SFP: exocrine pancreas Flashcards
What is the clinical presentation of acute pancreatitis?
Young patient with central abdominal pain that radiates to the back and shoulders.
What is seen in labs for acute pancreatitis?
Elevated pancreatic enzymes.
What is acute hemorrhagic pancreatitis?
The most severe form of pancreatitis; may include severe necrosis and hemorrhage.
What is the gross pathology of acute pancreatitis?
Edema, necrosis, hemorrhage.
What is seen on histology of pancreatitis?
Looks normal except there are a bunch of neutrophils. There might be red blood cells and destruction via necrosis.
What types of necrosis can be seen in the pancreas?
Hemorrhagic, gangrenous, fat.
What are the common causes of acute pancreatitis?
Gallstones or excessive alcohol; could be caused by a variety of factors though.
What is the pathophysiology of acute pancreatitis?
Destruction of acinar cells leads to increased activated enzymes being released at an incorrect time and inflammation in the pancreatic tissue, damaging it. There may also be a mutation in activation genes that lead to trypsin, which may also cause increased inflammation and digestive enzymes at inappropriate times.
Relate CF and pancreatitis.
CF can lead to a chronic pancreatitis from thick mucus obstructing ducts in the pancreas.
Describe what tests may identify acute pancreatitis.
Amylase or lipase; lipase is more specific as it almost exclusively comes from the pancreas, so it’s the main test used. Lipase also stays around longer than amylase, making it a better test.
What is the peak of amylase?
6 hours.
How long does it take amylase to return to reference?
36-72 hours.
What conditions may alter a reading for acute pancreatitis?
Macroamylasemia or hypertriglyceridemia.
What is a pancreatic pseudocyst?
A localized collection of pancreatic secretions, fibrosis, and cholesterol clefts that lacks an epithelial lining and occurs after acute or chronic pancreatitis.
What is the treatment for acute pancreatitis?
Supportive care and manage the underlying cause.
What is a typical population for chronic pancreatitis?
Middle aged, gall stones/alcohol use, hyperlipidemia/hypercalcemia.
What are rarer causes of chronic pancreatitis?
Nonalcoholic tropical, familial hereditary, autoimmune pancreatitis.
What is the gross pathology of chronic pancreatitis?
Lobulated, hard from fibrosis, and calcified. It sometimes may mimic a mass.
What is the histology of chronic pancreatitis?
Fibrosis, metaplastic duct change, lymphocytes/plasma cells, relative sparing of islet cells. Loss of acinar structures from fibrosis.
What is the clinical course of chronic pancreatitis?
Recurrent epigastric pain, endocrine/exocrine insufficiency (may lead to diabetes), might increase pancreatic cancer risk, may have steatorrhea.
Describe serous cystadenomas of the pancreas.
Cuboidal cells filled with glycogen in the epithelium with a fibroatrophic stroma and complex cysts.
Which cyst of the pancreas is associated with loss of function of VHL?
Serous cystadenomas.
Do serous cystadenomas have malignant potential?
No.
What is the fluid content in serous cystadenoma?
Low levels of amylase, lipase, and CEA.
Describe mucinous cystic neoplasms of the pancreas.
More common in women. Wall is formed by ovarian stroma. Low grade dysplasia with mucinous epithelium.
Do mucinous cystic neoplasms have malignant potential?
Yes.
What is the fluid consisting of in mucinous cystic neoplasms?
Increased CEA.
Describe intraductal papillary mucinous neoplasms of the pancreas.
Proliferation that arises from the duct. Has mucinous epithelium, fibroatrophic stroma, and complex cysts.
Does IPMN have malignant potential?
Yes.
Describe the cyst fluid in IPMN.
Increased CEA.
Most exocrine neoplasms in the pancreas occur in the…
Head.
What is a typical presentation of exocrine pancreatic tumors?
Jaundice, weight loss, pain.
Most of the malignant neoplasms in the exocrine pancreas are…
Ductal adenocarcinomas.
What are common mutations associated with ductal adenocarcinomas?
KRAS, CDKN2A, TP53, SMAD4.
What is PanIN?
The precursor to ductal adenocarcinoma.
What marker may be used for follow-up on ductal adenocarcinoma?
CA-19-9.
