Pathology of the Exocrine Pancreas Flashcards
contents of acinar glands
- acidophilic zymogen granules which contain a variety of digestive enzymes and proenzymes
- trypsinogen is the main proenzyme
cells that secrete CCK and seretin
- enteroendocrine cells
- secreted into the blood in response to a meal
function of secretin
- stimulates pancreatic duct cells to produce a fluid high in bicarbonate
- serves to increase the pH and neutralize the acidic chyme entering the duodenum from the stomach
function of CCK
- stimulates pancreatic acinar cells to produce a secretion rich in digestive enzymes, which function optimally at a neutral or slightly alkaline pH
duct of Wirsung
- main pancreatic duct
- most commonly drains into the duodenum at the ampulla of Vater
- in most people it merges with the common bile duct proximal to the ampulla
duct of Santorini
- accessory pancreatic duct present in some people
- drains into the duodenum through a minor papilla 2 cm proximal to the ampulla of Vater
function of the sphincter of Oddi
- surrounds the common bile duct and pancreatic duct to control secretions into the duodenum
enzyme that cleaves trypsinogen
- enteropeptidase (brush border enzyme)
only two enzymes that are secreted in their active form
- lipase and amylase
embryologic origin of the duct of Wirsung
- fusion of the ventral duct and distal dorsal duct
embryologic origin of the duct of Santorini
- occasionally the proximal part of the distal duct persists
cause and result of pancreas divisum
- failure of fetal duct of dorsal and ventral pancreatic primordia to fuse
- as a result, the bulk of the pancreas drains through the dorsal pancreatic duct and the minor papilla (duct of Santorini)
clinical manifestations of pancreas divisum
- relative stenosis cause by bulk pancreatic secretions predisposes patients to development of recurrent and chronic pancreatitis
cause of annular pancreas
- one portion of ventral pancreatic primordium becomes fixed, while the other portion is drawn around the duodenum
symptoms of annular pancreas
- duodenal obstruction
- gastric distention
- vomiting
clinical manifestations of CF
- recurrent pulmonary infections causing chronic lung disease
- pancreatic insufficiency (steatorrhea, malnutrition)
- hepatic cirrhosis
- intestinal obstruction
genetic transmission of CF
- autosomal recessive
- most common lethal genetic disease affecting whites
gene affected in CF
- cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7
- cAMP regulated chloride channel located in apical membrane of glandular epithelium
presentation of CF
- CF PANCREAS
- chronic respiratory disease
- failure to thrive
- polyps (nasal)
- alkalosis, metabolic
- neonatal intestinal obstruction (meconium ileus)
- clubbing of fingers
- rectal prolapse
- electrolytes increased in sweat
- aspermia / absence of vas deferens
- sputum S. aureus / P. aeruginosa
pulmonary disease in CF
- loss or reduction of chloride secretion into the ducts of respiratory epithelium
- leads to increased sodium and water reabsorption from the airway resulting in thicker secretions of mucus
- leads to defective mucociliary action and the accumulation of hyperconnected, viscid secretions and stasis
sweat glands in CF
- reabsorption, not secretion, is affected
- decreased reabsorption of chloride resulting in increased concentrations of sweat chloride excreted onto the skin causing a hypertonic solution to be secreted containing both high sweat chloride and high sodium content
GI manifestations in CF
- pancreatic insufficiency/malabsorption
- lipid soluble vitamin deficiency
- failure to thrive
- biliary stasis
chief distinction between acute and chronic pancreatitis
- irreversible impairment of pancreatic function
- parenchymal fibrosis is seen in chronic
characteristics of serous cystadenomas
- benign but have malignant potential
- composed of glycogen-rich cuboidal cells surrounding small cysts
- fluid is clear, thin and straw-colored
- more common in women
- surgical resection is curative
characteristics of mucinous cystic neoplasms
- almost always in women
- can be benign, borderline malignant, or malignant
- present as painless, slow-growing masses
- cystic spaces are filled with thick mucin
characteristics of intraductal papillary mucinous neoplasms (IPMNs)
- produce cysts containing mucin
- most are malignant but can be benign or borderline malignant
- more common in men
- involve the head of the pancreas more than the tail
- should be resected because of malignant potential
two features useful in distinguishing IPMNs from mucinous cystic neoplasms
- IPMNs lack dense stroma
- IPMNs arise in main pancreatic ducts
characteristics of pancreatic carcinoma
- primarily a disease of the elderly
- more common in blacks
- CAs of the body and tail do not impinge on the biliary tract and hence remain silent for some time
symptoms of pancreatic carcinoma
- pain is usually the first symptom
- obstructive jaundice is associated with most cases of carcinoma of pancreatic head - painless jaundice
