GIT Path: Biliary Tree, Gall Bladder and Pancreas

Question 1

gastrinomas are associated with MEN ___

Answer 1

MEN (multiple endocrine neoplasia) 1

Question 2

IPMN of the pancreas arise from the ____ (part of pancreas)

Answer 2

head

Question 3

pain is usually the first symptom in pancreatic adenocarcinoma due to ______

Answer 3

invasion of the posterior abdominal wall and nerves

Question 4

hyper/hypocalcemia is a feature of acute pancreatitis

Answer 4

hypocalcemia due to fat necrosis with calcium deposition which appears radiopaque

Question 5

what is Whipple triad

Answer 5

• low blood glucose
• presence of hypoglycemic symptoms
• resolution when blood glucose is normalized

seen in insulinomas (β cells of pancreas)

Question 6

80% of the cases of acute pancreatitis is associated with _____ and _____

Answer 6

gallstones and alcohol

Question 7

________ has a stroma rich pancreatic tumor

Answer 7

ductal adenocarcinoma

all others are stroma poor

Question 8

Roitansky Aschoff sinus is a morphological feature of _____

Answer 8

chronic cholecystitis

Question 9

how can you tell the difference between a IPMN (intraductal papillary mucinous neoplasm) or Mucinous cystic neoplasm of the pancreas?

Answer 9

both ave tall columnar mucin producing cells

IPMN: most arise from the head of the pancreas and NO ovarian type stroma (not a lot of cells)

MCN: most arise from the tail of the pancreas, almost exclusively in women, and have ovarian type stroma (have a lot of cells)

Question 10

acinar cell carcinoma results in ↑ release of _______

Answer 10

lipase → subcutaneous fat necrosis and panniculitis

Question 11

↑ levels of CA-19-9 is indicative of what type of carcinoma?

Answer 11

pancreatic adenocarcinoma

Question 12

what is trousseau’s sign? where do you see it

Answer 12

migratory thrombophlebitis (inflammation of the blood vessels due to clot) 
seen with pancreatic adenocarcinoma

Question 13

genetic causes such as pancreatic divisum is a cause of ____ pancreatitis

Answer 13

chronic pancreatitis

Question 14

describe a few features of histology of pancreatic adenocarcinoma

Answer 14

• ductal type
• dense stromal fibrosis (desmoplasia)
• propensity for perineurial invasion → pain that is the first symptom

Question 15

the most common causes of pancreatic insufficiency are ____ and _____

Answer 15

CF and pancreatitis

Question 16

pseudocysts can be seen in _____ pancreatitis

Answer 16

chronic; pseudocysts are pancreatic ducts that are dilated when the acini are destroyed

Question 17

what are some clinical features of acute pancreatitis?

Answer 17

• shock with ATN, ARDS
• hypocalcemia, tent
• DIC, hemolysis

Question 18

what are the two main types of gallstones (cholelithiasis) and which is more common?

Answer 18

• cholesterol: cholesterol monohydrate (more common)

- pigment stones: bilirubin calcium salts

Question 19

the most common COD in patients with CF is ______

Answer 19

cardiorespiratory complications

Question 20

will you see ovarian type stroma in intraductal papillary mucinous neoplasm of the pancreas?

Answer 20

NO;
arise within the ductal system with dilated duct filled with mucin and cysts are lined by tall columnar mucin secreting cells; “papillary frond” like appearance that is surprised by dense acellular stroma

IPMN should be resected before it has the potential to turn malignant

Question 21

a rare complication of _____ cholecystitis is porcelain gallbladder.

Answer 21

chronic;

extensive dystrophic calcification following inflammation of the gallbladder aka porcelain gallbladder

Question 22

what is a PanIN?

Answer 22

pancreatic intraepithelial neoplasia which is a precursor lesion for pancreatic Adenocarcinoma

Question 23

discuss the mutations that get accumulated in PanIN’s

Answer 23

• KRAS → tumor supressor gene mutation → invasive adenocarcinoma

Question 24

within the first 24 hours in someone with acute pancreatitis, you will see ↑ levels of _____

Answer 24

amylase

Question 25

what are complications of acute pancreatitis?

Answer 25

ATN, ARDS, pancreatic abscess

Question 26

what are some histological feature seen in chronic cholecystitis?

Answer 26

• cystically dilated structures called Rokinasky Aschoff sinus
• chronic inflammation in lamina propria

Question 27

how does the exocrine dysfunction in pancreatic insufficiency present in a patient?

Answer 27

fat malabsorption → steatorrhea because lipolytic activity ↓ faster than the proteolysis
fat soluble vitamins not absorbed

Question 28

the majority of pancreatic adenocarcinomas arise from the _____ of the pancreas

Answer 28

head; these patients will present with symptoms of obstructive jaundice
head > tail > body

Question 29

pancreatic neuroendocrine tumors arise form _____

Answer 29

islet cells (functional tumors and non functional tumors)

Question 30

↑ levels of ______ is seen within 72-96 hours

Answer 30

lipase