Pancreas Flashcards
What is the function of acinar cells?
synthesize, store, and secrete digestive enzymes (proteolytic, lipolytic, amylolytic, nucleases, trypsin inhibitor)
How are pancreatic enzymes activated?
activated in lumen of duodenum in the brush border (peptidase, enterokinases)
What is acute pancreatitis?
autodigestive and inflammatory process of pancreas with variable severity
What are the etiologies of acute pancreatitis?
alcohol, duct obstruction (gallstone, neoplasm, parasite), hyperlipidemia, hypercalcemia, trauma, infections, hereditary
_________ is a more common cause of acute pancreatitis in females, _________ is more common in males.
gallstones; alcohol
What is the pathogenesis of acute pancreatitis?
trypsinogen is activated to trypsin within acinar cells –> activates other proenzymes within the pancreas –> autodigestion of parenchyma, acute inflammation, oxygen free radicals
What is the clinical presentation of acute pancreatitis?
middle aged adults, acute upper abdominal pain without relief, nausea, vomiting
What are the gross findings of acute pancreatitis?
swollen and edematous pancreas
plaques of fat necrosis, can be hemorrhagic
What are the microsocopic findings of acute pancreatitis?
necrosis of peripancreatic fatty tissue and peripheral acinar lobules
inflammatory reaction, accumulation of macrophages
What laboratory findings are associated with acute pancreatitis?
increased serum amylase and lipase (diagnostic when 3x ULN and with consistent symptoms)
increased serum trypsinogen-2 and trypsin-antitrypsin complex
What are the major complications of acute pancreatitis?
local: pancreatic necrosis, pancreatic abscess, pseudocysts, chronic pancreatitis
systemic: hypotension, renal failure, respiratory failure
What are the three categories of chronic pancreatitis?
1) chronic calcified pancreatitis (alcohol related)
2) chronic obstructive pancreatitis (duct obstruction)
3) chronic inflammatory pancreatitis (autoimmune)
What is the pathology of chronic pancreatitis?
shrunken and firm pancrease
irregular ducts with calculi
microscopic: fibrosis, loss of exocrine tissue, inflammation
What are the risk factors of pancreatic ductal carcinoma?
old age, black race, male gender, jewish religion
What environmental factors increase risk of pancreatic ductal adenocarcinoma?
tobacco
maybe diet, occupation, alcohol
What genetic mutations are related to pancreatic cancers?
KRAS gene (oncogene)
p53 gene (tumor suppressor)
Tumors in which parts of the pancreas are most likely to present early?
head of pancreas –> can compress common bile duct and lead to jaundice
tumors of body and tail often present very late
What are the metastatic patterns of spread from the pancreatic head?
- directly to duodenum and stomach
- mets to regional lymph nodes
- vascular spread to liver
What are the metastatic patterns of spread from tumors in the body or tail of pancreas?
- direct spread to spleen, colon, adrenal, and kidney
- peritoneal mets
- mets to regional lymph
- vascular spread
What are the symptoms of pancreatic carcinoma?
vague symptoms: anorexia, weight loss, nausea, abdominal discomfort
can present with jaundice once it gets large enough
What is suggested by the carcinoembryonic antigen and CA19-9?
pancreatic carcinoma
What is an intraductal papillary mucinous neoplasm?
precursor lesion of pancreatic ductal adenocarcinoma
more frequent in men and women, involves head of pancreas
What is a mucinous cystic neoplasm?
precursor lesion of pancreatic ductal adenocarcinoma
more common in men, more often in head of pancreas
What are well-differentiated neuroendocrine tumors?
neoplasms of the pancreas that are either caused sporadically or as a part of systemic diseases
leads to functional changes (ex. insulinoma, glucagonoma, etc.)
