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GI > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What is the function of acinar cells?

A

synthesize, store, and secrete digestive enzymes (proteolytic, lipolytic, amylolytic, nucleases, trypsin inhibitor)

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2
Q

How are pancreatic enzymes activated?

A

activated in lumen of duodenum in the brush border (peptidase, enterokinases)

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3
Q

What is acute pancreatitis?

A

autodigestive and inflammatory process of pancreas with variable severity

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4
Q

What are the etiologies of acute pancreatitis?

A

alcohol, duct obstruction (gallstone, neoplasm, parasite), hyperlipidemia, hypercalcemia, trauma, infections, hereditary

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5
Q

_________ is a more common cause of acute pancreatitis in females, _________ is more common in males.

A

gallstones; alcohol

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6
Q

What is the pathogenesis of acute pancreatitis?

A

trypsinogen is activated to trypsin within acinar cells –> activates other proenzymes within the pancreas –> autodigestion of parenchyma, acute inflammation, oxygen free radicals

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7
Q

What is the clinical presentation of acute pancreatitis?

A

middle aged adults, acute upper abdominal pain without relief, nausea, vomiting

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8
Q

What are the gross findings of acute pancreatitis?

A

swollen and edematous pancreas

plaques of fat necrosis, can be hemorrhagic

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9
Q

What are the microsocopic findings of acute pancreatitis?

A

necrosis of peripancreatic fatty tissue and peripheral acinar lobules

inflammatory reaction, accumulation of macrophages

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10
Q

What laboratory findings are associated with acute pancreatitis?

A

increased serum amylase and lipase (diagnostic when 3x ULN and with consistent symptoms)

increased serum trypsinogen-2 and trypsin-antitrypsin complex

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11
Q

What are the major complications of acute pancreatitis?

A

local: pancreatic necrosis, pancreatic abscess, pseudocysts, chronic pancreatitis
systemic: hypotension, renal failure, respiratory failure

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12
Q

What are the three categories of chronic pancreatitis?

A

1) chronic calcified pancreatitis (alcohol related)
2) chronic obstructive pancreatitis (duct obstruction)
3) chronic inflammatory pancreatitis (autoimmune)

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13
Q

What is the pathology of chronic pancreatitis?

A

shrunken and firm pancrease

irregular ducts with calculi

microscopic: fibrosis, loss of exocrine tissue, inflammation

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14
Q

What are the risk factors of pancreatic ductal carcinoma?

A

old age, black race, male gender, jewish religion

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15
Q

What environmental factors increase risk of pancreatic ductal adenocarcinoma?

A

tobacco

maybe diet, occupation, alcohol

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16
Q

What genetic mutations are related to pancreatic cancers?

A

KRAS gene (oncogene)

p53 gene (tumor suppressor)

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17
Q

Tumors in which parts of the pancreas are most likely to present early?

A

head of pancreas –> can compress common bile duct and lead to jaundice

tumors of body and tail often present very late

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18
Q

What are the metastatic patterns of spread from the pancreatic head?

A
  • directly to duodenum and stomach
  • mets to regional lymph nodes
  • vascular spread to liver
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19
Q

What are the metastatic patterns of spread from tumors in the body or tail of pancreas?

A
  • direct spread to spleen, colon, adrenal, and kidney
  • peritoneal mets
  • mets to regional lymph
  • vascular spread
20
Q

What are the symptoms of pancreatic carcinoma?

A

vague symptoms: anorexia, weight loss, nausea, abdominal discomfort

can present with jaundice once it gets large enough

21
Q

What is suggested by the carcinoembryonic antigen and CA19-9?

A

pancreatic carcinoma

22
Q

What is an intraductal papillary mucinous neoplasm?

A

precursor lesion of pancreatic ductal adenocarcinoma

more frequent in men and women, involves head of pancreas

23
Q

What is a mucinous cystic neoplasm?

A

precursor lesion of pancreatic ductal adenocarcinoma

more common in men, more often in head of pancreas

24
Q

What are well-differentiated neuroendocrine tumors?

A

neoplasms of the pancreas that are either caused sporadically or as a part of systemic diseases

leads to functional changes (ex. insulinoma, glucagonoma, etc.)

25
Q

Why do pancreatic enzymes normally not cause autodigestion of the pancreas?

A

enzymes in the pancrease are pro-enzymes that are not active until activated by trypsin

trypsin is stored in an inactive form in the pancreas and also has trypsin inhibitors

26
Q

What are the precursor lesions of the pancreatic ducts?

A

PanIN, IPMN, MCN

27
Q

What syndromic diseases are associated with well-differentiated neuroendocrine tumors?

A

MEN1, von Hippel-Lindau syndrome, tuberous sclerosis

28
Q

What is this?

A

pancreas

many islets of langerhans

29
Q

What is this?

A

acute pancreatitis

acute inflammation and hemorrhage

30
Q

What type of pancreatitis is caused by gallstones?

A

acute pancreatitis

31
Q

What type of pancreatitis is caused by alcohol?

A

acute OR chronic

32
Q

What type of pancreatitis is caused by tobacco?

A

acute OR chronic pancreatitis

33
Q

What type of pancreatitis is caused by endoscopic retrograde cholangiopancreatography?

A

acute pancreatitis

34
Q

What type of pancreatitis is caused by pancreatic duct obstruction?

A

chronic OR acute

35
Q

What immunoglobulins mediate autoimmune pancreatitis?

A

IgG4 in type 1

36
Q

What main genetic mutation causes hereditary pancreatitis?

A

PRSS1 gene –> defect in trypsinogen

37
Q

What is the treatment for acute pancreatitis?

A

aggressive early IV fluids (but not IV nutrition)

pain control

38
Q

Pseudocysts are a later complication of which type of acute pancreatitis?

A

interstitial pancreatitis

39
Q

Walled off pancreatic necrosis is a late complication of which type of pancreatitis?

A

necrotizing pancreatitis

40
Q

What mutation is associated with Peutz-Jeghers syndrome?

A

STK11 mutation

41
Q

What are insulinomas? How are they diagnosed?

A

pancreatic tumors that produce insulin and have fasting hypoglycemia

diagnosed by high insulin and c-peptide levels after fasting

42
Q

What are gastrinomas?

A

gastrin stimulating tumors that lead to abdominal pain, diarrhea, enlarged gastric folds, and peptic ulcer disease

43
Q

What are mucinous cystic neoplasms?

A

cysts that occur in pancreas body and tail that have “ovarian-like” stroma and are more common in women 40+

44
Q

What are intraductal mucinous neoplasms?

A

cysts with mucin-producing cells arranged in a papillary pattern

men > women, old age

45
Q

What are serous cystadenomas?

A

cystic tumors with low to no malignant potential that are more common in older women

46
Q

When do you need imaging to evaluate for acute pancreatitis?

A

usually don’t if you have symptoms + lipase or amylase 3x ULN

if you only have one of those, imaging can be diagnostic

47
Q

What disease is characterized by “ovarian-like stroma”?

A

serous cystadenoma

GI (10 decks)

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