Pathology of the GI Tract- Pancreas (1)

Question 1

what are three examples of pancreatic anomalies?

Answer 1

pancreatic divisum, annular pancreas, and ectopic pancreas

Question 2

what is pancreatic divisum associated with?

Answer 2

chronic pancreatitis

Question 3

what is annular pancreas associated with?

Answer 3

duodenal obstruction

Question 4

what could ectopic pancreatic tissue lead to?

Answer 4

mucosal bleeding

Question 5

what do acinar and ductal cells of the pancreas secrete as a protective mechanism?

Answer 5

trypsin inhibitors aka serine protease inhibitor Kazal type I (SPINK1)

Question 6

why does hypercalcemia lead to pancreatitis?

Answer 6

calcium has a key role in trypsin regulation; trypsin autoactivation is favored when calcium levels are increased

Question 7

what is the feature shared by most forms of hereditary pancreatitis?

Answer 7

a defect that increases or sustains the activity of trypsin

Question 8

what are three common genes that are mutated that lead to recurring pancreatitis?

Answer 8

CFTR (loss of function), SPINK1 (loss of function), PRSS1 (gain of function)

Question 9

what are possible sequelae of pancreatitis?

Answer 9

sterile pancreatic abscesses and pancreatic pseudocysts

Question 10

what are two ominous complications associated with pancreatitis?

Answer 10

ARDS and renal failure

Question 11

what is responsible for the scar tissue found in chronic pancreatitis?

Answer 11

TGF-beta, which is produced by activated macrophages

Question 12

what can autoimmune pancreatitis mimic?

Answer 12

both types can mimic pancreatic carcinoma

Question 13

what is helpful when making the diagnosis of chronic pancreatitis?

Answer 13

visualization of calcifications within the pancreas- dystrophic calcifications

Question 14

what could result from chronic pancreatitis?

Answer 14

pseudocyst formation, pancreatic exocrine insufficiency/ weight loss; DM

Question 15

what are pseudocysts of the pancreas?

Answer 15

they lack an epithelial lining; arise following a bout of acute pancreatitis

Question 16

what are the complications associated with pseudocysts?

Answer 16

secondary infection or they may compress or even perforate into adjacent structures

Question 17

pancreatic cancer has a higher incidence in what populations?

Answer 17

african americans, ashkenazi jews, japanese americans, and native hawaiian islanders

Question 18

what is the strongest environmental influence on pancreatic cancer?

Answer 18

cigarette smoking

Question 19

invasive pancreatic cancers arise from what?

Answer 19

non-invasive precursor lesions referred to as pancreatic intraepithelial neoplasia (PanIN)

Question 20

what has been found to be a major cause of mutations in in PDA?

Answer 20

an aberrant methylation is a major cause of mutations

Question 21

alterations of what 4 genes have been confirmed to be far more common than any other genes in PDAs?

Answer 21

KRAS, TP53, CDKN2A, and SMAD4

Question 22

approximately 10% of patients with pancreatic cancer have a deleterious germline mutation in a cancer predisposition gene or report one or more first-degree relatives with pancreatic cancer; what gene mutation is the most common cause of familial pancreatic cancer?

Answer 22

BRCA2

Question 23

what are two characteristic features of most pancreatic cancers?

Answer 23

most are adenocarcinomas and they elicit an intense desmoplastic response that results in the deposition of dense collagen

Question 24

what contributes to the increased risk of thromboembolism in disseminated cancers aka Migratory thrombophlebitis?

Answer 24

tumor-associated inflammation and coagulation factors as well as procoagulants (e.g mucin)