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Gasteroenterology2 > Pancreatic Diseases > Flashcards

Pancreatic Diseases Flashcards

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1
Q

what hormone stimulates release of pancreatic enzymes

A

gastrin

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2
Q

what pancreatic enzymes do not require trypsin activation

A

amylase & lipase

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3
Q

small ducts secrete…….. and large ducts secret……….

A

bicarbonate; mucin

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4
Q

what protease inhibitor is secreted by pancreatic acinar & ductal cells to inhibit intrapancreatic trypsin activity

A

SPINK1

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5
Q

what parts of the pancreas are derived from the dorsal primordium

A

body; tail; anterior head; accessory duct

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6
Q

what parts of the pancrease are derived from the ventral promordium

A

posterior head; main pancreatic duct

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7
Q

what is the pathogenesis of pancreas divisum

A

failure of foregut duct systems of dorsal & ventral primordia to fuse

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8
Q

describe the malformation of annular pancreas

A

ventral pancreatic bud wraps around duodenum adhering to the duodenum but before rotation begins; that results in narrowing of the duodenum

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9
Q

For pancreas divisum, what duct secretes most of the enzymes and why

A

main pancreatic duct is significantly shortened making the accessory duct the primary secreter

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10
Q

what are the physiological consequences of a pancreas divisum

A

most pts. are asymptomatic but does increase risk of chronic pancreatitis due to chronic backpressure and relative outflow obstruction

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11
Q

what are the physiological consequences of an annular pancreas

A

GI obstructive symptoms most commonly vomiting

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12
Q

what is an ectopic pancreas

A

normal appearing pancreatic glands & ducts as sites outside the pancreas

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13
Q

what are the 2 main causes of acute pancreatitis in the US

A

alcoholism & biliary tract diseases

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14
Q

what are the proposed mechanisms for alcohol-induced pancreatitis

A

transient contraction of sphincter of Oddi and oxidative stress leading to local inflammation
increased IC Ca promotes release and activation of trypsin and other digestive enzymes

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15
Q

chronic alcohol consumption leads to what physioligcal outcome in the pancreas

A

secretion of protein-rich pancreatic fluid may form protein plugs leading to obstruction of small pancreatic ducts

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16
Q

hereditary pancreatitis typically presents in which decade of life

A

within the 1st two

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17
Q

what are the main genetic mutations assoc. w/ hereditary pancreatitis

A

Gain of function to Cationic trypsinogen gene resulting in a more resistant trypsinogen isotype to trypsin inhibitors

inactivating mutations of SPINK1 leaving trypsin activity unregulated

CFTR mutations decrease bicarb secretion in pancreatic duct cells

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18
Q

what are secondary complications that can arrise from hereditary pancreatitis

A

PRSS1: results in a more resilient trypsinogen to inactivating mechanisms; long-term complications: pancreatic adenocarcinoma
CFTR: long term complications are duct obstruction b/c of decreased bicaronbate excretion leading to protein plugging
SPINK1: inhibits trypsin activity

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19
Q

describe the histopahtology of acute pancreatitis

A

fat necrosis of peripancreatic fat
liquefactive hemorrhagic necrosis
inflammatory neutrophil infiltration
edema

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20
Q

describe the histopahtology of fat necrosis

A

hypocalcemia due to dystrophic calcification and saponification to form insoulble calcium soaps

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21
Q

What pancreatic enzyme would you expect to find elevated within the first 24 hrs. of acute pancreatitis symptoms

A

amylase

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22
Q

what pancreatic enzyme would you find elevated within 72-96 hrs. of onset acute pancreatitis

A

lipase

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23
Q

accumulation of lipase leads to what physiologic consequence

A

hypocalcemia due to precipitation of calcium fat salts

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24
Q

what is cullen sign

A

purple-blue periumbilical and flank discoloration

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25
what is Gray-Turner sign
retroperitoneal hemorrhage through through fascial skin layers
26
what extrapacreatic manifestations would you expect to see with acute pancreatitis
ascending cholangitis leading to sepsis renal failure (aqotemia) and acute tubular necrosis; ARDS; Ileus
27
what histolical findings would you expect within the 1st 4 weeks of acute pancreatitis
peripancreatic homogenous fluid collection w/o discernable borders accute hetrogenous necrotic fluid collection
28
what histoligical findgins would you expect to see after 4 wks of AP onset
Pseudocyst: well circumscribed grandular abdominal mass hemogenous in nature wall off necrosis: encapsulated collection of heterogenous fluid
29
List the sequelae for acute pancreatitis
pancreatic abscesses, pseduocytsts, duodenal obstruction
30
what is the most common cause of chronic pancreatitis
long-term alcohol abuse
31
what factors predominate in chronic pancreatitis
fibrogenic: TGF beta & PDFG
32
describe the mechanism for aalcholo inducted increases Ca activity
pancreatic hypixia and oxidative damage increases total pancreatic protein activation forming calcified plugs which prevents excretion of enzymes and subsequently resulting in autodigestion of parenchyma
33
pancreatic stellate cells have the same functions of hepatic stellate cells. chronic pancreatitis = ?
cirrhosis of the pancrease
34
describe the hisotlogical characterisitcs of CP
Acinar hypoplasia & atrophy fusion of dilated pancreatic ducts embedded in sclerotic tissue squamous metaplasia of ductal epithelium Islets of langerhans spared
35
how do opiates contribute to pancreatitis
increases tone of sphincter of oddi
36
what are lower GI complications of CP
steatorrhea & diarrhea Vit. K. def Vit. D. def DM (very late stage)
37
amylase & lipase serum levels are normal in pts. w/ chronic pancreatits. what lab test can be ordered instead
fectal elastase low in CP
38
what a classic CT indications of CP
pancreatic calcifications in a "chain of lake pattern"; gladular atrophy and dilaton of the pancreatic ducts
39
what is the pathogenesis of type 1 autoimmune CP
IgG4 secreting plasma cells cause dense lymphoplasmacytic inflammation
40
describe the pathogenesis of type 2 autoimmune CP
neutrophilic inflitrates lymphoplasmacytic infiltrates also seen but no IgG4-secreting plasma cells are seen
41
what is also assoc. w/ type 1 AI CP
phlebitis
42
review the following
slide 38 on pancreasePath ppt
43
describe the hitological findings of pancreatic pseudocysts
pseudocyst: NO EPITHERLIAL LINING hemorrhagic fat necrosis w/ notable fibrosis & granulation tissue rich in pancreatic enzymes
44
suspect a pseudocyst in pts. with all the clinical presentations of acute pancreatic in addition to having a h/o what?
abdominal trauma or persistent abdominal pain w/ a palpable epigastric mass OR if acute pancreatitis persists beyond 6 wks. of onset
45
serous cystadeomas are commonly found in which part of the pancreas
tail
46
tail
tail
47
what are the epidemiological factors assoc. w/ cystademonas
twice as common in women; onset avearge in 7th decade
48
what mutation is the most commonly assoc. w/ serous cystadenomas
inactivation of VHL tumor supressor gene on ch. 3
49
describe the histologic characteristics of serous cystademonmas
glycogen rish cuboidal cells surrounding small cysts
50
what are epidemi. factors of mucinous cystic neoplams
almost exculsivley in females
51
what is the most common sporatic mutaion assoc. w/ mucinous nps
KRAS
52
what are the histological characteristics of mucinous cystic nep
columnar mucin-producing epithelium lining cysts dense stroma similar to ovarian stroma
53
what hormones would you expect to be upregulated for pts. w/ mucinous cystic nep
estrogen progesterone inhibin
54
review the following slide
pacnreas path. ppt slide 48
55
mucinous cystic neoplasia typically occurins in what part of the pancrease
body
56
Is PIMNs more common in men or women
men
57
80% of IPMNs are assoc. w/ sporatic KRAS mutations; what additional mutations occur when the neoplasm transitions to invasive cancer
TP53, GNAS, & SMAD4
58
solid-pseuopapillary tumors are commonly seen in which pt. population
adolescent girls and young women
59
what mutation is assoc. w/ solid pseudopapillary tumors
activatoin mutations of CTNNB1 (beta-catenin)
60
most pts. w/ solid-pseudopapillary tumors expreifecne pain why
these tumors are massive
61
85% of pancreatic adenocarcinomas are derived from what cells
ductal epitehlium
62
what is the main malignant precursor for adenocarcinoma
PanINs
63
what are epidemilogical factors of pancreatic carcinoma
increasesd prevelance: African & japanese americans native hawaiians ashkenazi jews smoking doubles risk other comorbidies: metabolic syndrome & chronic pancreatitis
64
review this slide
parncreaepath ppt. slide 56
65
describe the gross features of pancreas adenocarcinoma
hard, stellate, grey-whit mass w/ poorly defined borders
66
pancreatic carcinomas located in the head are more likely to present with this symptoms
head obstruction of distal common bile duct develop jaundice
67
why are cancers of the body & tail not assoc. w/ jaundice
these do not impinge on the biliary tract
68
what is trousseau sign
superficial migratory thrombophlebitis
69
what is Courvoiser's sign
RUQ mass; enlarged palpable gallbladder in pts. w/ obstructive jaundice
70
what tumor maker can be used to monitor progression of pancreatic carcinomas
CEA & carbohydrate antigen 19-9
71
what pancreatic neoplasm is almost exculeivly diagnosed in ped. pts.
pancreatoblastoma distinck squamous islands admixed w/ undifferentiated cells

Gasteroenterology2 (4 decks)

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