Pancreas and Peritoneal

Question 1

What results from the failure of dorsal and ventral pancreatic duct fusion?

Answer 1

Pancreas divisum

Question 2

What is defined as a bandlike ring of normal pancreatic tissue completely encircling the second portion of the duodenum?

Answer 2

Annular pancreas

Question 3

What is an ectopic pancreas?

Answer 3

Pancreatic tissue found in the stomach, duodenum, jejunum, meckel’s diverticulum, and ileum. Usually very small

Question 4

How do acute pancreatitis and chronic pancreatitis differ grossly?

Answer 4

Acute pancreatitis: Necrosis

Chornic pancreatitis: Fibrosis

Question 5

How does chronic pancreatitis lead to pancreatic insufficiency?

Answer 5

Irreversible loss of acinar tissue

Question 6

What pancreatitis may mimic pancreatic cancer on gross specimen?

Answer 6

Type I autoimmune pancreatitis

Question 7

What is the histological problem in type I autoimmune pancreatitis?

Answer 7

IgG4 producing plasma cell increase

Question 8

How do you treat autoimmune pancreatitis?

Answer 8

Steroid therapy

Question 9

What are other diseases which may be manifestations of IgG4 disease?

Answer 9

Retroperitoneal fibrosis
Type 1 autoimmune pancreatitis
Reidel’s thyroiditis
Chronic sclerosing sialadenitis (Kuttner’s tumor) : a salivary gland tumor

Question 10

What disease is analogous to sarcoidosis in its systemic organ manifestations by the same histopathological features?

Answer 10

IgG4 related disease

Question 11

What are the two most common causes of pancreatic pseudocysts?

Answer 11

Acute pancreatitis

Trauma

Question 12

What enzyme levels are high in pancreatic pseudocysts?

Answer 12

Amylase

Question 13

What does the microscopic appearance of a pancreatic pseudocyst look like?

Answer 13

Lacks true epithelial lining and instead is lined by fibrin and granulation tissue

Question 14

A older gentleman comes into your office with abdominal pain. A pancreatic tumor is resected, and his tumor had cysts with straw-colored fluid in them. It was a curative resection. What was the cyst?

Answer 14

Serous cystadenoma

Question 15

A middle aged woman comes into your office with a mass in her belly that was painless. A cyst was removed from the tail of her pancreas. What is the likely cause? What do you have to worry about?

Answer 15

Mucinous cystadenoma

Worry about malignancy

Question 16

An older gentleman comes into your office with a bump in his belly that was painless. CT examination shows a dilated duct system in the pancreas. What is the likely diagnosis and what do you have to worry about?

Answer 16

Intraductal papillary mucinous neoplasm

Worry about malignancy

Question 17

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

Answer 17

Fourth leading cause

Question 18

What are risk factors for pancreatic carcinoma?

Answer 18

Smoke
Physical inactivity
Diabetes
Chronic pancreatitis
Family hx
obesity

Question 19

What are common clinical presentations of pancreatic carcinoma?

Answer 19

Pain, jaundice, cachexia, thrombophlebitis

Question 20

How is pancreatic carcinoma diagnosed?

Answer 20

Imaging study, tissue bx

Often with endoscopic ultrasound guided biopsy technique

Question 21

What is the whipple procedure?

Answer 21

Transect pancreas, take out duodenum and bile duct.

Attach stomach to jejunum, hepatic duct to jejunum, and pancreas to duodenum

Question 22

What pancreatic cancer is most common in children?

Answer 22

Pancreatoblastoma

Question 23

What cancer is most likely to be found in a young woman?

Answer 23

Pancreatic solid-pseudopapillary tumor

Question 24

Where are pancreatic neuroendocrine tumors usually found? What about pancreatic adenocarcinoma?

Answer 24

PNT: body or tail
PA: Head

Question 25

What do pancreatic neuroendocrine tumors look like? What about pancreatic adenocarcinoma?

Answer 25

PNT: Well circumscribed PA: not well circumscribed

Question 26

What is the clinical course of pancreatic neuroendocrine tumors like? What about pancreatic adenocarcinoma?

Answer 26

PNT: Long clinical course PA: 1 year

Question 27

What are some hormones that are released by pancreatic neuroendocrine tumors?

Answer 27

``` Insulin Gastrin Glucagon Somatostatin VIP ACTH ```

Question 28

What are some common causes of peritonitis?

Answer 28

``` Bacteria Bile leakage Hemorrhagic necrotizing pancreatitis Foreign material Endometriosis (localized hemorrhage) ```

Question 29

What is defined as excess fluid in the peritoneal cavity?

Answer 29

Ascites

Question 30

What is the most common cause of ascites? Second most common?

Answer 30

Portal hypertension | Cancer

Question 31

What is the most significant complication of ascites?

Answer 31

Spontaneous bacterial peritonitis (bacterial infection without known source)

Question 32

``` Why do you do a cell count with ascites? Culture? Albumin? Total protein? Cytology? ```

Answer 32

Cell count: infection Culture: infection Albumin: for serum ascites-albumin gradient Total protein: if protein rich, then exudate Cytology: Malignancy

Question 33

If the SAAG is <1.1, what are the most likely causes of the ascites?

Answer 33

Cancer TB Pancreatitis Nephrotic syndrome

Question 34

If the SAAG is >1.1, what are the most likely causes of the ascites?

Answer 34

Cirrhosis Hepatic mets Bud-chiari syndrome Cardiac disease

Question 35

What two metastatic tumors are the most common causes of malignant ascites?

Answer 35

Ovarian carcinoma: #1 | Pancreatic carcinoma: #2

Question 36

What is idiopathic retroperitoneal fibrosis?

Answer 36

Dense fibrosing of the retroperitoneum causing ureter obstruction, dilating renal calyxes. IgG4 related