Pancreas

Question 1

What is pancreas agenesis?

Answer 1

Absence of pancreas

Often with other malformations that make incompatible with life

Question 2

What is the most common congenital pancreatic anomaly?

Answer 2

Panrcreas divisum

Question 3

What happens with pancreas divisum?

Answer 3

Dorsal and ventral ducts don’t fuse…the bulk of the pancreas drains through the dorsal pancreatic duct

Question 4

What is it called when pancreatic tissue wraps around the second part of the duodenum?

Answer 4

Annular pancreas…usually a non-issue

Question 5

What effect does acute pancreatitis have on fatty tissue and the pancreatic parenchyma?

Answer 5

Leakage of pancreatic enzymes injures the fat and parenchyma

Question 6

What are the microscopic and gross findings of acute hemorrhagic necrotizing pancreatitis?

Answer 6

Hemorrhage
Fat necrosis (soft, chalky white areas)

Question 7

What are the microscopic and gross findings of long-standing chronic pancreatitis?

Answer 7

Irreversible destruction
Fibrosis (TGF-b and PDGF)
Sprinkling of chronic inflammatory cells

Question 8

How does chronic pancreatitis cause pancreatic insufficiency?

Answer 8

Repeated injury –> irreversible loss of acinar cell mass –> pancreatic insufficiency

Question 9

On examination of pancreatitis; gross findings include a mass, and microscopic findings include lymphocytic sclerosing. What type of pancreatitis is it?

Answer 9

Type I autoimmune pancreatitis (IgG-related disease)

Question 10

What is the treatment for IgG-related diseases like Type I autoimmune pancreatitis?

Answer 10

Glucocorticoid therapy

Question 11

It is determined that a pancreatic cyst is lined by fibrin and granulation tissue instead of epithelium. What is this cyst most accurately called? What are the two most common causes?

Answer 11

Pancreatic pseudocyst

Caused by acute pancreatitis or trauma

Question 12

Lab examination of a pancreatic cyst shows small cysts with clear, thin, straw-colored fluid surrounded by glycogen-rich cuboidal cells. What kind of cyst is it? Why did the patient come in? Who is the most likely patient? Is this cyst likely cancerous?

Answer 12

Serous (microcystic) cystadenoma…fluid filled and small…name makes sense

Presents with abdominal pain…most often in old people

Benign

Question 13

A middle aged woman is found to have cysts on her pancreas that are large, multiloculated, and filled with mucin. What kind of cysts? Where are these cysts most likely located on the pancreas? Is this cancerous?

Answer 13

Mucinous cystadenoma…filled with mucin…name makes sense

Slow growing mass in tail or body of pancreas

Cystadenoma is benign…cystadenocarcinoma is malignant

Question 14

An older patient presents with a growth in his neoplasm that communicates with a dilated pancreatic duct system and lacks “ovarian type” stroma. What is the name of the growth? Is it cancerous?

Answer 14

Intraductal papillary mucinous neoplasm

Can be benign or malignant

Question 15

Where does pancreatic cancer rank on the list of causes of cancer deaths?

Answer 15

Pancreatic cancer is the FOURTH leading cause of cancer deaths

Question 16

What is the most common type of pancreatic carcinoma?

Answer 16

Ductal adenocarcinoma is the MOST common form of pancreatic cancer

Question 17

What are some risk factors to developing ductal adenocarcinoma?

Answer 17

Smoking
Obesity/inactivity
Diabetes
Chronic pancreatitis
Family history
Specific inherited predispositions 
Hereditary pancreatitis
Older than 60

Question 18

If resection of pancreatitis is curative, how come so few pancreatic tumors are resected?

Answer 18

Tumors have to be stage I or II to be resected…most pancreatic tumors don’t present until stage III or IV

Question 19

How is pancreatic carcinoma diagnosed?

Answer 19

Imaging followed by biopsy

Question 20

What is done in the Whipple procedure for the treatment of pancreatic cancer?

Answer 20

Removal of part of the stomach, part of the pancreas, and most (all?) of the duodenum…new connections are then made with the remaining parts

Question 21

After a Whipple procedure, what is the order of things entering the duodenum/jejunum?

Answer 21

Pancreas (very beginning…mouth)
Bile duct (shortly after)
Stomach (after a while)

Question 22

Who is most likely to develop a solid-pseudopapillary tumor?

Answer 22

Young women

Question 23

Who is most likely to develop a pancreatoblastoma?

Answer 23

Pre-teens/teenagers

Question 24

What type of pancreatic tumor is well-circumscribed?

Answer 24

Pancreatic neuroendocrine tumors are well-circumscribed

Question 25

What hormones can be produced by pancreatic neuroendocrine tumors?

Answer 25

Insulin –> hypoglycemia
Gastrin –> peptic ulcer (Z-E syndrome)
Glucagon –> hyperglycemia, rash, anemia
Somatostatin –> diabetes, gallstones, steatorrhea, hypochlorhydria
VIP –> watery diarrhea, hypokalemia, achlorhydria