Pathology of the Exocrine Pancreas

Question 1

contents of acinar glands

Answer 1

• acidophilic zymogen granules which contain a variety of digestive enzymes and proenzymes
• trypsinogen is the main proenzyme

Question 2

cells that secrete CCK and seretin

Answer 2

• enteroendocrine cells

- secreted into the blood in response to a meal

Question 3

function of secretin

Answer 3

• 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

Question 4

function of CCK

Answer 4

• stimulates pancreatic acinar cells to produce a secretion rich in digestive enzymes, which function optimally at a neutral or slightly alkaline pH

Question 5

duct of Wirsung

Answer 5

• 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

Question 6

duct of Santorini

Answer 6

• accessory pancreatic duct present in some people

- drains into the duodenum through a minor papilla 2 cm proximal to the ampulla of Vater

Question 7

function of the sphincter of Oddi

Answer 7

• surrounds the common bile duct and pancreatic duct to control secretions into the duodenum

Question 8

enzyme that cleaves trypsinogen

Answer 8

• enteropeptidase (brush border enzyme)

Question 9

only two enzymes that are secreted in their active form

Answer 9

• lipase and amylase

Question 10

embryologic origin of the duct of Wirsung

Answer 10

• fusion of the ventral duct and distal dorsal duct

Question 11

embryologic origin of the duct of Santorini

Answer 11

• occasionally the proximal part of the distal duct persists

Question 12

cause and result of pancreas divisum

Answer 12

• 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)

Question 13

clinical manifestations of pancreas divisum

Answer 13

• relative stenosis cause by bulk pancreatic secretions predisposes patients to development of recurrent and chronic pancreatitis

Question 14

cause of annular pancreas

Answer 14

• one portion of ventral pancreatic primordium becomes fixed, while the other portion is drawn around the duodenum

Question 15

symptoms of annular pancreas

Answer 15

• duodenal obstruction
• gastric distention
• vomiting

Question 16

clinical manifestations of CF

Answer 16

• recurrent pulmonary infections causing chronic lung disease
• pancreatic insufficiency (steatorrhea, malnutrition)
• hepatic cirrhosis
• intestinal obstruction

Question 17

genetic transmission of CF

Answer 17

• autosomal recessive

- most common lethal genetic disease affecting whites

Question 18

gene affected in CF

Answer 18

• cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7
• cAMP regulated chloride channel located in apical membrane of glandular epithelium

Question 19

presentation of CF

Answer 19

• 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

Question 20

pulmonary disease in CF

Answer 20

• 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

Question 21

sweat glands in CF

Answer 21

• 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

Question 22

GI manifestations in CF

Answer 22

• pancreatic insufficiency/malabsorption
• lipid soluble vitamin deficiency
• failure to thrive
• biliary stasis

Question 23

chief distinction between acute and chronic pancreatitis

Answer 23

• irreversible impairment of pancreatic function

- parenchymal fibrosis is seen in chronic

Question 24

characteristics of serous cystadenomas

Answer 24

• 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

Question 25

characteristics of mucinous cystic neoplasms

Answer 25

• almost always in women
• can be benign, borderline malignant, or malignant
• present as painless, slow-growing masses
• cystic spaces are filled with thick mucin

Question 26

characteristics of intraductal papillary mucinous neoplasms (IPMNs)

Answer 26

• 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

Question 27

two features useful in distinguishing IPMNs from mucinous cystic neoplasms

Answer 27

• IPMNs lack dense stroma

- IPMNs arise in main pancreatic ducts

Question 28

characteristics of pancreatic carcinoma

Answer 28

• 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

Question 29

symptoms of pancreatic carcinoma

Answer 29

• pain is usually the first symptom

- obstructive jaundice is associated with most cases of carcinoma of pancreatic head - painless jaundice