124b Pancreas Disease Flashcards Preview

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Flashcards in 124b Pancreas Disease Deck (25):
1

pancreas - location in abdomen?
consists of what?

retroperitoneal

exocrine (majority) - acini + ducts AND
endocrine - islets of Langerhans

2

histo appearance of exocrine pancreas?

acinar - pink

triangular cell, basal nucleus

apical - dense pink granules (zymogen)

extensive basal ER for making/transporting granules

3

Normal ductal anatomy vs pancreatic divisum in pancreas?

normal - duct of wirsung to main pancreatic duct with smaller duct of santorini

divisum -separate branches (no duct of wirsung)

4

what occurs in acute pancreatitis?

autodigestive and inflammation

5

what causes acute pancreatitis in women? men?

gallstones (women) - mechanical

alcohol (men) - metabolic

+ other things

6

what are 3 protections against autodigestion in pancreas?

inactive precrusors (zymogens) are secreted

duodenum enterokinase (in brush border) activates trypsinogen to trypsin which activates everything else

protease inhibitors in acinar cells in case of premature activation

7

what do duct cells produce in pancreas?

bicarbonate and mucin

8

what is the key step leading to autodigestion in pancreatitis?

activation of trypsin

9

Pathogenesis of gallstones leading to acute pancreatisi?

Blockage ampulla of vater --> bile into pancreas

increased ductal P --> damages acinar cells/duct

10

alcohol - pancreatitis pathogenesis (4 ways)?

spasm/relaxation of sphincter of Oddi

Acinar cells sensitized to CCK --> zymogen activation

Alcohol metabolism in pancreas

Increased protein secretion plugs ducts

11

symptoms of acute pancreatitis?

rapid onset of severe, persistent pain to back
nausea and vomiting
low grade fever
hypotension

12

pathology appearace of acute pancreatisi?

microvascular leakage --> swollen gland
lipases --> fat necrosis --> white
extensive hemorrhage --> brown
proteolytic activation --> loss of parenchyma
inflammatory cells

13

lab tests for acute pancreatitis?

increase serum lipase (more specific)

increase serum/urine amylase

increase WBC

14

what is and what causes chronic pancreatitis?

chronic inflammatory process with fibrosis, loss of structure (exocrine then endocrine) from repeat acute from booze

15

pancreatic pseudocyst - what causes it? what is it made of?

acute and chronic pancreatitis

fibrotic wall (no epithelial) filled with fluid and inflammatory cells

16

what are the 3 types of chronic pancreatitis?

Calcified - fibrosis with stones and protein plugs from booze

Obstructive - tumor of main pancreatic duct

Inflammatory - autoimmune cause (Sjogren's)

17

clincial presenation from chornic panc

maldigestion from atrophy of acinar tissue

diabetes from loss of endocrine tissue

Pseudocyst

18

what cell type are the most exocrine pancreatic tumors?

Ductal

19

risks for pancreatic carcinoma?

smoking, alcohol, chronic pancreatitis

20

pancreatic adenocarinoma genetics - frequent mutations

K-ras (12p) - most important/prevalent; early
p53 (17p)
BRCA2 (13q)
Rb gene
**cancers need multiple gene mutations**

21

K-ras - role?

GTPase for signal transduction pathway
mutation makes it always active

22

in what part of the pancreas does pancreatic cancer occur most often?

head with fibroblast proliferation -> obstructs common bile duct --> jaundice

23

body vs head for pancreatic cancer presentation and spread

head - jaundice; liver, lungs, lymph nodes

body/tail - thromboembolism; subcutaneous, extensive mets

24

stage if extension to peripancreatic tissue?

T3 (T4 celiac axis and unresectable)

25

early diagnosis of pancreatic ca?

MRI - food early, but expensive
serum marker (CA 19-9) for advanced disease