Pancreas Path I

Question 1

pancreas

Answer 1

has head, body, tail

gland acini

Question 2

tumors of pancreas

Answer 2

most arise from epithelium of large ducts

adenocarcinomas

Question 3

pancreas divisum

Answer 3

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

Question 4

embryo of pancreas

Answer 4

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

Question 5

ERCP

Answer 5

can be used to see pancreas divisum

dye to ampulla of vater - no dye to pancreas

in minor sphincter - do see dye in pancreas

Question 6

predisposition to chronic pancreatitis

Answer 6

pancreas divisum

Question 7

annular pancreas

Answer 7

double bubble sign

part of pancreas drags behind and wraps duodenum

usually below sphincter of oddi

see green-tinged vomit**

Question 8

double bubble

Answer 8

annular pancreas

Question 9

bile tinged vomit

Answer 9

annular pancreas

Question 10

acute pancreatitis

Answer 10

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

Question 11

mild acute pancreatitis

Answer 11

inflammation, edema, reversible

Question 12

severe acute pancreatitis

Answer 12

life-threatening

-ARDS, shock, DIC

Question 13

chronic pancreatitis

Answer 13

repeated bouts

Question 14

causes of acute pancreatitis

Answer 14

alcohol
gallstones

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

Question 15

alcohol acute pancreatitis

Answer 15

better prognosis - but still bad

40yo male

Question 16

biliary stones in acute pancreatitis

Answer 16

brown stones
female age 70yo
worse prognosis

Question 17

pancreatitis path

Answer 17

autodigestion

saponification of parenchyma and adipose

injury can be to duct or to acini or both

Question 18

duct obstruction in pancreatitis

Answer 18

initially edema

• secondary impaired blood flow
• ischemia

cells of duct begin to malfunction

spill enzymes to tissue - autodigests

Question 19

PRSS1, SPINK1, CFRT

Answer 19

mutations in trypsin
acute pancreatitis

high risk of pancreatic cancer as well

Question 20

diagnosis of acute pancreatitis

Answer 20

epigastric pain to back
fever, N/V

elevated serum amylase and lipase

Question 21

acute pancreatitis early

Answer 21

enlarged with edema and red

some early white saponification

Question 22

chronic pancreatitis

Answer 22

multiple bouts of acute

most common cause - alcohol abuse

also autoimmune - IgG4, and genetic mutations in trypsin

Question 23

repeated bouts of epigastric pain to back followed by malabsorption

Answer 23

chronic pancreatitis

Question 24

early chronic pancreatitis

Answer 24

days to weeks

Question 25

intermediate chronic pancreatitis

Answer 25

months to years

Question 26

late chronic pancreatitis

Answer 26

years to decades hard - sclerotic tissue - calcifications

Question 27

chronic pancreatitis

Answer 27

lots of pancreas is fibrotic get calcifications that you can see on CT/Xray

Question 28

chronic pancreatitis complications

Answer 28

calcification can cause severe pain - perineural fibrosis stones diabetes ascites - constant destruction of peritoneal surfaces pseudocysts pleural effusions - ascites can traverse diaphragm fat malabsorption**

Question 29

true cyst

Answer 29

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

Question 30

pseudocyst

Answer 30

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

Question 31

abscess

Answer 31

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

Question 32

pseudocysts in pancreas

Answer 32

inflammatory response to digestive enzymes in pancreas pseudocyst forms lined with inflammatory wall** - no epithelium

Question 33

serous cystadenoma

Answer 33

elderly 60yo make serous yellow fluid makes cysts benign

Question 34

mucinous cystic neoplasm

Answer 34

mucin producing create cysts benign, borderline, malignant all common

Question 35

pancreatic serous cystadenoma

Answer 35

smooth border - tumor full of lots of cyst -yellow straw colored fluid - serous fluid benign

Question 36

slow growing painless mass in adult women in pancreas

Answer 36

mucinous cyst neoplasm need to look at biopsy

Question 37

pancreatic mucinous cystadenoma

Answer 37

smooth borders -likely benign mostly tall of pancreas lining - epithelium making mucin - fills cyst

Question 38

intraductal papillary mucinous neoplasm

Answer 38

duct epithilium produces neoplasms growing to obstruct lumen -continue to grow and expand mostly male - mostly benign - mostly head of pancreas

Question 39

carcinoma of pancreas

Answer 39

4th leading cause of death in US risk fx - old age, smokers, diet, hereditary when discovered - widely metastatic painless jaundice with pruritits

Question 40

epigastric pai to back, jaundice, pruritis

Answer 40

possible pancreatic cancer

Question 41

migratory thrombophlebitis

Answer 41

troussea sign with pancreatic cancer

Question 42

courvoisiers

Answer 42

palpable gallblader with pancreatic cancer

Question 43

virchows node

Answer 43

left supraclavicular with pancreatic cancer

Question 44

sister mary joseph

Answer 44

umbilical skin mass with pancreatic cancer

Question 45

blumers shelf

Answer 45

rectal pouch mass -drop mets - to this location with pancreatic cancer

Question 46

smoking risk fx for cancer in

Answer 46

``` pancreas lung HNSCC bladder esophagus ```

Question 47

diagnosis of pancreatic cancer

Answer 47

CT scan common endoscopic ultrasound fine needle aspiration or needle core bx

Question 48

Ca 19-9

Answer 48

elevated in pancreatic cancer marker to follow treatment not for diagnosis

Question 49

aspiration

Answer 49

cell sucked out of tissue with negative pressure

Question 50

exfoliative

Answer 50

scraped off surface

Question 51

adenocarcinoma of pancreas

Answer 51

really hard - with irregular borders

Question 52

KRAS

Answer 52

12p chromosome altered in invasive pancreatic adenocarcinoma

Question 53

desmoplasia

Answer 53

connective tissue deposition - makes tumors hard