Pancreas and Peritoneal Flashcards
What results from the failure of dorsal and ventral pancreatic duct fusion?
Pancreas divisum
What is defined as a bandlike ring of normal pancreatic tissue completely encircling the second portion of the duodenum?
Annular pancreas
What is an ectopic pancreas?
Pancreatic tissue found in the stomach, duodenum, jejunum, meckel’s diverticulum, and ileum. Usually very small
How do acute pancreatitis and chronic pancreatitis differ grossly?
Acute pancreatitis: Necrosis
Chornic pancreatitis: Fibrosis
How does chronic pancreatitis lead to pancreatic insufficiency?
Irreversible loss of acinar tissue
What pancreatitis may mimic pancreatic cancer on gross specimen?
Type I autoimmune pancreatitis
What is the histological problem in type I autoimmune pancreatitis?
IgG4 producing plasma cell increase
How do you treat autoimmune pancreatitis?
Steroid therapy
What are other diseases which may be manifestations of IgG4 disease?
Retroperitoneal fibrosis
Type 1 autoimmune pancreatitis
Reidel’s thyroiditis
Chronic sclerosing sialadenitis (Kuttner’s tumor) : a salivary gland tumor
What disease is analogous to sarcoidosis in its systemic organ manifestations by the same histopathological features?
IgG4 related disease
What are the two most common causes of pancreatic pseudocysts?
Acute pancreatitis
Trauma
What enzyme levels are high in pancreatic pseudocysts?
Amylase
What does the microscopic appearance of a pancreatic pseudocyst look like?
Lacks true epithelial lining and instead is lined by fibrin and granulation tissue
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?
Serous cystadenoma
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?
Mucinous cystadenoma
Worry about malignancy
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?
Intraductal papillary mucinous neoplasm
Worry about malignancy
Where does pancreatic cancer rank in the list of causes of cancer deaths?
Fourth leading cause
What are risk factors for pancreatic carcinoma?
Smoke Physical inactivity Diabetes Chronic pancreatitis Family hx obesity
What are common clinical presentations of pancreatic carcinoma?
Pain, jaundice, cachexia, thrombophlebitis
How is pancreatic carcinoma diagnosed?
Imaging study, tissue bx
Often with endoscopic ultrasound guided biopsy technique
What is the whipple procedure?
Transect pancreas, take out duodenum and bile duct.
Attach stomach to jejunum, hepatic duct to jejunum, and pancreas to duodenum
What pancreatic cancer is most common in children?
Pancreatoblastoma
What cancer is most likely to be found in a young woman?
Pancreatic solid-pseudopapillary tumor
Where are pancreatic neuroendocrine tumors usually found? What about pancreatic adenocarcinoma?
PNT: body or tail
PA: Head
What do pancreatic neuroendocrine tumors look like? What about pancreatic adenocarcinoma?
PNT: Well circumscribed
PA: not well circumscribed
What is the clinical course of pancreatic neuroendocrine tumors like? What about pancreatic adenocarcinoma?
PNT: Long clinical course
PA: 1 year
What are some hormones that are released by pancreatic neuroendocrine tumors?
Insulin Gastrin Glucagon Somatostatin VIP ACTH
What are some common causes of peritonitis?
Bacteria Bile leakage Hemorrhagic necrotizing pancreatitis Foreign material Endometriosis (localized hemorrhage)
What is defined as excess fluid in the peritoneal cavity?
Ascites
What is the most common cause of ascites? Second most common?
Portal hypertension
Cancer
What is the most significant complication of ascites?
Spontaneous bacterial peritonitis (bacterial infection without known source)
Why do you do a cell count with ascites? Culture? Albumin? Total protein? Cytology?
Cell count: infection
Culture: infection
Albumin: for serum ascites-albumin gradient
Total protein: if protein rich, then exudate
Cytology: Malignancy
If the SAAG is <1.1, what are the most likely causes of the ascites?
Cancer
TB
Pancreatitis
Nephrotic syndrome
If the SAAG is >1.1, what are the most likely causes of the ascites?
Cirrhosis
Hepatic mets
Bud-chiari syndrome
Cardiac disease
What two metastatic tumors are the most common causes of malignant ascites?
Ovarian carcinoma: #1
Pancreatic carcinoma: #2
What is idiopathic retroperitoneal fibrosis?
Dense fibrosing of the retroperitoneum causing ureter obstruction, dilating renal calyxes. IgG4 related
