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Block 10 week 4 > Exocrine Pancreas-Usera > Flashcards

Exocrine Pancreas-Usera Flashcards

1
Q

What is the location of the spleen?
How long is it?
How much does it weight?
Is the exocrine pancreas or endocrine pancreas bigger?

A

extends from C loop of duodenum to hilum of the spleen

20 cm

85-90 grams

80-85%

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2
Q

What are the ducts coming out of the exocrine pancreas?

A

Duct of santorini
Papilla of Vater
Duct of Wirsung

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3
Q

What is this:
Abscence of pancreas

Is this common?

What gene is implicated in this?

What will be the result of this?

A

pancreas agenesis

Rare

PDX1

DM, malabsorption, associated with other anomalies that are incompatible with life (13q12.1)

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4
Q

What are all the congenital anomalies of the pancreas?

A

Agenesis
Pancreas Divisum
Annular Pancreas
Ectopic Pancreas

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5
Q

(blank) encodes a transcription factor essential for pancreatic development

A

PDX1

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6
Q

What is this:
failure of fusion of fetal duct systems of dorsal and ventral pancreatic primoria

What is the incidence?

A

Pancreas Divisum

3-10%

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7
Q

Normally, the adult pancreas will have the majority of pancreatic drainage through the ventral pancreatic duct into However, in pancreas divisum, how is the drainage?

A

Majority of pancreatic drainage is through the dorsal pancreatic duct and minor papilla.

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8
Q

In pancreas divisum, the head of the pancreas drains through (blank and blank)

A

duct of Wirsung and papilla of vater (major papilla)

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9
Q

What is the most common congenital anomaly?

A

Pancreas divisum

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10
Q

What is this:
Rare, congenital anomaly that may not become apparent until adult life.
Pancreas completely or incompletely encircles 2nd portion of duodenum occasionally obstructing more proximal duodenum

A

Annular pancreas

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11
Q

What gender is more affected by annular pancreas?

How does the pancreas develop?

A

males

from 2 buds

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12
Q

THe larger dorsal bud forms (blank) of the pancreas.

The smaller ventral bud forms the (blank) of the pancreas and what other things?

A

body and tail

Head and gallbladder and hepatic duct

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13
Q

Why is an annular pancreas thought to develop?

A

as a result of abnormalities in migration of ventral bud such that 2 buds join to encircle the duodenum.

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14
Q

In the annular pancreas, the pancreatic duct from the annular portion may drain into the (blank) or directly into the (blank),
Is it frequently (blank)

A

main pancreatic duct or duodenum

asymptomatic

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15
Q

When does an annular pancreas typically present?

A

in infancy, or 4th and 5th decade of life

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16
Q

In newborn with annular pancreas that results in duodenal obstruction will present with (blank). It may be associated with duodenal (blank or blank).
There is a 50% associated with other (blank) involving the heart, trachea, esophagus, and malrotation of the intestine.

A

bilious vomiting
duodenal stenosis or atresia
congenital anomalies

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17
Q

What are the symptoms of annular pancreas in the adult?

A
  • Upper abdominal colicky pain
  • Postprandial fullness
  • Vomiting
  • Higher incidence of pancreatitis
  • Peptic ulcers may develop
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18
Q

What is this:
pancreatic tissue in location other than the pancreas

presents in app. (blank)% of autopsies

Where are some locations you can find this?

What will ectopic pancreas consist of?

A

Ectopic pancreas

2%

SUBMUCOSA of stomach, duodenum, jejunum, meckel diverticulum, ileum

Acini and occasionally islet cells

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19
Q

What is the definition of pancreatitis?

A

inflammation of the pancreas with injury of the exocrine pancreatic tissue

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20
Q

What are the clinical symptoms of pancreatitis?

A

mild, self-limited disease to life-threatening acute inflammatory process

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21
Q

What is the duration of pancreatitis?

A

transietn attack to permanent loss of function

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22
Q

If you have acute pancreatitis, the exocrine tissue can return to normal function if the underlying cause of pancreatitis is (blank)

A

removed

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23
Q

What is chronic pancreatitis?

A

irreversible injury with loss of pancreatic exocrine tissue

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24
Q

What is this:

reversible pancreatic parenchymal injury associated with inflammation

A

acute pancreatitis

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25
Q

Is acute pancreatitis rare?

A

no it is common! annual incidence of 10-20 cases/100,000 in western countries

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26
Q

What accounts for 80% of cases of acute pancreatitis?

A

gallstones (biliary tract disease) and alcohol

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27
Q

Gallstones are present in (blank)% of cases of acute pancreatitis.
About (blank)% of those with gallstones will develop acute pancreatitis

A

35-60

5%

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28
Q

What gender more commonly will get biliary tract disease (gallstones) resulting in acute pancreatitis?
What gender more commonly will get alcohol induced acute pancreatitis?

A

women (3:1)

men (6:1)

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29
Q

What is the mneumonic for acute pancreatitis causes?

A

BAD SHIT

Black scorpion bite
Alcohol ( or autoimmune : PAN)
Drugs ( tetracycline, azothioprin, sulfa, diuretics )
Stones ( gallstones or steroid i.e obstruction of pancreatic ductal system)
Hyperlipidemia/ Hypercalcemia
Infection ( mumps )
Trauma

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30
Q

Obstruction of the pancreatic ductal system is a major cause of acute pancreatitis, what are all the ways you can do this?

A
  • Periampullary neoplasm (cancer of the pancreatic head)
  • Pancreatic divisum
  • Choledochocele (congenital cystic dilatation of the common bile duct)
  • Biliary sludge
  • Parasites (Ascaris, Clonorchis)
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31
Q

What med is a major cause of acute pancreatitis?

A

azathioprine

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32
Q

What infection is a major cause of acute pancreatitis?

A

MUMPS

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33
Q

What is a genetic cause of acute pancreatitis? Why?

A

PRSS1 (cationic trypsinogen) and SPINK1 (trypsin inhibitor) genes

Both induce trypsin activation

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34
Q

What are the metabolic disorders that cause acute pancreatic?

A

alcohol, hyperliproprotenemia, hypercalcemia

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35
Q

What are the ischemic injury causes of acute pancreatitis?

A

Shock, vasculitis, atheroembolism

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36
Q

What are the trauma induced causes of acute pancreatitis?

A

gallstones, iatrogenic (operative injury, procedures with dye injection)

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37
Q

What will duct obstruction cause?

A

interstitial edema=> impaired blood flow=> ischemia=> acinar cell injury

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38
Q

What will acinar cell injury cause?

A

release of intracellular proenzymes and lysosomal hydrolases-> activation of enzymes (intra- and extracellular)-> acinar cell injury

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39
Q

What wil defective intracellular transport cause?

A

delivery of proenzymes to lyososomal compartment-> intracellular activation of enzymes-> acinar cell injury

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40
Q

What are all the lesions that acute pancreatitis causes?

A

-interstitial inflammation and edema
-proteolysis
-fat necrosis
hemorrhage

41
Q

What is the histology of acute pancreatitis?

A
  • edema
  • fat necrosis
  • acute inflammation (neutrophils)
  • proteolytic destruction of pancreatic parenchyma
  • destruction of BVs w/ interstitial hemorrhage
42
Q

What is the clinical presentation of acute pancreatitis?

A 
abdominal and back pain 
Epigastric tenderness
N/V
low fever
hypotension
subq fat necrosis
43
Q

What are the lab findings of acute pancreatitis?

A

elevated serume amylases levels within 2-24 hours-> return to normal w/in 2-3 days
(sensitivity 90-98%) but specificity is 70%
Lipase (specific for pancreatitis)!!!!

44
Q

Lipase levels in acute pancreatitis rise within 2-24 hours but remain elevated for up to (blank)

A

14 days

45
Q

Persistent elevations of serum amylase indicated (blank)

A

a pseudocyst or other pathology

46
Q

Full blown acute pancreatitis is a (blank)

A

medical emergency

47
Q

IF acute pancreatitis gets out of hand, what will be the complications?

A 
leukocytosis
hemolysis
DIC
ARDS
Fat necrosis
Shock and ATN
peripheral vascular collapse
48
Q

How do you treat acute pancreatitis?

A

Rest (total restricition of oral intake)
IV fluid
Analgesics

49
Q

What are the sequelae of acute pancreatitis?

A

5% death
pancreatic abscess
(40-60% infectious)
Pancreatic pseudocyst

50
Q

What is this:
inflammation of the pancreas with irreversible destruction of the exocrine pancreatic parenchyma, fibrosis, and in later stages, destruction of endocrin pancreatic parenchyma

Is it common?

A

Chronic pancreatitis

no (0.4-0.5% prevalence)

51
Q

What is the most cmmon cause of chronic pancreatitis? Who typically gets it?

A

chronic alcohol abuse
middle aged males
(no known etiology in 40%)

52
Q

What are other causes of chronic pancreatitis?

A

long standing obstruction
hereditary pancreatitis
CFTR gene mutations
Tropical pancreatisi

53
Q

What are the the causes of long standing obstruction that results in chronic pancreatitis?

A
  • pseudocysts
  • calculi
  • trauma
  • neoplasma
  • pancreas divisum
54
Q

What are the hereditary causes of chronic pancreatitis?

A

Germline mutations in PRSS1 (cationic trypsinogen gene, AD) or SPINK1 (serine protease inhibitor gene, AR)

55
Q

Why does a CFTR gene mutation cause chronic pancreatitis?

How common do you see this in chronic pancreatitis patients?

A

-Mucus production due to decreased bicarb secretion promotes plugging of ductules
25-30% of patients

56
Q

What is this:

poorly characterized heterogenous disease in Africa and Asia

A

Tropical pancreatitis

57
Q

In chronic pancreatitis, alcohol causes increased (blank) which blocks ducts.

A

protein

58
Q

Alcohol and its metabolites induce oxidative stress and are toxic by doing what?

A
  • creating free radicals w/in acinar cells
  • activation of transcription factors (chemokines)
  • fusion of lysosomes and zymogen granules
  • acinar cel necrosis
  • inflammation
  • necrosis
59
Q

What are the histlological findings of chronic pancreatitis?

A
  • parenchymal fibrosis
  • reduced number and size of acini w/ relative sparing of islets
  • variable dilation of pancreatic ducts (protein plugs or conceretions, epithelial atrophy or hyperplasia, squamos metaplasia)
  • chronic inflammation
60
Q

What is this:
duct centric mixed inflammatory cell infiltrate, venulitis, and increase number of IgG4-producing plasma cells

How do you treat this?

A

Autoimmune pancreatitis

steroids

61
Q

What is the clinical presentation of autoimmune pancreatitis?

A
  • repeated attacks of mild to severe abdominal pain
  • persistent abdominal pain and back pain
  • jaundice
  • silent w/ development of diabetes or pancreatic insufficiency
62
Q

Autoimmune pancreatitis can be precipitated by (blank X 3)

A

alcohol use, overeating or use of drugs that increase the tone of sphincter of oddi

63
Q

Is the sequalea of chronic pancreatitis usually immediately life-threatening?
What is the 20-25 year mortality rate?

A

no

50%

64
Q

What are the sequelae of chronic pancreatitis?

A
  • pancreatic exocrine insuffiency with malabsorption
  • diabetes
  • chronic pain
  • 100% develop pancreatic pseudocysts
  • possible predisp to cancer
65
Q

What are the cystic lesions of the pancreas?

A 
٭ Congenital cysts
٭ Pseudocysts
٭ Mucinous cystic lesions
٭ Nonmucinous cystic lesions
٭ Solid pseudopapillary Tumors
66
Q

Congenital cysts result from anomalous development of the (Blank)

A

pancreatic duct

67
Q

Describe what congenital cysts look like?

A

unilocular, thin walled, up to 5 cm in diameter

68
Q

Congenital cysts are lined by uniform (blank) epithelium. Enclosed by a thin (Blank). Filled with (blank) fluid.
How do they occur?

A

cuboidal
thin fibrous capsule
clear serous fluid
sporadically

69
Q

Congenital cysts are syndromic with (blank) and (blank)

A

APKD

Von Hippel Linndau Disease

70
Q

What is a pancreatic pseudocyst?

A

Fluid collection > 4 weeks old and surrounded by a defined wall of fibrous tissue.

71
Q

What will you find within a pancreatic pseudocysts?

A

hemorrhagic (necrotic) material rich in pancreatic enzymes (pancreatic uice)

72
Q

Why is it considered a “pseudocyst”?

A

lacks an epithelial lining, instead encased by granulation tissue (fibrosis)

73
Q

Pseudocysts can be any size and single or multiple. Most communicate with (blank) system ( app. 75%)

A

pancreatic ductal system

74
Q

Pseudocysts are associated with what three things?

A

acute pancreatitis
chronic pancreatitis
trauma

75
Q

What are the complications of pancreatic pseudocysts?

A
  • abdominal pain
  • duodenal or biliary obstruction
  • vascular occlusion
  • fistula formation into adjacent viscera
  • pleura space or pericardium
  • pseudoaneurysm
  • pancreatic ascites and pleural effusion
76
Q

If you aspirate fluid from a pseudocyst what willl the laboratory findings show to make the diagnosis?
What are other diagnostic signs?

A

Increase amylase
Decrease CEA
Increase CA 19-9

  • pancreatic ascites or pleural effusion
  • absence of septae within the cyst
77
Q

What are the 2 mucinous cystic lesions?

A
  • intraductal papillary mucinous neoplasm +/- invasive carcinoma
  • mucinous cystic neoplasm
78
Q

What gender gets mucinous cystic neoplasms the most?

Where in the pancreas do they usually arise?

How do they present?

How should you trea tthem?

Do they affect the ductal system?

What kind of eptihelium lines these cysts?

A

Females (95%)

body or tail

painless, slow growing massess, cysts are large and filled with thick mucin

pathologic eval for invasive malignancy after complete removal (distal pancreatectomy)

No

columnar muinous epithelium overlying an ovarian type stroma

79
Q

What gender gets intraductal papillary mucinous neoplasms the most?
Where in the pancreas do they occur?
Are they unifocal or mutlifocal?Do theyy invove the ductal system?

How do you treat it?

A

men

head

unifocal (80-90%)- > 10-20% are multifocal

yes the larger pancreatic duct

surgical resection and eval for invasive malignancy

80
Q

Is a serous cystadenoma benign or malignant?

What are the cells lining the cyst like?

A

benign

glycogen rich cuboidal cells lining small (1-3 mm) cysts containing clear (serous) fluid

81
Q

Serous cystadenomas make up (blank)% of all cystic neoplasms of the pancreas.
What gender does this occur most often in?
What age?
what does it clinically presnt as?
How do you treat it?

A 
25%
2X more often in women
7th decade (60s)
abdominal pain or masses
surgical resection is curative
82
Q

What is this:
large, well-circumscribed with solid and cystic components. Cystic areas filled with hemorrhagic debris. Neoplastic cells in sheets or in papillary projections

A

Solid pseudopapillary neoplasm

83
Q

How does a solid pseudopapillary neoplasm present?

It is a result of an (blank) mutation and (blank) is curative

A

abdominal discomfort

activating mutation of B-catenin

surgical resection

84
Q

(blank) is now the 4th leading cause of death in the US. What is the prognosis like with pancreatic cancer?

A

Pancreatic ductal adenocarcinoma
5 yr survival < 3%
Most die within 6 months

85
Q

*0% of pancreatic cacinoma cases are present in people of what ages?
What are the risk factors?
Does it exhibit familial clustering?

A

60-80 yrs
smoking, diet rich in fats, chronic pancreatitis, diabetes, alcohol

yes

86
Q

What are the genes and diseases associated with familial clustering?

A

BRCA2 (hereditary breast and ovarian cancer)
P16/CDKN2A (familial atypical mole/ melanoma syndrome)
Hereditary pancreatitis
Peutz-Jeghers syndrome

87
Q

Wat are the gross findings of pancreatic cancer and where are they usually located?

A 
60% in the head
15% in the body
5% in the tail
20% are diffuse at presentation
Usually hard, stellate, gray white, poorly defined masses
88
Q

What is the most common type of pancreatic carcinoma? Does the histology differ with differing locations throughout the pancreas?
Is it invasive?

A

ductal carcinomas
no
highly invasive

89
Q

Pancreatic carcinoma has an intense (Blank) response and often grows along (blank). What does it often invade?

A

fibroblatic response
nerves
lymphovascular spaces and metastasize

90
Q

What does pancreatic carcinoma look like histologicaly?

A

Abortive tubular strutures or cell clusters growin in a deeply infiltrative pattern

91
Q

Pancreatic carcinoma tries to recapitulate normal ductal epithelium by forming (Blank) and secreting (blank)

A

glands

mucin

92
Q

What kind of cells are found in pancreatic carcinoma?

What is a variant of pancreatic carcinoma?

A

pleomorphic cuboidal to columnar epithelial cells

adenosquamos carcinoma

93
Q

Pancreatic carcinoma is clinically silent until (Blank).

A

invasion of other structures, then pain

94
Q

When will pancreatic cancer cause jaundice?

A

head of pancreas-> cuz it obstructs common bile duct

95
Q

What are some general symptoms of pancreatic cancer?

A 
weight loss
fatigue
general malaise
weakness
migratory thrombophlebitis (10% ) trousseau sign
96
Q

Only 20% of pancreatic adenocarcinomas are even considered (blank)at time of diagnosis.

A

resectable

97
Q

If the surgeon achieves negative margins then the 5 year survival rate of pancreatic cancer can be as high as (blank)%.

A

40%

98
Q

WHen fighting pancreatic cancer a whipple procedure will be performed, what all does this entail?

A

Head and neck of pancreas
gall bladder
proximal duodenal

Block 10 week 4 (10 decks)

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