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GI II > Exocrine pancreas disorders > Flashcards

Exocrine pancreas disorders Flashcards

1
Q

Pancreas cell that secrete proenzymes

A

Acinar cells

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2
Q

Parts of pancreas that develop from the ventral bud

A

Uncinate process and inferior part of head

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3
Q

Genetic anomalies associated with annular pancreas

A

Trisomy 21
Tracheoesophageal fistula
Cardiac anomalies

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4
Q

Most common congenital anomaly of pancreas

A

Pancreas divisum

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5
Q

Failure of fusion of the dorsal and ventral pancreatic buds leading to the majority of the pancreas draining into the duodenum through minor papilla

A

Pancreas divisum

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6
Q

Caused by failure of part of the ventral bud of the pancreas to undergo atrophy, or by aberrant migration

A

Ectopic pancreas

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7
Q

Most common sites of ectopic pancreas

A

Stomach
Duodenum

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8
Q

Initiated by injuries that lead to auto-digestion of the pancreas, when protective mechanisms are disrupted or overwhelmed

A

Pancreatitis

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9
Q

Metabolic causes of acute pancreatitis

A

Alcoholism
Hypertriglyceridemia
Hypercalcemia
Drugs

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10
Q

Mechanical causes of acute pancreatitis

A

Gallstones
Trauma/surgery
Iatrogenic injury
ERCP

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11
Q

Vascular causes of acute pancreatitis

A

Shock
Atheroembolism
Vasculitis (polyarteritis nodasa)

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12
Q

Genetic mutations that can cause acute pancreatitis

A

PRSS1 –> trypsin activation
SPINK1 –> trypsin inhibitor
CASR –> Ca receptor
CFTR –> cystic fibrosis

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13
Q

Infectious causes of acute pancreatitis

A

Mumps
Coxsackie virus

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14
Q

Gross appearance of fat necrosis in pancreatitis

A

Yellow-white chalky areas

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15
Q

FAs combine with Ca to form insoluble soaps creating a granular blue microscopic appearance in necrotic fat cells.

A

Saponification of fat necrosis in pancreatitis

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16
Q

Pt presents with recent onset constant and intense abdominal pain referred to upper back and L shoulder with anorexia, nausea, and vomiting.

A

Acute pancreatitis

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17
Q

Serous, slightly turbid, brown-tinged fluid with fat globules in the peritoneal cavity, reflect digestion of adipose tissue

A

Systemic lipase release causing fat necrosis, associated with pancreatitis

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18
Q

Signs associated with hemorrhagic pancreatitis

A

Gray-Turner sign –> flank hemorrhage
Cullen sign –> periumbilical hemorrhage

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19
Q

Cause of tetany in acute pancreatitis

A

Hypocalcemia because of Ca used in saponification of fat necrosis

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20
Q

Additional conditions that can be caused by acute pancreatitis

A

DIC
Shock
ARDS
Tetany

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21
Q

Serum amylase findings in acute pancreatitis

A

Markedly increased for first 24 hrs
Normal in 3-5 days

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22
Q

Serum lipase findings in acute pancreatitis

A

Elevated during 72-96 hrs

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23
Q

Complications of acute pancreatitis

A

Pancreatic pseudocyst
Pancreatic abscess
Acute kidney failure

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24
Q

Cause of pancreatic pseudocyst in acute pancreatitis

A

Persistent elevation of serum amylase

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25
Q

Cause of pancreatic abscess in acute pancreatitis

A

Infection with gram negative organisms

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26
Q

Cause of acute kidney failure in acute pancreatitis

A

Acute tubular necrosis

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27
Q

Irreversible destruction of exocrine parenchyma and fibrosis, and loss of endocrine parenchyma in the pancreas

A

Chronic pancreatitis

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28
Q

Most common cause of chronic pancreatitis

A

Long term alcohol use

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29
Q

Causes of chronic pancreatitis

A

Alcoholism
Chronic pancreatic duct obstruction (calculi or neoplasm)
Autoimmune injury
Hereditary factors

30
Q

Chronic pancreatitis associated with a manifestation of systemic IgG related disease

A

Type 1 autoimmune pancreatitis

31
Q

Histology shows swirling or storiform fibrosis and obliterative inflammation of the veins within the pancreas

A

Type 1 autoimmune pancreatitis

32
Q

Dense lymphoplasmacytic inflammation of the pancreas that is enriched in IgG4 secreting plasma cells

A

Lymphoplasmacytic sclerosing pancreatitis associated with type 1 autoimmune pancreatitis

33
Q

Chronic pancreatitis characterized by neutrophilic infiltrates within the epithelium and lumen of medium-sized pancreatic ducts

A

Type 2 autoimmune pancreatitis

34
Q

Gross morphology of chronic pancreatitis

A

Gland is hard, sometimes with visibly dilated duct containing calcified concretions.

35
Q

Cause of chronic pancreatitis associated with ductal dilation and intraluminal protein plugs and calcifications

A

Alcohol abuse

36
Q

Microscopy shows chronic inflammatory infiltrate that surrounds lobules and ducts, with sparing of the islets of Langerhans

A

Chronic pancreatitis

37
Q

Microscopy shows extensive fibrosis and atrophy, dilated duct with inspissated concretions, and lymphoplasmacytic infiltrates.

A

Chronic pancreatitis

38
Q

CT scan findings of chronic pancreatitis

A

Dystrophic calcifications within the pancreas

39
Q

Complications of chronic pancreatitis

A

Pancreatic exocrine insufficiency
Chronic malabsorption
DM type 1
Pancreatic pseudocyst
Pancreatic carcinoma

40
Q

Congenital pancreatic enzyme deficiencies

A

Co-lipase deficiency
Lipase deficiency
Trypsinogen deficiency

41
Q

Two main functions of exocrine pancreas

A

Secretion of digestive enzymes

Secretion of bicarbonate-rich fluid, to neutralize gastric acid

42
Q

What is a sign that pancreatic lipase secretion is reduced by >90%?

A

Steatorrhea

43
Q

What is azotorrhea?

A

Protein malabsorption

44
Q

Area of intra- or peri-pancreatic hemorrhagic fat necrosis walled off by fibrosis and granulation tissue

A

Pancreatic pseudocyst

45
Q

Contents of pancreatic pseudocyst

A

Fluid containing necrotic tissue and enzymes

46
Q

Possible outcomes of a pancreatic pseudocyst

A

Spontaneous resolution
Compression of adjacent structures
Perforation

47
Q

Benign tumor of the pancreatic tail resulting from inactivation of VHL gene. Gross morphology shows honeycomb of microcystic spaces.

A

Serous cystic neoplasm/cystadenoma of the pancreas

48
Q

Microscopy of this pancreatic growth shows cystic spaces lined by glycogen-rich cuboidal cells that contain thin, clear, straw-colored fluid

A

Serous cystic neoplasm

49
Q

Treatment for serous cystic neoplasm of the pancreas

A

Surgical resection is curative

50
Q

Precursor lesion to invasive carcinoma of the pancreas

A

Mucinous cystic neoplasms

51
Q

Genetic mutations associated with mucinous cystic neoplasms of the pancreas

A

KRAS mutation (50%)
RNF43 loss-of-function
TP53 and SMAD4

52
Q

Gross appearance of larger cystic spaces filled with thick, tenacious mucin on the pancreas

A

Mucinous cystic neoplasms

53
Q

Microscopy of mucinous cystic neoplasm of the pancreas

A

Cysts lined by mucin-producing epithelium
Dense, ovary-like stroma

54
Q

Treatment of benign mucinous cystic neoplasm of the pancreas

A

Surgical resection is curative

55
Q

Prognosis of invasive adenocarcinoma in mucinous cystic neoplasm of the pancreas

A

50% die within 5 yrs

56
Q

Benign tumor of head of pancreas and major ducts that is seen in men. Can progress to invasive cancer.

A

Intraductal papillary mucinous neoplasm

57
Q

Genetic mutations of intraductal papillary mucinous neoplasm of pancreas

A

KRAS (80%)
RNF43
GNAS
TP53 and SMAD4

58
Q

Microscopy of pancreatic growth shows ducts filled with complex papillary projections lined by tall, columnar epithelial cells. Varying grades of dysplasia.

A

Intraductal papillary mucinous neoplasm of pancreas

59
Q

Most common pancreatic carcinoma

A

Infiltrating ductal adenocarcinoma

60
Q

Third leading cause of cancer deaths in the US

A

Pancreatic carcinoma

61
Q

Most common precursor lesion of pancreatic carcinoma

A

Pancreatic intraepithelial neoplasia (PanIN)

62
Q

Most common genetic mutation associated with pancreatic carcinoma

A

BRCA2

63
Q

Syndrome associated with increased risk of pancreatic cancer

A

Peutz-Jeghers syndrome

64
Q

Gross appearance of pancreatic ductal adenocarcinoma

A

Hard, stallate, gray-white, poorly defined mass

65
Q

Microscopy of pancreatic tumor shows abortive tubular structures or cell clusters, and aggressive and deeply infiltrative growth pattern. Tends to grow along nerves and invade into blood vessels.

A

Pancreatic infiltrating ductal adenocarcinoma

66
Q

Courvoisier sign

A

Palpably enlarged nontender gallbladder with mild painless jaundice

Associated with pancreatic carcinoma

67
Q

Trousseau sign

A

Migratory thrombophlebitis caused by release of platelet-activating factors and procoagulants from tumor

Associated with pancreatic adenocarcinoma

68
Q

Direct metastasis of pancreatic cancer tends to go where

A

Spleen
Adrenals
Transverse colon
Stomach

69
Q

Primary areas of distant metastasis of pancreatic cancer

A

Liver
Lungs

70
Q

Tumor markers associated with pancreatic cancer

A

CEA
CA19-9

71
Q
A

GI II (31 decks)

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