pancreas (not 4 star, misplaced)

Question 1

pancreas is derived from

Answer 1

foregut (endoderm structure)

Question 2

hepatic diverticulum on ventral surface of distal foregut gives rise to

Answer 2

endodermal structures:
liver
gallbladder
biliary tree
ventral pancreatic bud (head of pancreas)

Question 3

ventral pancreatic bud becomes

Answer 3

pancreatic head

main pancreatic duct

Question 4

dorsal pancreatic bud becomes

Answer 4

body + tail of pancreas

accessory pancreatic duct

Question 5

dorsal pancreatic bud develops on

Answer 5

dorsal surface of foregut

Question 6

fusion of ventral and dorsal pancreatic bud occurs at

Answer 6

8 wks GA when foregut duodenum rotates to form C shape and then ventral pancreatic bud meets the dorsal pancreatic bud

Question 7

ventral pancreatic bud encircles duodenum → narrows duodenum

Answer 7

annular pancreas

Question 8

most asymptomatic

symptoms due to duodenal narrowing may begin at any age

Answer 8

annular pancreas

Question 9

child presenting with gastric outlet obstruction (similar to duodenal atresia):
bilious vomiting
feeding intolerance abdominal distention

Answer 9

annular pancreas

Question 10

infant with following associated findings:  
polyhydramnios
down syndrome
esophageal and duodenal atresia
imperforate anus
meckel diverticulum

Answer 10

annular pancreas

Question 11

adult 20-50 yo presenting with:
ab pain
postprandial fullness + nausea
peptic ulceration
pancreatitis
biliary obstruction (rare)

Answer 11

annular pancreas

Question 12

ventral and dorsal pancreatic buds fail to fuse

Answer 12

pancreas divisum

Question 13

arises from dorsal mesentary of stomach (mesodermal structure)

Answer 13

spleen

Question 14

pancreatic juice that is secreted into pancreatic ducts includes

Answer 14

digestive enzymes of pancreas
HCO3: neutralizes stomach acid
NaCl: Cl goes into lumen of duct → Na follows → H20 follows → watery secretion of juice

Question 15

CFTR gene (cystic fibrosis transmembrane conductance regulator) → CFTR protein is a Cl- ion channel
mutation in CFTR causes:

Answer 15

Cl- wont enter pancreatic duct lumen → no Na or H20 → thick pancreatic secretions

Question 16

manifestations of cystic fibrosis

Answer 16

thick pancreas secretions
thick mucous in lungs
salty sweat (Cl- channel normally allows for Cl- reabsorption in sweat glands → abnormal: excess Cl in sweat)

Question 17

pancreatic complications of cystic fibrosis

Answer 17

thick pancreatic juice: no enzymes into duodenum
malabsorption of fat + fat soluble-vitamins and protein
steatorrhea
treatment: supplement pancreatic enzymes + ADEK enzymes

Question 18

inflammed pancreas that starts digesting itself

Answer 18

acute pancreatitis

Question 19

severe upper abdominal pain +/- radiation to back
WORSE with food
N/V
sitophobia: fear of food

Answer 19

acute pancreatitis

Question 20

diagnosis of acute pancreatitis

Answer 20

↑ serum lipase = diagnosis of acute pancreatitis !!

CT scan: for confirmation (also look for pancreatic pseudocysts)

Question 21

complications of acute pancreatitis

Answer 21

multiorgan failure
DIC
hemorrhage of pancreas
necrosis of pancreas
sequester Ca in abdomen: Ca binds fat → soap deposits in abdomen →saponification → Ca precipates out into blood →hypocalcemia
can progress to chronic pancreatitis with pancreatic pseudocyst: lined with fibrous scar tissue and granulation tissue from chronic inflammation, filled with pancreatic juice + enzymes, not lined by epithelium = real cyst)

Question 22

most common causes of acute pancreatitisalcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure:
malabsorption
steatorrhea
diabetes
↑ risk pancreatic cancer

Answer 22

gallstones
alcohol
*acronym for common causes in “play on words”

Question 23

chronic pancreatitis
alcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure:
malabsorption
steatorrhea
diabetes
↑ risk pancreatic cancer

Answer 23

chronic pancreatitis

Question 24

common cause of chronic pancreatitis

Answer 24

alcohol abuse

Question 25

treatment of chronic pancreatitis

Answer 25

pancreatic enzymes
ADEK enzymes
limit fat intake

Question 26

pancreatic tumors

Answer 26

neuroendocrine tumors:
gastrinoma: Zollinger-Ellison syndrome: duodenal ulcers
VIPoma: watery diarrhea
cancer: 
pancreatic adenocarcinoma

Question 27

weight loss
ab pain
sudden severe, painless jaundice (obstruct biliary tract)

Answer 27

pancreatic adenocarcinoma

Question 28

hypercoagulability
venous thrombosis
migratory thrombophlebitis: redness + tenderness on palpation of extremities

Answer 28

Trousseau syndrome:
can be caused by many malignancies, including:
pancreatic adenocarcinoma

Question 29

bp cuff on patient tighten for 1 min → carpopedal spasm of hand

Answer 29

Trausseau sign: sign of hypocalcemia (not related)

Question 30

risk factors for pancreatic adenocarcinoma

Answer 30

chronic pancreatitis
tobacco
>50 yo
black or ashkenazi jew

Question 31

CA 19-9 is a tumor marker for

Answer 31

pancreatic adenocarcinoma

Question 32

CEA is a tumor marker for

Answer 32

nonspecific for many gut tumors:
pancreatic adenocarcinoma
and
colon cancer

Question 33

signs of pancreatic insufficiency

Answer 33

diarrhea
steatorrhea
malabsorption 
weight loss 
ADEK deficiency