pancreas (not 4 star, misplaced) Flashcards
pancreas is derived from
foregut (endoderm structure)
hepatic diverticulum on ventral surface of distal foregut gives rise to
endodermal structures: liver gallbladder biliary tree ventral pancreatic bud (head of pancreas)
ventral pancreatic bud becomes
pancreatic head
main pancreatic duct
dorsal pancreatic bud becomes
body + tail of pancreas
accessory pancreatic duct
dorsal pancreatic bud develops on
dorsal surface of foregut
fusion of ventral and dorsal pancreatic bud occurs at
8 wks GA when foregut duodenum rotates to form C shape and then ventral pancreatic bud meets the dorsal pancreatic bud
ventral pancreatic bud encircles duodenum → narrows duodenum
annular pancreas
most asymptomatic
symptoms due to duodenal narrowing may begin at any age
annular pancreas
child presenting with gastric outlet obstruction (similar to duodenal atresia):
bilious vomiting
feeding intolerance abdominal distention
annular pancreas
infant with following associated findings: polyhydramnios down syndrome esophageal and duodenal atresia imperforate anus meckel diverticulum
annular pancreas
adult 20-50 yo presenting with: ab pain postprandial fullness + nausea peptic ulceration pancreatitis biliary obstruction (rare)
annular pancreas
ventral and dorsal pancreatic buds fail to fuse
pancreas divisum
arises from dorsal mesentary of stomach (mesodermal structure)
spleen
pancreatic juice that is secreted into pancreatic ducts includes
digestive enzymes of pancreas
HCO3: neutralizes stomach acid
NaCl: Cl goes into lumen of duct → Na follows → H20 follows → watery secretion of juice
CFTR gene (cystic fibrosis transmembrane conductance regulator) → CFTR protein is a Cl- ion channel mutation in CFTR causes:
Cl- wont enter pancreatic duct lumen → no Na or H20 → thick pancreatic secretions
manifestations of cystic fibrosis
thick pancreas secretions
thick mucous in lungs
salty sweat (Cl- channel normally allows for Cl- reabsorption in sweat glands → abnormal: excess Cl in sweat)
pancreatic complications of cystic fibrosis
thick pancreatic juice: no enzymes into duodenum
malabsorption of fat + fat soluble-vitamins and protein
steatorrhea
treatment: supplement pancreatic enzymes + ADEK enzymes
inflammed pancreas that starts digesting itself
acute pancreatitis
severe upper abdominal pain +/- radiation to back
WORSE with food
N/V
sitophobia: fear of food
acute pancreatitis
diagnosis of acute pancreatitis
↑ serum lipase = diagnosis of acute pancreatitis !!
CT scan: for confirmation (also look for pancreatic pseudocysts)
complications of acute pancreatitis
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)
most common causes of acute pancreatitisalcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure: malabsorption steatorrhea diabetes ↑ risk pancreatic cancer
gallstones
alcohol
*acronym for common causes in “play on words”
chronic pancreatitis alcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure: malabsorption steatorrhea diabetes ↑ risk pancreatic cancer
chronic pancreatitis
common cause of chronic pancreatitis
alcohol abuse
treatment of chronic pancreatitis
pancreatic enzymes
ADEK enzymes
limit fat intake
pancreatic tumors
neuroendocrine tumors: gastrinoma: Zollinger-Ellison syndrome: duodenal ulcers VIPoma: watery diarrhea cancer: pancreatic adenocarcinoma
weight loss
ab pain
sudden severe, painless jaundice (obstruct biliary tract)
pancreatic adenocarcinoma
hypercoagulability
venous thrombosis
migratory thrombophlebitis: redness + tenderness on palpation of extremities
Trousseau syndrome:
can be caused by many malignancies, including:
pancreatic adenocarcinoma
bp cuff on patient tighten for 1 min → carpopedal spasm of hand
Trausseau sign: sign of hypocalcemia (not related)
risk factors for pancreatic adenocarcinoma
chronic pancreatitis
tobacco
>50 yo
black or ashkenazi jew
CA 19-9 is a tumor marker for
pancreatic adenocarcinoma
CEA is a tumor marker for
nonspecific for many gut tumors:
pancreatic adenocarcinoma
and
colon cancer
signs of pancreatic insufficiency
diarrhea steatorrhea malabsorption weight loss ADEK deficiency
