anomaly of the pancreas

A

pancreas divisum

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10
Q

pancreas divisum is caused by

A

failure of fusion of the fetal duct system

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11
Q

what happens in pancreas divisum

A

bulk of the pancreas (body, tail) drains into the smaller minor papillae, not the ampulla of varter

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12
Q

bandlike ring of normal pancreatic tissue that completely encircles the second portion of duodenum, causing duodenum stricture/obstruction

A

annular pancreas

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13
Q

ectopic pancreas

A

pancreatic heterotropia

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14
Q

common sites of ectopic pancreas (3)

A
  • stomach, Small intestine, meckel diverticulum
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15
Q

rare abnormal development of the pancreatic ducts that are <5cm in diameter, unilocular, containing clear serous fluid and does not communicate with the ductal system

A

pancreatic cysts

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16
Q

pancreatic cysts are associated with two conditions

A

-AD PKD
- von Hipple-Lindau syndrome

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17
Q

pancreatic cysts epithelial is how many layers

A

single layer, either cuboidal or columnar

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18
Q

autosomal recessive mutations in CTFR gene causing defective electrolyte transport across cell membranes

A

cystic fibrosis

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19
Q

in CF, pancreatic fluid is

A

mucin-rich

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20
Q

autosomal recessive disorder where inappropriately increased iron absorption from duodenum and small intestine

A

hereditary hemochromatosis

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21
Q

how is autodigestion of the pancreas prevented

A

they are converted to their active form in the duodenum, plus acinar cells are resistant to the action of activated enzymes

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22
Q

pancreatitis can lead to

A

autodigestion

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23
Q

reversible inflammatory disorder that is most commonly caused by impaction of stones within the common bile duct (choledocholithiasis)

A

acute pancreatitis

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24
Q

second most common cause of acute pancreatitis

A

excessive alcohol intake

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25
acute morphology of pancreatitis (5)
-microvascular leak and edema -fat necrosis - acute inflammation -autodigestion of parenchyma -interstitial hemorrhage and vessel destruction
26
other causes of acute pancreatitis (5)
-cancer -pancreas divisum -biliary sludge -parasites -neoplasms near the ampulla
27
medications that can cause acute pancreatitis (4)
-anti convulsants -thiazide diuretics -cancer chemotherapy -estrogen
28
infections that can cause acute pancreatitis (2)
mumps virus, coxsackie virus
29
metabolic states that can cause acute pancreatitis (3)
hypercalcemia, hypertriglyeceridemia, hyperparathyroidism
30
trauma that can cause acute pancreatitis (2)
blunt force, iatrogenic from surgery or endoscopy (ERCP)
31
ischemia that can cause acute pancreatitis (4)
thrombosis, embolism, vasculitis, shock
32
germline mutation that can cause acute pancreatitis
genes that encode pancreatic enzymes
33
what can cause autodigestion of the pancreas (5)
- premature activation of trypsin - active lipase - duct obstruction increasing pressure and accumulation of fluid -inflammation and tissue injury -edema
34
fatty acids combine with calcium to form insoluble calcium soaps
saponification
35
these two enzymes are elevated in acute pancreatitis
amylase, lipase
36
long standing inflammation that leads to irreversible destruction of pancreas
chronic pancreatitis
37
full blown acute pancreatitis symptoms
constant abdomen pain with guarding and activation of inflammatory response
38
most common cause of chronic pancreatitis
long term alcohol abuse (middle aged men)
39
clinical features of chronic pancreatitis (4)
-jaundice -indigestion -recurrent abdominal or back pain -or silent presentation until insufficiency or diabetes
40
diagnosis of chronic pancreatitis
is challenging
41
inciting agents of chronic pancreatitis increase the protein concentration of secretions
form ductal plugs or concretions
42
possible pathogenesis of chronic pancreatitis (4)
-ductal obstruction -oxidative stress -toxic metabolites -inappropriate activation of pancreatic enzymes
43
ductal dilation in chronic pancreatitis is more common in what form (cause?)
alcohol induced
44
chronic pancreatitis parenchyma
fibrosis
45
acinar in chronic pancreatitis
atrophied
46
long standing cases of chronic pancreatitis may form these
pseudocysts/retention cysts
47
alcohol consumption increases contraction of this in pancreatitis
sphincter of Oddi
48
common sequela of acute or chronic pancreatitis, especially alcoholic
pseudocysts
49
pancreatic pseudocysts lack this
epithelial lining
50
contents of pancreatic pseudocysts
pancreatic enzymes
51
liquified necrotic pancreatic tissue walled off by fibrous tissue
pseudocysts
52
autoimmune pancreatitis (chronic) is a manifestation of this
IgG4 related disease
53
how does autoimmune pancreatitis present
-obstructive jaundice induced by IgG4- sclerosing cholangitis (onion skin)
54
histology of autoimmune pancreatitis
dense lymphoplasmacytic infiltrate and fibrosis
55
most exocrine pancreatic neoplasms are located
head
56
if an exocrine pancreatic neoplasm is in the head, what can occur?
it may obstruct the bile duct
57
microscopic epithelial precursor lesion of pancreatic ductal adenocarcinoma classification
pancreatic intraepithelial neoplasia
58
most of all pancreatic neoplasms
ductal adenocarcinoma
59
where does ductal adenocarcinoma most common arise
small ducts
60
risk factors of pancreatic cancer (4)
-age -smoking -chronic pancreatitis, DM -genetic defects (familial)
61
ductal adenocarcinoma tumor response
intensely desmoplastic (fibrous formation)
62
somatic mutations in ductal adenocarcinomas (4)
KRAS, P16, SMAD4, TP53
63
most frequent altered oncogene in pancreatic cancer
KRAS
64
most frequently inactivated tumor suppressor gene
P16
65
this is common in ductal adenocarcinoma extension
hepatomegaly and liver metastasis
66
carcinoma arising in the acinar cells
acinar cell carcinoma
67
benign cystic neoplasia that appears honeycomb like with a central fibrous scar and numerous thiny, thin walled cysts
microcystic serous cystadenoma
68
benign serous cystic neoplasia that is usually unilocular
macrocystic serous cystadenoma
69
composed of glycogen rich cuboidal cells that line small cysts containing serous fluid
serous cystic neoplasia
70
serous cystadenocarcinoma common?
no extremely rare
71
does a mucinous cystic neoplasm have communication with the ductal system
no
72
mucin producing cystic neoplasm that communicates with the ductal system
intraductal papillary mucinous neoplasm
73
premalignant mucinous cystadenoma is primary located
in the body and tail
74
which gender has a higher prevalence of mucinous cystic neoplasia
women
75
important diagnostic feature of mucinous cystic neoplasms
ovarian type stroma beneath epithelium
76
often smooth lined, multi loculated, with some with many mural nodules (high grade)
mucinous cystic neoplasm
77
irregular branching glands are lined by columnar epithelium with minimally enlarged hyperchromatic nuclei arranged in a perpendicular fashion
LG MCN
78
solid areas with mural nodules or papillary projections with less organized differentiation
HG MCN
79
intraductal papillary neoplasia architecture
papillary architecture with mucin producing cells
80
where does intraductal papillary neoplasia mostly occur
the head
81
oncogenic mutation of GNAS on chromosome 20
in 2/3 of intraductal papillary neoplasia
82
what duct does intraductal papillary neoplasia typically arise in
within the main pancreatic duct or its branches
83
most common pancreatic neoplasm in young children, very rare and originating from the epithelial exocrine cells
pancreatoblastoma
84
what syndrome is associated with pancreatoblastoma
Beckwith-Wiedemann syndrome

BHP II (12 decks)

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