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GI II Exam 2 > 19-1: Pancreas > Flashcards

19-1: Pancreas Flashcards

(49 cards)

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1
Q

what are the primary roles of the pancreas?

A

exocrine – secretes enzymes for digestion (trypsinogen, chymotrypsinogen, procarboxypeptidase, etc.)

endocrine – secretes insulin, glucagon, and somatostatin

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2
Q

what is the most common congenital anomaly of the pancreas?

A

pancreas divisum due to failure of ventral and dorsal bud fusion

*associated with chronic pancreatitis

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3
Q

what complication is associated with a congenital annular pancreas?

A

duodenal obstruction

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4
Q

what is an ectopic pancreas?

A

a congenital anamoly in which the pancreas is formed within an abnormal place

usually stomach or duodenum

can cause pain or mucosal bleeding

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5
Q

what are some pancreatic protective mechanisms that prevent autodigestion?

A

enzymes are synthesized as inactive proenzymes and packaged within secretory granules

proenzymes are not activated until they come into contact with activated trypsin. Trypsin is activated by enterokinase within the duodenum

acinar and ductal cells secrete trypsin inhibitors

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6
Q

what is the clinical presentation of acute pancreatitis?

A

constant, intense, upper or bid back pain
occasionally radiates to left shoulder
anorexia
N/V

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7
Q

what lab findings are associated with acute pancreatitis?

A

elevated serum amylase and lipase

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8
Q

what lab finding is most specific for acute pancreatitis?

A

lipase - remains elevated for 8-14 days

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9
Q

what is the etiology of acute pancreatitis?

A

release of toxic enymes and cytokines activating a systemic inflammatory response

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10
Q

what PE findings are highly associated with high mortality in severe acute pancreatitis?

A

Cullen’s sign (periumbilical ecchymosis)

Grey Turner’s sign (flank ecchymosis)

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11
Q

what metabolic processes are associated with pancreatitis?

A

alcohol
hyperlipoproteinemia
hypercalcemia
drugs

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12
Q

what genetic mutations are associated with pancreatitis?

A

PRSS1 - encodes trypsin
SPINK1 - encodes trypsin regulators
CASR - encodes calcium metabolism regulators

CFTR

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13
Q

what mechanical processes are associated with pancreatitis?

A 
gallstones
trauma
iatrogenic injury
operative injury
endoscopic procedures with dye injection (ERCP)
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14
Q

what vascular processes are associated with pancreatitis?

A

shock
atheroembolism
vasculitis

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15
Q

what infectious agents are associated with pancreatitis?

A

Mumps

Coxsackievirus (of course)

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16
Q

what is the pathogenesis of pancreatitis?

A

after tissue damage occurs, trypsin can directly or indirectly activate factors found in the blood

the resulting inflammation and small-vessel thrombosis causes further damage to the acinar cells which amplifies intrapancreatic enzyme activation

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17
Q

what are the basic abnormalities associated with pancreatitis?

A 
microvascular leak and edema
fat necrosis
acute inflammation
autodigestion of pancreatic parenchyma
blood vessel destruction and interstitial hemorrhage
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18
Q

what are some possible systemic complications of pancreatitis?

A

acute respiratory distress syndrome

acute renal failure

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19
Q

what is the definition of chronic pancreatitis?

A

prolonged inflammation of the pancreas associated with irriversible destruction of exocrine parenchyma, fibrosis and eventual loss of endocrine parenchyma

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20
Q

what is the most common cause of chronic pancreatitis?

Study These Flashcards
A

long-term alcohol use (yikes, we’re in trouble)

21
Q

what cytokine is associated with chronic pancreatitis?

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A

TGF-B – involved in scar formation and fibrosis

22
Q

what is autoimmune pancreatitis type 1?

Study These Flashcards
A

associated with the presence of IgG4 secreting plasma cells in the pancreas

one manifestation of systemic IgG related disease

23
Q

What is autoimmune pancreatitis type 2?

Study These Flashcards
A

restricted to the pancreas except in a subset of patients with ulcerative colitis

24
Q

what is the clinical presentation of autoimmune pancreatitis?

Study These Flashcards
A

mimic pancreatic carcinoma

mass lesion in the pancreatic head on imaging

25
what is the clinical presentation of chronic pancreatitis?
repeated bouts of abdominal pain persistent back pain on imaging: calcifications and pseudocysts labs: pancreatic exocrine insufficiency and DM
26
what mainfestations of chronic pancreatitis lead to morbidity and contribute to mortality?
pancreatic exocrine insufficiency chronic malabsorption DM
27
patients with herediatry pancreatitis associated with PRSS1 have a risk of developing what?
pancreatic cancer
28
what are congenital pancreatic cysts?
thin-walled cysts that likely result from anamalous pancreatic duct development extremely rare
29
what are pancreatic pseudocysts?
arise following a bout of pancreatitis - usually from chronic alcoholic pancreatitis lack an epithelial lining many resolve spontaneously but some may become secondarily infected, compress adjacent structures or perforate
30
what are serous cystic neoplasms?
always benign F > M 60 y/o + most common in the pancreatic tail
31
what are mucinous cystic neoplasms?
95% women may be precursors to invasive carcinoma usually located in the pancreatic tail
32
what are solid-pseudopapillary neoplasms?
young women pancreatic tail locally agressive malignancy
33
what are intraductal papillary mucinous neoplasms (IPMNs)?
mucin-producing neoplasms that involve the duct of the pancreas M > F located in the pancreatic head precursor to invasive carcinoma
34
what demographics are associated with pancreatic cancer?
60 y/o + African Americans, Japanese Americans, Native Americans, Hawaiian islanders and Ashkenazi Jews
35
what risk factors are associated with pancreatic cancer?
cigarette smoking (2x risk) chronic pancreatitis visceral obesity and high BMI DM
36
what hereditary conditions have an increased risk of pancreatic cancer?
``` PJ syndrome (STK11) Hereditary pancreatitis (PRSS1 or SPINK1) Familial atypical multiple mole melanoma syndrome (CDKN2A) ``` Family hx of pancreatic cancer (> 3 relatives) Hereditary breast and ovarian cancer Hereditary non-polyposis colorectal cancer
37
which gene mutations are highly associated with pancreatic ductal carcinoma?
KRAS TP53 CDKN2A SMAD4
38
where are pancreatic cancers most likely to occur?
in the head of the pancreas
39
why are pancreatic cancers hard to detect?
they are asymptomatic until they invade into adjacent structures
40
what are the classic presentations of pancreatic cancer?
pain weight loss anorexia general malaise and weakness
41
what symptoms are associated with a tumor within the head of the pancreas?
obstructive jaundice caused by the head of the pancreas obstructing the distal common bile duct Courvoisier sign - a palpably enlarged, nontender gallbladder with mild, painless, jaundice
42
what is the growth pattern of pancreatic cancer?
grows along nerves and invades into blood vessels and the retroperitoneum
43
what is frequently involved in pancreatic cancer via direct invasion?
``` spleen adrenals transverse colon stomach local lymph nodes ```
44
where are primary pancreatic metastases most common?
liver and lungs
45
what are the microscopic features of pancreatic adenocarcinomas?
dense desmoplasic reaction
46
what is Trousseau sign?
migratory thrombophlebitis - caused by elaboration of platelet activating factors and procoagulants from the tumors or its necrotic products
47
what is the precursor lesion associated with pancreatic cancer?
pancreatic intraepithelial neoplasia (PanIN) often found in the pancreatic parenchyma microscopically show dramatic telomere shortening
48
what is the model of progression from normal tissue to invasive carcinoma in the pancreas?
1. normal pancreas 2. PanIN-1A: telomere shortening 3. PanIN-1B: KRAS activation 4. PanIN-2: CDKN2A inactivation 5. PanIN-3: TP53, SMAD4, and BRCA2 inactivation 6. invasive carcinoma
49
what is the prognosis of pancreatic cancer?
typically survival after diagnosis is unlikely (usually die within 1-2 years) > 80% of pancreatic cancers are unresectable at the time of diagnosis due to invasion

GI II Exam 2 (16 decks)

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