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Flashcards in Pancreas Path I Deck (53):
1

pancreas

has head, body, tail

gland acini

2

tumors of pancreas

most arise from epithelium of large ducts

adenocarcinomas

3

pancreas divisum

improper fusion of duct

duct of santorini does not obliterate becomes main drain - to minor papilla to small bowel

and duct of wirsung becomes insignificant - may drain lower pancreas

4

embryo of pancreas

rotation of ventral anlagen
-rotates toward dorsal and fusion takes place

normally - has duct obliteration and wirsung duct left behind

duct of santorini obliterates and minor papilla nonfunctional

5

ERCP

can be used to see pancreas divisum

dye to ampulla of vater - no dye to pancreas

in minor sphincter - do see dye in pancreas

6

predisposition to chronic pancreatitis

pancreas divisum

7

annular pancreas

double bubble sign

part of pancreas drags behind and wraps duodenum

usually below sphincter of oddi

see green-tinged vomit**

8

double bubble

annular pancreas

9

bile tinged vomit

annular pancreas

10

acute pancreatitis

acinar cell injury or obstruction of ducts of pancreas

trypsin from acini - to small bowel - activated there so doesn't destroy pancreas

enzymes digest pancreas in pancreatitis

11

mild acute pancreatitis

inflammation, edema, reversible

12

severe acute pancreatitis

life-threatening
-ARDS, shock, DIC

13

chronic pancreatitis

repeated bouts

14

causes of acute pancreatitis

alcohol
gallstones

also mutations in trypsin protein - shock - trauma - vasculitis - mumps

15

alcohol acute pancreatitis

better prognosis - but still bad

40yo male

16

biliary stones in acute pancreatitis

brown stones
female age 70yo
worse prognosis

17

pancreatitis path

autodigestion

saponification of parenchyma and adipose

injury can be to duct or to acini or both

18

duct obstruction in pancreatitis

initially edema
-secondary impaired blood flow
-ischemia

cells of duct begin to malfunction

spill enzymes to tissue - autodigests

19

PRSS1, SPINK1, CFRT

mutations in trypsin
acute pancreatitis

high risk of pancreatic cancer as well

20

diagnosis of acute pancreatitis

epigastric pain to back
fever, N/V

elevated serum amylase and lipase

21

acute pancreatitis early

enlarged with edema and red

some early white saponification

22

chronic pancreatitis

multiple bouts of acute

most common cause - alcohol abuse

also autoimmune - IgG4, and genetic mutations in trypsin

23

repeated bouts of epigastric pain to back followed by malabsorption

chronic pancreatitis

24

early chronic pancreatitis

days to weeks

25

intermediate chronic pancreatitis

months to years

26

late chronic pancreatitis

years to decades

hard - sclerotic tissue - calcifications

27

chronic pancreatitis

lots of pancreas is fibrotic

get calcifications that you can see on CT/Xray

28

chronic pancreatitis complications

calcification can cause severe pain - perineural fibrosis

stones

diabetes

ascites - constant destruction of peritoneal surfaces

pseudocysts

pleural effusions - ascites can traverse diaphragm

fat malabsorption**

29

true cyst

epthelial lining
-usually neoplasm - b9 or mal
-will continue to grow
-inside - depends on epithelium

30

pseudocyst

have no epithelium
-usually filled with something
-fluid not made by what is lining wall

-usually lined with granulation and chronic inflammaion

-usually do not grow in size

31

abscess

get walled off - creates area of fibrosis
-walls off acute inflammation
-pain and systemic infection

if remains in place - what is left is pseudocyst
-lining of cyst - no epithelium

32

pseudocysts in pancreas

inflammatory response to digestive enzymes in pancreas

pseudocyst forms

lined with inflammatory wall** - no epithelium

33

serous cystadenoma

elderly 60yo

make serous yellow fluid

makes cysts

benign

34

mucinous cystic neoplasm

mucin producing

create cysts

benign, borderline, malignant all common

35

pancreatic serous cystadenoma

smooth border - tumor full of lots of cyst

-yellow straw colored fluid - serous fluid

benign

36

slow growing painless mass in adult women in pancreas

mucinous cyst neoplasm

need to look at biopsy

37

pancreatic mucinous cystadenoma

smooth borders
-likely benign

mostly tall of pancreas

lining - epithelium making mucin - fills cyst

38

intraductal papillary mucinous neoplasm

duct epithilium produces neoplasms growing to obstruct lumen
-continue to grow and expand

mostly male - mostly benign - mostly head of pancreas

39

carcinoma of pancreas

4th leading cause of death in US

risk fx - old age, smokers, diet, hereditary

when discovered - widely metastatic

painless jaundice with pruritits

40

epigastric pai to back, jaundice, pruritis

possible pancreatic cancer

41

migratory thrombophlebitis

troussea sign

with pancreatic cancer

42

courvoisiers

palpable gallblader with pancreatic cancer

43

virchows node

left supraclavicular

with pancreatic cancer

44

sister mary joseph

umbilical skin mass

with pancreatic cancer

45

blumers shelf

rectal pouch mass
-drop mets - to this location

with pancreatic cancer

46

smoking risk fx for cancer in

pancreas
lung
HNSCC
bladder
esophagus

47

diagnosis of pancreatic cancer

CT scan common
endoscopic ultrasound

fine needle aspiration or needle core bx

48

Ca 19-9

elevated in pancreatic cancer

marker to follow treatment

not for diagnosis

49

aspiration

cell sucked out of tissue with negative pressure

50

exfoliative

scraped off surface

51

adenocarcinoma of pancreas

really hard - with irregular borders

52

KRAS

12p chromosome

altered in invasive pancreatic adenocarcinoma

53

desmoplasia

connective tissue deposition - makes tumors hard