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Exocrine pancreas disorders Flashcards

1
Q

Pancreas cell that secrete proenzymes

A

Acinar cells

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2
Q

Parts of pancreas that develop from the ventral bud

A

Uncinate process and inferior part of head

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3
Q

Genetic anomalies associated with annular pancreas

A

Trisomy 21
Tracheoesophageal fistula
Cardiac anomalies

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4
Q

Most common congenital anomaly of pancreas

A

Pancreas divisum

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5
Q

Failure of fusion of the dorsal and ventral pancreatic buds leading to the majority of the pancreas draining into the duodenum through minor papilla

A

Pancreas divisum

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6
Q

Caused by failure of part of the ventral bud of the pancreas to undergo atrophy, or by aberrant migration

A

Ectopic pancreas

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7
Q

Most common sites of ectopic pancreas

A

Stomach
Duodenum

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8
Q

Initiated by injuries that lead to auto-digestion of the pancreas, when protective mechanisms are disrupted or overwhelmed

A

Pancreatitis

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9
Q

Metabolic causes of acute pancreatitis

A

Alcoholism
Hypertriglyceridemia
Hypercalcemia
Drugs

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10
Q

Mechanical causes of acute pancreatitis

A

Gallstones
Trauma/surgery
Iatrogenic injury
ERCP

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11
Q

Vascular causes of acute pancreatitis

A

Shock
Atheroembolism
Vasculitis (polyarteritis nodasa)

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12
Q

Genetic mutations that can cause acute pancreatitis

A

PRSS1 –> trypsin activation
SPINK1 –> trypsin inhibitor
CASR –> Ca receptor
CFTR –> cystic fibrosis

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13
Q

Infectious causes of acute pancreatitis

A

Mumps
Coxsackie virus

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14
Q

Gross appearance of fat necrosis in pancreatitis

A

Yellow-white chalky areas

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15
Q

FAs combine with Ca to form insoluble soaps creating a granular blue microscopic appearance in necrotic fat cells.

A

Saponification of fat necrosis in pancreatitis

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16
Q

Pt presents with recent onset constant and intense abdominal pain referred to upper back and L shoulder with anorexia, nausea, and vomiting.

A

Acute pancreatitis

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17
Q

Serous, slightly turbid, brown-tinged fluid with fat globules in the peritoneal cavity, reflect digestion of adipose tissue

A

Systemic lipase release causing fat necrosis, associated with pancreatitis

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18
Q

Signs associated with hemorrhagic pancreatitis

A

Gray-Turner sign –> flank hemorrhage
Cullen sign –> periumbilical hemorrhage

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19
Q

Cause of tetany in acute pancreatitis

A

Hypocalcemia because of Ca used in saponification of fat necrosis

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20
Q

Additional conditions that can be caused by acute pancreatitis

A

DIC
Shock
ARDS
Tetany

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21
Q

Serum amylase findings in acute pancreatitis

A

Markedly increased for first 24 hrs
Normal in 3-5 days

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22
Q

Serum lipase findings in acute pancreatitis

A

Elevated during 72-96 hrs

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23
Q

Complications of acute pancreatitis

A

Pancreatic pseudocyst
Pancreatic abscess
Acute kidney failure

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24
Q

Cause of pancreatic pseudocyst in acute pancreatitis

A

Persistent elevation of serum amylase

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25
Cause of pancreatic abscess in acute pancreatitis
Infection with gram negative organisms
26
Cause of acute kidney failure in acute pancreatitis
Acute tubular necrosis
27
Irreversible destruction of exocrine parenchyma and fibrosis, and loss of endocrine parenchyma in the pancreas
Chronic pancreatitis
28
Most common cause of chronic pancreatitis
Long term alcohol use
29
Causes of chronic pancreatitis
Alcoholism Chronic pancreatic duct obstruction (calculi or neoplasm) Autoimmune injury Hereditary factors
30
Chronic pancreatitis associated with a manifestation of systemic IgG related disease
Type 1 autoimmune pancreatitis
31
Histology shows swirling or storiform fibrosis and obliterative inflammation of the veins within the pancreas
Type 1 autoimmune pancreatitis
32
Dense lymphoplasmacytic inflammation of the pancreas that is enriched in IgG4 secreting plasma cells
Lymphoplasmacytic sclerosing pancreatitis associated with type 1 autoimmune pancreatitis
33
Chronic pancreatitis characterized by neutrophilic infiltrates within the epithelium and lumen of medium-sized pancreatic ducts
Type 2 autoimmune pancreatitis
34
Gross morphology of chronic pancreatitis
Gland is hard, sometimes with visibly dilated duct containing calcified concretions.
35
Cause of chronic pancreatitis associated with ductal dilation and intraluminal protein plugs and calcifications
Alcohol abuse
36
Microscopy shows chronic inflammatory infiltrate that surrounds lobules and ducts, with sparing of the islets of Langerhans
Chronic pancreatitis
37
Microscopy shows extensive fibrosis and atrophy, dilated duct with inspissated concretions, and lymphoplasmacytic infiltrates.
Chronic pancreatitis
38
CT scan findings of chronic pancreatitis
Dystrophic calcifications within the pancreas
39
Complications of chronic pancreatitis
Pancreatic exocrine insufficiency Chronic malabsorption DM type 1 Pancreatic pseudocyst Pancreatic carcinoma
40
Congenital pancreatic enzyme deficiencies
Co-lipase deficiency Lipase deficiency Trypsinogen deficiency
41
Two main functions of exocrine pancreas
Secretion of digestive enzymes Secretion of bicarbonate-rich fluid, to neutralize gastric acid
42
What is a sign that pancreatic lipase secretion is reduced by >90%?
Steatorrhea
43
What is azotorrhea?
Protein malabsorption
44
Area of intra- or peri-pancreatic hemorrhagic fat necrosis walled off by fibrosis and granulation tissue
Pancreatic pseudocyst
45
Contents of pancreatic pseudocyst
Fluid containing necrotic tissue and enzymes
46
Possible outcomes of a pancreatic pseudocyst
Spontaneous resolution Compression of adjacent structures Perforation
47
Benign tumor of the pancreatic tail resulting from inactivation of VHL gene. Gross morphology shows honeycomb of microcystic spaces.
Serous cystic neoplasm/cystadenoma of the pancreas
48
Microscopy of this pancreatic growth shows cystic spaces lined by glycogen-rich cuboidal cells that contain thin, clear, straw-colored fluid
Serous cystic neoplasm
49
Treatment for serous cystic neoplasm of the pancreas
Surgical resection is curative
50
Precursor lesion to invasive carcinoma of the pancreas
Mucinous cystic neoplasms
51
Genetic mutations associated with mucinous cystic neoplasms of the pancreas
KRAS mutation (50%) RNF43 loss-of-function TP53 and SMAD4
52
Gross appearance of larger cystic spaces filled with thick, tenacious mucin on the pancreas
Mucinous cystic neoplasms
53
Microscopy of mucinous cystic neoplasm of the pancreas
Cysts lined by mucin-producing epithelium Dense, ovary-like stroma
54
Treatment of benign mucinous cystic neoplasm of the pancreas
Surgical resection is curative
55
Prognosis of invasive adenocarcinoma in mucinous cystic neoplasm of the pancreas
50% die within 5 yrs
56
Benign tumor of head of pancreas and major ducts that is seen in men. Can progress to invasive cancer.
Intraductal papillary mucinous neoplasm
57
Genetic mutations of intraductal papillary mucinous neoplasm of pancreas
KRAS (80%) RNF43 GNAS TP53 and SMAD4
58
Microscopy of pancreatic growth shows ducts filled with complex papillary projections lined by tall, columnar epithelial cells. Varying grades of dysplasia.
Intraductal papillary mucinous neoplasm of pancreas
59
Most common pancreatic carcinoma
Infiltrating ductal adenocarcinoma
60
Third leading cause of cancer deaths in the US
Pancreatic carcinoma
61
Most common precursor lesion of pancreatic carcinoma
Pancreatic intraepithelial neoplasia (PanIN)
62
Most common genetic mutation associated with pancreatic carcinoma
BRCA2
63
Syndrome associated with increased risk of pancreatic cancer
Peutz-Jeghers syndrome
64
Gross appearance of pancreatic ductal adenocarcinoma
Hard, stallate, gray-white, poorly defined mass
65
Microscopy of pancreatic tumor shows abortive tubular structures or cell clusters, and aggressive and deeply infiltrative growth pattern. Tends to grow along nerves and invade into blood vessels.
Pancreatic infiltrating ductal adenocarcinoma
66
Courvoisier sign
Palpably enlarged nontender gallbladder with mild painless jaundice Associated with pancreatic carcinoma
67
Trousseau sign
Migratory thrombophlebitis caused by release of platelet-activating factors and procoagulants from tumor Associated with pancreatic adenocarcinoma
68
Direct metastasis of pancreatic cancer tends to go where
Spleen Adrenals Transverse colon Stomach
69
Primary areas of distant metastasis of pancreatic cancer
Liver Lungs
70
Tumor markers associated with pancreatic cancer
CEA CA19-9
71

GI II (31 decks)

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