Pancreas

Question 1

what is the hooked portion of the pancreas called and why is it important

Answer 1

uncinate process - important because it becomes a surgical margin

Question 2

where is the pancreas located

Answer 2

retroperitoneal

Question 3

does the pancreas have a capsule

Answer 3

no

Question 4

define endocrine

Answer 4

substances are secreted directly into bloodstream

Question 5

define exocrine

Answer 5

substances are secreted into a ductal system

Question 6

what is the endocrine portion (1-2%) of the pancreas

Answer 6

islets of langerhans which include beta cells, alpha cells, delta cells, and PP cells

Question 7

what is the exocrine portion of the pancreas composed of

Answer 7

acinar cells and ducts

Question 8

what are acinar cells made of

Answer 8

zymogen granules

Question 9

what do zymogen granules of acinar cells do

Answer 9

make digestive, pancreatic enzymes

Question 10

what do the small pancreatic ducts release

Answer 10

bicarbonate fluid

Question 11

what do the large pancreatic ducts release

Answer 11

mucin

Question 12

what do the pancreatic ducts express

Answer 12

cystic fibrosis transmembrane conductance regulator (CFTR)

Question 13

what is the most common congenital anomaly of the pancreas

Answer 13

pancreas divisum

Question 14

what is pancreas divisum

Answer 14

congenital anomaly where the duct of wirsung does not connect to the duct of Santorini
most patients are asymptomatic but it can cause pancreatitis

Question 15

what is annular pancreas

Answer 15

congenital anomaly where there is a band-like ring of pancreatic tissue that encircles the second portion of the duodenum
can lead to a duodenal obstruction

Question 16

what is pancreatic heterotropia

Answer 16

congenital anomaly where there is pancreatic tissue in other areas of the abdominal cavity
ex. stomach

Question 17

what is a pancreatic cyst

Answer 17

small, unilocular cyst made of a single layer of flattened cuboidal cells in a pancreatic duct
usually contains clear, serous fluid

Question 18

what is an important fact about a pancreatic cyst

Answer 18

it does not communicate with the ductal system

Question 19

what are the two conditions associated with pancreatic cysts

Answer 19

polycystic kidney disease
von Hippel-Lindau Syndrome

Question 20

what three things will you see macroscopically in the pancreas of someone with cystic fibrosis

Answer 20

fibrosis
fat replacement
cyst formation

Question 21

what will you see microscopically in the pancreas of someone with cystic fibrosis

Answer 21

dilation of acini with accumulation of eosinophilic secretions

Question 22

what is hereditary hemochromatosis

Answer 22

recessive disease that is classified as the inappropriate increased iron absorption from the duodenum and small intestine
leads to a brown appearing pancreas macroscopically

Question 23

what is the most common cause of acute pancreatitis

Answer 23

impaction of stones within the common bile duct (choledocholithiasis)

Question 24

what is the second most common cause of acute pancreatitis

Answer 24

excessive alcohol intake

Question 25

what is the macroscopic presentation of acute pancreatitis

Answer 25

fat necrosis

Question 26

where is the most common location for adenocarcinoma of the pancreas

Answer 26

head

Question 27

which two viruses can cause acute pancreatitis

Answer 27

mumps coxsackievirus

Question 28

which procedure can cause acute pancreatitis

Answer 28

endoscopy procedures like ERCP

Question 29

what is fat saponification

Answer 29

fatty acids combine with calcium to form calcium soaps

Question 30

what is the most common cause of chronic pancreatitis

Answer 30

long term alcohol abuse in middle aged men

Question 31

what is the macroscopic presentation of chronic pancreatitis

Answer 31

parenchymal fibrosis with proteinaceous plugs

Question 32

what are three ways in which alcohol affects the pancreas

Answer 32

increases contraction of sphincter of Oddi causes protein plugs generate free radicals in the acini

Question 33

what is a pancreatic pseudocyst

Answer 33

the bodies attempt to wall off areas of necrotic pancreatic tissue leads to a cystic structure made of fibrosis the cyst is often filled with pancreatic enzymes

Question 34

what is autoimmune pancreatitis

Answer 34

form of chronic pancreatitis that is a IgG4 related disease leads to sclerosing cholangitis (inflammation of the bile duct)

Question 35

onion-skin is seen in which condition

Answer 35

primary sclerosing cholangitis

Question 36

what are the three types of non-cystic exocrine pancreatic neoplasms

Answer 36

pancreatic intraepithelial neoplasia ductal adenocarcinoma acinar cell carcinoma

Question 37

what are the three types of cystic exocrine pancreatic neoplasms

Answer 37

serous cystic mucinous cystic intraductal papillairy

Question 38

what is a pancreatic intraepithelial neoplasia (PanIN)

Answer 38

precursor, "in-situ" lesion of pancreatic ductal adenocarcinoma classified by WHO in PanIN-1-3

Question 39

which cancer has one of the highest mortality rates of all malignancies

Answer 39

ductal adenocarcinoma

Question 40

85-90% of all pancreatic neoplasms are what

Answer 40

ductal adenocarcinoma

Question 41

what are some risk factors to ductal adenocarcinoma

Answer 41

old age smoking chronic pancreatitis diabetes mellitus genetic defects

Question 42

what is the most frequent altered oncogene in pancreatic cancer

Answer 42

KRAS

Question 43

what is the most frequently inactivated tumor suppressor gene

Answer 43

P16

Question 44

what is acinar cell carcinoma

Answer 44

lobulated, encapsulated mass with a flesh consistency

Question 45

what are the two categories of WHO classifications for serous cystic neoplasms

Answer 45

serous cystadenoma (benign) serous cystadenocarcinoma (malignant)

Question 46

what is a microcystic serous cystadenoma

Answer 46

benign cyst that is very sponge/honeycomb like made of many smaller cysts filled with small watery fluid has a central, fibrous scar

Question 47

what is a macrocystic serous cystadenoma

Answer 47

benign, unilocular cyst that only has one layer of cuboidal cells

Question 48

what are the two types of mucin producing cystic neoplasms

Answer 48

mucinous cystic neoplasm (MCN) intraductal papillary mucinous neoplasm (IPMN)

Question 49

who is most likely to get a mucinous cystic neoplasia

Answer 49

women around 50 years of age

Question 50

what is the difference between a mucinous cystic neoplasm and a intraductal papillary mucinous neoplasm

Answer 50

the mucinous cystic neoplasm has no communication with the ductal system the intraductal papillary mucinous neoplasm communicates with the ductal system

Question 51

what is the most important diagnostic feature of a mucinous cystic neoplasm

Answer 51

ovarian-type stroma beneath the epithelium

Question 52

what is the most common neoplastic cyst of the pancreas

Answer 52

intraductal papillary neoplasia

Question 53

what is the microscopic presentation of a intraductal papillary neoplasm

Answer 53

papillary architecture with mucin producing cells

Question 54

what is the most common type of pancreatic neuroendocrine tumor

Answer 54

insulinoma

Question 55

what is the most common pancreatic neoplasm in young children

Answer 55

pancreatoblastoma

Question 56

pancreatoblastomas are associated with which condition

Answer 56

beckwith-weidemann syndrome

Question 57

what could you see under the microscope in the pancreas of a patient with diabetes mellitus

Answer 57

amyloid deposits