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Flashcards in pancreas (not 4 star, misplaced) Deck (33):
1

pancreas is derived from

foregut (endoderm structure)

2

hepatic diverticulum on ventral surface of distal foregut gives rise to

endodermal structures:
liver
gallbladder
biliary tree
ventral pancreatic bud (head of pancreas)

3

ventral pancreatic bud becomes

pancreatic head
main pancreatic duct

4

dorsal pancreatic bud becomes

body + tail of pancreas
accessory pancreatic duct

5

dorsal pancreatic bud develops on

dorsal surface of foregut

6

fusion of ventral and dorsal pancreatic bud occurs at

8 wks GA when foregut duodenum rotates to form C shape and then ventral pancreatic bud meets the dorsal pancreatic bud

7

ventral pancreatic bud encircles duodenum → narrows duodenum

annular pancreas

8

most asymptomatic
symptoms due to duodenal narrowing may begin at any age

annular pancreas

9

child presenting with gastric outlet obstruction (similar to duodenal atresia):
bilious vomiting
feeding intolerance abdominal distention

annular pancreas

10

infant with following associated findings:
polyhydramnios
down syndrome
esophageal and duodenal atresia
imperforate anus
meckel diverticulum

annular pancreas

11

adult 20-50 yo presenting with:
ab pain
postprandial fullness + nausea
peptic ulceration
pancreatitis
biliary obstruction (rare)

annular pancreas

12

ventral and dorsal pancreatic buds fail to fuse

pancreas divisum

13

arises from dorsal mesentary of stomach (mesodermal structure)

spleen

14

pancreatic juice that is secreted into pancreatic ducts includes

digestive enzymes of pancreas
HCO3: neutralizes stomach acid
NaCl: Cl goes into lumen of duct → Na follows → H20 follows → watery secretion of juice

15

CFTR gene (cystic fibrosis transmembrane conductance regulator) → CFTR protein is a Cl- ion channel
mutation in CFTR causes:

Cl- wont enter pancreatic duct lumen → no Na or H20 → thick pancreatic secretions

16

manifestations of cystic fibrosis

thick pancreas secretions
thick mucous in lungs
salty sweat (Cl- channel normally allows for Cl- reabsorption in sweat glands → abnormal: excess Cl in sweat)

17

pancreatic complications of cystic fibrosis

thick pancreatic juice: no enzymes into duodenum
malabsorption of fat + fat soluble-vitamins and protein
steatorrhea
treatment: supplement pancreatic enzymes + ADEK enzymes

18

inflammed pancreas that starts digesting itself

acute pancreatitis

19

severe upper abdominal pain +/- radiation to back
WORSE with food
N/V
sitophobia: fear of food

acute pancreatitis

20

diagnosis of acute pancreatitis

↑ serum lipase = diagnosis of acute pancreatitis !!
CT scan: for confirmation (also look for pancreatic pseudocysts)

21

complications of acute pancreatitis

multiorgan failure
DIC
hemorrhage of pancreas
necrosis of pancreas
sequester Ca in abdomen: Ca binds fat → soap deposits in abdomen →saponification → Ca precipates out into blood →hypocalcemia
can progress to chronic pancreatitis with pancreatic pseudocyst: lined with fibrous scar tissue and granulation tissue from chronic inflammation, filled with pancreatic juice + enzymes, not lined by epithelium = real cyst)

22

most common causes of acute pancreatitisalcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure:
malabsorption
steatorrhea
diabetes
↑ risk pancreatic cancer

gallstones
alcohol
*acronym for common causes in "play on words"

23

chronic pancreatitis
alcohol abuse: alcohol irritates pancreas → chronic inflammation → chronic pancreatic failure:
malabsorption
steatorrhea
diabetes
↑ risk pancreatic cancer

chronic pancreatitis

24

common cause of chronic pancreatitis

alcohol abuse

25

treatment of chronic pancreatitis

pancreatic enzymes
ADEK enzymes
limit fat intake

26

pancreatic tumors

neuroendocrine tumors:
gastrinoma: Zollinger-Ellison syndrome: duodenal ulcers
VIPoma: watery diarrhea
cancer:
pancreatic adenocarcinoma

27

weight loss
ab pain
sudden severe, painless jaundice (obstruct biliary tract)

pancreatic adenocarcinoma

28

hypercoagulability
venous thrombosis
migratory thrombophlebitis: redness + tenderness on palpation of extremities

Trousseau syndrome:
can be caused by many malignancies, including:
pancreatic adenocarcinoma

29

bp cuff on patient tighten for 1 min → carpopedal spasm of hand

Trausseau sign: sign of hypocalcemia (not related)

30

risk factors for pancreatic adenocarcinoma

chronic pancreatitis
tobacco
>50 yo
black or ashkenazi jew

31

CA 19-9 is a tumor marker for

pancreatic adenocarcinoma

32

CEA is a tumor marker for

nonspecific for many gut tumors:
pancreatic adenocarcinoma
and
colon cancer

33

signs of pancreatic insufficiency

diarrhea
steatorrhea
malabsorption
weight loss
ADEK deficiency