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GI - 2 > 19-1 > Flashcards

19-1 Flashcards

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1
Q

How does the pancreas normally arise during fetal development?

A

Fusion of ventral and dorsal outpouchings of the foregut

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2
Q

What are 2 common congenital anomalies of the pancreas?

A
  1. Pancreas Divisum

2. Annular Pancreas

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3
Q

Pancreas Divisum

A

Failure of fusion of ductal systems of dorsal and ventral pancreas

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4
Q

Failure of fusion of ductal systems of dorsal and ventral pancreas

A

Pancreas Divisum

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5
Q

With Pancreas Divisum, the majority of the pancreas is drained through what?

A

The Minor sphincter!

– Should be the papilla of vater/oddi

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6
Q

Those with Pancreas Divisum are at an increased risk for?

A

Chronic Pancreatitis

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7
Q

Annular Pancreas

A

Ring of pancreatic tissue that encircles the 2nd portion of duodenum

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8
Q

Ring of pancreatic tissue that encircles the 2nd portion of duodenum

A

Annular Pancreas

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9
Q

What does an Annular Pancreas usually result in?

A

Duodenal obstruction

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10
Q

What bud of the developing pancreas usually causes the Annular Pancreas?

A

Ventral bud

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11
Q

What can Ectopic Pancreatic Tissue cause?

A

Inflammation, damage, mucosal bleeding

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12
Q

Both Acute and Chronic Pancreatitis are initiated by?

A

Injuries that lead to autodigestion by its own enzymes

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13
Q

What are 3 protective factors that try to prevent autodigestion of the pancreas by its own enzymes?

A
  1. Most enzymes are synthesized as proenzymes (zymogens) and in granules
  2. Proenzymes are activated by Trypsin that is (+) by duodenal enteropeptidase in the duodenum
  3. Pancreatic cells secrete Trypsin (-) like SPINK1
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14
Q

What are 3 protective factors that try to prevent autodigestion of the pancreas by its own enzymes?

A
  1. Most enzymes are synthesized as proenzymes (zymogens) and in granules
  2. Proenzymes are activated by Trypsin that is (+) by duodenal enteropeptidase in the duodenum
  3. Pancreatic cells secrete Tyrpsin (-) like SPINK1
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15
Q

Pancreatitis occurs when the ______ are overwhelmed/disrupted

A

Protective factors

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16
Q

Etiologies of Acute Pancreatitis?

A 
Gallstones
Alcohol
Hypertriglyceridemia
Trauma
Meds
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17
Q

Etiologies of Chronic Pancreatitis?

A

TIGAR-O

  • Toxic metabolic = alcohol
  • Idiopathic = smoking
  • Genetic
  • Autoimmune = celiac/IgG
  • Recurrent acute pancreatitis
  • Obstructive
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18
Q

Acute vs. Chronic pancreatitis - reversible injury?

A 
Acute = reversible injury and inflammation
Chronic = Irreversible destruction
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19
Q

2/3 of these are needed to diagnose Acute Pancreatitis

A
  1. Epigastric pain that radiates to the back
  2. CT changes consistent wit pancreatitis
  3. Lipase (and amylase) elevated 3X the ULN
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20
Q

What physical things can be seen with Acute Pancreatitis on the abdomen?

A

Cullen sign

Grey Turner Sign

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21
Q

What electrolyte change can be seen with Acute Pancreatitis and what causes it?

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A

Hypocalcemia due to saponification of necrotic fat

22
Q

What morphologic changes can be seen with Acute Pancreatitis?

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A

Edema, fat necrosis, blood vessel destruction and hemorrhage

23
Q

What cytokines can (+) pancreatic stellate cells to deposit collagen and cause fibrosis with Chronic Pancreatitis?

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A

TGF - beta

PDGF

24
Q

Autoimmune Pancreatitis can cause Chronic Pancreatitis. What will be seen with Autoimmune Pancreatitis?

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A

Mass lesion at the pancreatic head

25
Autoimmune Pancreatitis can cause Chronic Pancreatitis. What will be seen with Autoimmune Pancreatitis?
Mass lesion at the pancreatic head
26
Symptoms/signs of Chronic Pancreatitis?
Intermittent epigastric pain CALCIFICATIONS Pancreatic insufficiency (steatorrhea and diabetes)
27
What morphologic changes can be seen with Chronic Pancreatitis?
Fibrosis, atrophy and ductal dilation
28
List 6 genes that cause predisposition to pancreatitis?
CFTR PRSS1 SPINK1 CASR, CTRC, CPA1
29
List 6 genes that cause predisposition to pancreatitis?
CFTR PRSS1 SPINK1 CASR, CTRC, CPA1
30
The genes that cause predisposition to pancreatitis all do so by stimulating activation of?
Trypsin
31
Unilocular, thin-walled cysts lined with cuboidal epithelium
Congenital cysts
32
Congenital cysts are thin-walled and lined with ____ epithelium
Cuboidal
33
Congenital cysts may be associated with other conditions. What type of fluid are in these cysts?
Clear serous
34
What causes Congenital cysts?
Incorrect pancreatic duct development
35
Cysts that lack epithelial lining
Pseudocysts
36
Pseudocysts lack _____
Epithelial lining
37
What causes Pseudocysts?
Acute pancreatitis | - fat necrosis being walled off by fibrosis and granulation tissue
38
Pseudocysts usually resolve or become?
Infected
39
Pancreatic Carcinomas are _____ that (+) ______ reaction
Adenocarcinomas | (+) dense desmoplastic reaction
40
A majority of Pancreatic Carcinomas arise from?
PanIN (pancreatic intraepithelial neoplasia)
41
List a few risk factors for Pancreatic Carcinomas
Smoking Chronic pancreatitis Obesity and Diabetes
42
Describe the PanIN progression along with the involved genes
- Telomere shortening and KRAS activation - (-) CDKN2A - (-) TP53, SMAD4, BRCA2
43
Describe the PanIN progression along with the involves genes
- Telomere shortening and KRAS activation - (-) CDKN2A - (-) TP53, SMAD4, BRCA2 = Invasive carcinoma
44
What is a DNA abnormality that can cause (-) of CDKN2A with Pancreatic Carcinomas?
DNA methylation
45
Most common location for Pancreatic Carcinomas?
Pancreatic head
46
Pancreatic carcinomas are silent until they invade adjacent structures. What are the initial and nonspecific symptoms?
Pain, Weight loss, Weakness
47
What are defining symptoms of Pancreatic Carcinoma?
Jaundice | New onset diabetes
48
What tests will be (+) with Pancreatic Carcinoma?
Courvoisier sign Trousseau sign of malignancy CA 19-9
49
Pancreatic Carcinomas tend to grow along ____
Nerves
50
Most common distant metastases for Pancreatic Carcinomas?
Lung and liver

GI - 2 (61 decks)

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