Usera: Exocrine Pancreas Flashcards by Megan Foggia

The major pancreatic duct (which joins the common bile duct & empties into the small intestine)

Duct of Wirsung

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Accessory pancreatic duct emptying into the duodenum

Duct of Santorini

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Congenital absence of the pancreas may be due to defects in this gene

PDX1 - transcription factor necessary for pancreatic development

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What is a consequence of pancreatic agenesis?

malabsorption

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Most common congenital anomaly of the pancreas
A congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts

pancreas divisum

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Rare, congenital anomaly that may not become apparent until adult life
Developmental malformation in which the pancreas forms a ring around the duodenum, leading to a risk of duodenal obstruction

annular pancreas

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Pancreatic tissue in location other than the pancreas
Present in approximately 2% of autopsies
Stomach, duodenum, jejunum, Meckel diverticulum, ileum
Located within the submucosa
Consists of acini and occasionally islet cells
Pathogenesis is unknown

Ectopic pancreas

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What is pancreatitis? What are the two general categories?

inflammation of the pancreas with injury of the exocrine pancreatic tissue; can be acute, in which the exocrine tissue can return to normal function is the pancreatitis is removed, or chronic if there is irreversible injury with loss of pancreatic exocrine tissue

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Reversible pancreatic parenchymal injury associated with inflammation

Acute pancreatitis

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What are the two most common causes of acute pancreatitis?

biliary tract disease (gallstones)
alcohol

*biliary tract disease a more common cause in women, alcohol more likely in men
*other causes include trauma, hypercalcemia, hyperlipidemia, drugs, mumps, etc

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(blank) are present in 35-60% of cases of acute pancreatitis

gallstones

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What types of things can cause an obstruction of the pancreatic ductal system leading to acute pancreatitis?

Periampullary neoplasm (cancer of the pancreatic head)
Pancreatic divisum
Choledochocele (congenital cystic dilatation of the CBD)
Biliary sludge
Parasites (Ascaris, Clonorchis)

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Infection with this virus can cause acute pancreatitis

mumps virus

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3 metabolic disorders that can lead to acute pancreatitis

alcohol
hyperlipoproteinemia (hyper TAGs)
hypercalcemia

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3 forms of ischemic injury that can lead to acute pancreatitis

shock
vasculitis
atheroembolism

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What types of trauma can cause acute pancreatitis?

gallstones
iatrogenic injury (during operation)

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What gene is associated with acute pancreatitis?

PRSS1 & SPINK1

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So, list three major causes of acute pancreatitis?

duct obstruction
acinar cell injury (alcohol, drugs, trauma, ischemia, viruses)
defective intracellular transport (alcohol, metabolic injury, duct obstruction)

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As a consequence of acinar cell injury, enzymes are released from damaged acinar cells. What are the long term effects of these activated enzymes?

interstitial inflammation & edema
proteolysis
fat necrosis
hemorrhage

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What are some histological findings in acute pancreatitis?

necrosis of the pancreatic parenchyma
fat necrosis
areas of hemorrhage

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How do people with acute pancreatitis present clinically?

abdominal pain AND back pain
epigastric tenderness
nausea & vomiting
low-grade fever

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What are the most valuable lab findings for acute pancreatitis?

serum lipase is specific for pancreatitis - the rise parallels the increase in amylase, but remains elevated for 14 days while serum amylase rises w/i 2-24 hrs and then returns to normal w/i 2-3 days
**lipase is more useful here, bc amylase is secreted by other organs too

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Why is full-blown acute pancreatitis a medical emergency?

leukocytosis, hemolysis, DIC
acute respiratory distress syndrome
diffuse fat necrosis
may have peripheral vascular collapse or shock with ATN

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How to treat acute pancreatitis?

rest –> total restriction of oral intake (nothing by mouth)
IV fluids
analgesics

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What are the sequelae or complications of acute pancreatitis?

5% die pancreatic abscess pancreatic pseudocyst

Inflammation of the pancreas with IRREVERSIBLE destruction of the exocrine pancreatic parenchyma, fibrosis and, in later stages, destruction of endocrine pancreatic parenchyma

chronic pancreatitis

What is the most common cause of chronic pancreatitis?

chronic alcohol abuse (in adults) | CF (in children)

Who gets chronic pancreatitis?

middle aged males

What are some other causes of chronic pancreatitis?

long-standing obstruction hereditary pancreatitis - PRSS1 or SPINK1 mutations CFTR gene mutations (very common in CF)

How do CFTR mutations cause chronic pancreatitis?

they decrease bicarbonate secretion by pancreatic ductal cells & promote plugging of the ducts/ductules

How can alcohol cause chronic pancreatitis?

alcohol increases the protein in ductal juice, which may calcify, leading to increased viscosity & ductal obstruction

What will the pancreas look like grossly with chronic pancreatitis?

fibrosis & calcification

What are some of the histological findings of chronic pancreatitis?

preservation of lobules & acini, surrounding parenchymal fibrosis reduced number & size of acini with relative sparing of islets variable dilation of the pancreatic ducts chronic inflammation

What is the "hot" lab test that is currently done to look for AUTOIMMUNE pancreatitis?

ordering an IgG4 after a duct-centric biopsy

How does chronic pancreatitis present clinically?

repeated attacks of mild to severe abdominal pain persistent abdominal & back pain jaundice silent w development of diabetes or pancreatic insufficiency

Patients with chronic pancreatitis may precipitate their attacks by doing these things...

alcohol use overeating use of drugs that increase the tone of the sphincter of Oddi

What are the long-term consequences/complications of chronic pancreatitis?

``` usu not immediately life-threatening pancreatic exocrine insufficiency w/ malabsorption diabetes chronic pain 10% may have pancreatic pseudocysts ```

Result from anomalous development of the pancreatic ducts Unilocular, thin-walled, up to 5 cm in diameter Lined by uniform cuboidal epithelium Enclosed by a thin fibrous capsule Filled with clear serous fluid

congenital cysts

What types of syndromes are associated with congenital cysts of the pancreas?

ADPKD | von Hippel-Lindau disease

Fluid collection (filled with proteins, etc) and lined by granulation tissue, with NO epithelial lining Necrotic-hemorrhagic material rich in pancreatic enzymes Single or multiple, Small or large Most communicate with the pancreatic ductal system Approximately 75% of pancreatic cysts Can be caused by acute pancreatitis, chronic pancreatitis, & related to trauma

pancreatic pseudocyst **granulation tissue very specific for pancreatic pseudocyst

What are some complications of pancreatic pseudocysts?

if they expand, they can result in abdominal pain, duodenal or biliary obstruction, vascular occlusion, or fistula formation can lead to spontaneous infection pseudoaneurysm pancreatic ascites & pleural effusion

95% in women Can be associated with invasive carcinoma Usually arise in the body or tail Present as painless, slow-growing masses Cysts are large, filled with thick mucin Do not connect with pancreatic ductal system Cysts are lined by columnar mucinous epithelium overlying an ovarian type stroma Pathologic evaluation for invasive malignancy after complete removal

mucinous cystic neoplasm

Who gets mucinous cystic neoplasms?

women!

Do mucinous cystic neoplasms connect with the pancreatic ductal system?

no!

Mucinous cystic neoplasms of the pancreas are lined by columnar mucinous epithelium overlying a (blank)

ovarian type stroma **thought to come from the same embryologic origin as the ovary

Mucin-producing intraductal neoplasm - occurs within the ductal system Occur more often in MEN Occur in the pancreatic HEAD 10-20% are multifocal Involve a larger pancreatic duct Evaluate for invasive malignancy after surgical resection!!

intraductal papillary mucinous neoplasm

Who gets intraductal papillary mucinous neoplasms? (IPMN) Where do they occur?

men! | in the pancreatic head

Benign cystic neoplasm Glycogen-rich cuboidal cells lining small cysts containing clear (serous) fluid Represent 25% of all cystic neoplasms of the pancreas Occur 2X more often in women 7th decade of life Present as abdominal pain or masses Surgical resection is curative

serous cystadenoma

Young women - classic presentation Head of the pancreas Large, well-circumscribed with solid and cystic components Cystic areas filled with hemorrhagic debris Neoplastic cells in sheets or in papillary projections Present with abdominal discomfort Activating mutation of β-catenin ** know this one

solid pseudopapillary neoplasm

Mutations in this protein lead to solid pseudopapillary neoplasms

Beta-catenin

Now the 4th leading cause of death in the US

pancreatic ductal adenocarcinoma **high mortality rate w/ a 5 yr survival rate of less then 3-5%

Who gets pancreatic cancer? What are the risk factors?

people ages 60-80 | smoking, diet rich in fats, alcohol, diabetes, & chronic pancreatitis all are risk factors

Where does pancreatic cancer occur in the pancreas?

most often in the head (60%) 15% in the body | 5% in the tail

How does pancreatic cancer present grossly?

hard, stellate, gray-white, poorly defined masses

Most cases of pancreatic carcinoma are highly invasive. Most are (blank) carcinomas. They often grow along & invade (blank), and can invade (blank) and metastasize

ductal; nerves; lymphovascular spaces

What will you see histologically with pancreatic carcinoma?

intense fibroblastic response (desmoplastic response) Try to look like normal ductal epithelium by forming glands and secreting mucin (poor attempt) Abortive tubular structures or cell clusters growing in a deeply infiltrative pattern

How does pancreatic cancer present clinically?

``` silent until invasion of other structures, then pain jaundice if the cancer arises in the head of the pancreas & obstructs the duct weight loss (very common), fatigue, general malaise, weakness migratory thrombophlebitis in 10% (Trousseau sign) ```

How do you treat pancreatic cancer?

surgical resection! Whipple procedure **The most common technique of a pancreaticoduodenectomy consists of the removal of the distal segment of the stomach, the first and second portions of the duodenum, the head of the pancreas, the common bile duct, and the gallbladder, because each of these receive the same blood supply!

What will you see endocscopically with IPMN?

fishmouth appearance spewing mucin into the ampulla of vader

What is the main concern with an IPMN?

whether it has progressed to adenocarcinoma

Usera: Exocrine Pancreas Flashcards

(60 cards)