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MHD > Exocrine Pancreas > Flashcards

Exocrine Pancreas Flashcards

1
Q

Describe the appearance of the acinar cells of the pancreas

A

Pyramidally shaped epithelial cells oriented radially around central lumen

Cuboidal epithelium
Basal nuclei with often prominent nucleoli
Granular cytoplasm (zymogen granules)

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2
Q

What do ductal cells secrete?

A

Water and sodium bicarbonate to wash the proteins from acinar cells down the ducts and into duodenum

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3
Q

The pancreas largely makes proenzymes (like trypsinogen) to prevent auto-digestion, but two enzymes are made in their active form. What are they?

A

Amylase and Lipase

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4
Q

Why doesn’t the pancreas undergo auto-digestion?

A

Inactive proenzymes (except for amylase and lipase)

Enzymes bound in zymogen granules

Trypsin inhibitors present

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5
Q

Acute Pancreatitis

What are the 2 main categories?

A

Acute interstitial pancreatitis (generally get full recovery)

Acute necrotizing and hemorrhagic pancreatitis (much more severe)

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6
Q

80% of Acute Pancreatitis is caused by…

A

Alcoholism

Biliary tract disease (obstruction)

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7
Q

Males vs. Females

What are the more likely causes of acute pancreatitis in each?

A

Males - Alcoholism

Females- Biliary tract disease

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8
Q

Why does alcoholism cause acute pancreatitis?

A

Alcohol activates hypersecretion of acinar cells and hyposecretion of water and bicarb by ductal cells

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9
Q

What are some metabolic disorders that could cause acute pancreatitis?

A

Hypertriglyceridemia

Hypercalcemia- Calcium activates enzymes

Hyperparathyroidism

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10
Q

What is an infectious process that can cause acute pancreatitis?

A

Mumps

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11
Q

3 mechanistic causes of acute pancreatitis (very general)…

A

Duct obstruction

Acinar Cell Injury

Defective intracellular transport

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12
Q

What are some clinical signs of acute pancreatitis?

A 
Abdominal pain
Elevated plasma amylase and lipase
Diffuse fat necrosis and Hypocalcemia
ARDS
DIC
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13
Q

How does enzymatic fat necrosis occur? What does it result in?

A

Calcium combines with free fatty acids (called saponification) –> develop hypocalcemia

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14
Q

How is Acute Pancreatitis treated?

A 
Address the underlying cause
Supportive care
-Analgesia
-IV fluids
-Correct electrolyte abnormalities
-Restore oral intake when abdominal pain improves
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15
Q

How is chronic pancreatitis distinct from acute?

A

Permanent damage to the pancreas occurs

There is acinar cell atrophy and replacement by fibrotic tissue

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16
Q

What are some causes of chronic pancreatitis?

A

Alcoholism (long term abuse)

Long standing obstruction

Hereditary (genes involving trypsinogen activators or trypsin inhibitors)

Cystic fibrosis

Tropical pancreatitis

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17
Q

Describe the histological appearance of chronic pancreatitis

A 
Fibrosis
Loss of acinar cells
Dilated pancreatic ducts
Destruction of islets of Langerhans (late stage- leads to diabetes)
May see ductal calcifications
18
Q

Symptoms of Chronic Pancreatitis

A

Recurrent attacks abdominal pain, radiating to back

Recurrent jaundice or indigestion

Exocrine pancreas insufficiency- steatorrhea

Diabetes

Pancreatic calcifications on imaging

19
Q

Pancreatic Pseudocysts

What are they caused by? What is their histological appearance?

A

Caused by acute or chronic pancreatitis

Histology-
No true epithelial lining
Chronic inflammation and granulation tissue

20
Q

Pancreatic Carcinoma

Pathogenic factors

A 
Pancreatic intraepithelial neoplasia (PanIN)
Smoking
Genetics
Chronic pancreatitis
Diabetes
21
Q

More than 90% of pancreatic cancer is associated with a gene mutation in….

A

K-RAS

22
Q

What other mutations (besides KRAS) may be involved in pancreatic carcinoma?

A

p16
p53
BRCA2
SMAD4

23
Q

What kind of cancer is pancreatic carcinoma?

A

Infiltrating ductal Adenocaricnoma

24
Q

Where in the pancreas are carcinomas most commonly located?

A

Head (60%)
Body (15%)
Tail (5%)
Diffuse (20%)

25
Q

In response to the tumor, the pancreas may undergo a dense stromal fibrosis classified as a….

A

Desmoplastic Response

26
Q

Common organs for distant metastases of pancreatic cancers

A

Liver
Lungs
Bones

27
Q

Pancreatic Carcinoma

What are the presenting symptoms?

A

Mostly asymptomatic until they impinge on other structures

Back pain - perineural invasion
Obstructive jaundice
Weight loss
Anorexia
Malaise
28
Q

Pancreatic Carcinoma

What are some tumor markers used to monitor?

A

CA19-9 and CEA in peripheral blood

Sensitive, but not very specific
More often used for monitoring post resection

29
Q

Pancreatic Carcinoma

What is obstructive jaundice?

A

Tumor obstructs the ampullary region/common bile duct. Prevents conjugated bile from entering duodenum, increasing pressure in biliary tract and forcing conjugated bile to enter the bloodstream

30
Q

Pancreatic Carcinoma

What is migratory thrombophlebitis?

A

Known as Trousseau sign
Venous thromboses that spontaneously appear and disappear

Attributed to procoagulants released by the tumor

31
Q

Pancreatic Carcinoma

What may be done to relieve obstructive jaundice?

A

Place a stent in the duct to keep it open

32
Q

What is the Whipple procedure?

A

For tumors in the head or neck of pancreas, this procedure is a pancreaticoduodenectomy

33
Q

Serous Cystadenoma

Appearance

A

Totally benign
Small cysts lined by glycogen-rich cuboidal cells
Release clear fluid

34
Q

Serous Cystadenoma

Treatment

A

Benign, so no treatment needed unless it is impinging on other organs

35
Q

Pancreatic Mucinous Cystadenoma

Appearance

A

Cysts filled with thick mucin

More often seen in body/tail of pancreas

36
Q

Pancreatic Mucinous Cystadenoma

What are the risks?

A

Potential for malignant transformation (into a pancreatic mucinous cystadenocarcinoma)

37
Q

Pancreatic Mucinous Cystadenoma

Who is the typical patient?

A

Female

38
Q

Intraductal Papillary Mucinous Neoplasm (IPMN)

Where does it appear? Who is the typical patient?

A

Arises in main pancreatic duct or its major branch

Commonly in pancreatic head

Men more common than women

39
Q

Agenesis of pancreas is likely due to what mutation?

A

PDX1 gene mutation

40
Q

Annular Pancreas

Describe the pathology

A

Pancreas head wraps around duodenum, causing obstruction

41
Q

Pancreas Divisum

Describe the pathology

A

Duct system within the pancreas does not fuse

Pancreatic secretions cannot easily reach duodenal lumen

Can cause chronic obstruction and chronic pancreatitis

42
Q

Ectopic Pancreas

Describe the pathology

A

Pancreas tissue seen in other organs (such as stomach, duodenum, jejunum, ileum)

Likely asymptomatic, but may cause bleeding, pain

Can cause acute/chronic inflammation of pancreatic adenocarcinoma

MHD (57 decks)

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