Robbins Ch. 19 the Pancreas Review Questions

Robbins Ch. 19 The Pancreas Study online at quizlet.com/_enhl7

What is the main pancreatic duct?

Duct of Wirsung

What does the Duct of Wirsung drain to?

ampulla of Vater

What is the accessory duct?

Duct of Santorini

Does the duct of Santorini drain proximal or distal to ampulla of Vater?

proximal

What type of cell make up exocrine pancreas?

acinar cells

These exocrine enzymes, how are they secreted?

inactive form

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What is pancreatitis?

inflammation of pancreas associated with injury to exocrine parenchyma

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Why do we see acute pancreatitis?

biliary tract disease and alcoholism, and gallstones

How would you treat acute pancreatitis?

restrict oral intake of food; Will be supported with IV fluids, etc

What is the difference between chronic and acute pancreatitis?

acute is reversible and chronic is not

Cysts in kidney, liver, and pancreas frequently co-exist in what condition?

polycystic disease

Pancreatic Pseudocysts lack what?

a true epithelial lining

Which of the following are you more likely to find cancer in

serous or mucinous cystadenomas - mucinous cystadenomas

What type of pancreatic cancer should be suspected if the patient develops metastatic fat necrosis due to lipase release?

acinar cell carcinoma

Are intra-ductal papillary muncinous neoplasms benign or cancerous/malignant?

both

When digestive enzymes come down, what is the main enzyme that needs to be activated?

trypsin

What activates trypsin?

enterokinase

What is a pancreas divisum, and what can it predispose you to?

- is the most common congenital anomaly of the pancreas - This anomaly is caused by a failure of fusion of the fetal duct systems of the dorsal and ventral pancreatic primordial → the bulk of the pancreas (formed by the dorsal pancreatic primordium) drains through the dorsal pancreatic duct and the small-caliber minor papilla (see Fig. 19-1B). - The duct of Wirsung in persons with divisum, normally is very short (1 to 2 cm) and drains only a small portion of the head of the gland through the larger caliber major papilla of Vater. - Clinical significance of pancreatic divisum, the relative stenosis caused by the bulk of the pancreatic secretions passing through the minor papilla predisposes individuals to the development of chronic pancreatitis

Diagnosis of acute pancreatitis (lab tests for...)

amylase (first), then lipase

What is the most common cause of chronic pancreatitis?

alcoholism/long-term alcohol abuse

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Know how chronic pancreatitis develops (proposed list) pg 896

1) Ductal obstruction by concretions 2) Toxic effects 3) Oxidative stress

PANCREATIC CARCINOMA Morphology (pg 902-903 Blue Box >>):

- Approximately 60% of cancers of the pancreas arise in the head of the gland - Grossly, Carcinomas of the pancreas are usually hard, stellate, gray-white, poorly defined masses - The vast majority are ductal adenocarcinomas that recapitulate to some degree normal ductal epithelium by forming glands and secreting mucin. - Two features are characteristic of pancreatic cancer: 1) It is highly invasive 2) elicits "desmoplastic response" - an intense non-neoplastic host reaction composed of fibroblasts, lymphocytes, and extracellular matrix - Most carcinomas of the head of the pancreas obstruct the distal common bile duct → marked distention of the biliary tree and most develop jaundice. In marked contrast, carcinomas of the body and tail of the pancreas do not impinge on the biliary tract and hence remain silent for some time. - Pancreatic cancers often grow along nerves and invade into the retroperitoneum. Peripancreatic, gastric, mesenteric, omental, and portahepatic lymph nodes are frequently involved. Distant metastases occur, principally to the liver, lungs, and bones

>> What are the microscopic characteristics of pancreatic carcinoma (from morphology -- blue box)?

- Microscopically, the appearance is usually a moderately to poorly differentiated adenocarcinoma forming abortive tubular structures or cell clusters and showing an aggressive, deeply infiltrative growth pattern. Dense stromal fibrosis accompanies the invasive cancer, and there is a proclivity for perineural invasion within and beyond the organ. Lymphatic and large vessel invasion are also commonly seen. The malignant glands are poorly formed and are usually lined by pleomorphic cuboidal- to-columnar epithelial cells. Well-differentiated carcinomas are the exception

>> What are the less common variants of pancreatic cancer?

- adenosquamous carcinomas - colloid carcinoma - hepatoid carcinoma - medullary carcinoma - signet-ring cell carcinoma - undifferentiated carcinoma - undifferentiated carcinomas with osteoclast-like giant cells

Figure 19-13 Carcinoma of the pancreas. (pg 902)

- A) A cross-section through the tail of the pancreas showing normal pancreatic parenchyma and a normal pancreatic duct (left), an ill-defined mass in the pancreatic substance (center) with narrowing of the pancreatic duct, and dilatation of the pancreatic duct upstream (right) from the mass. - B) Poorly formed glands are present in densely fibrotic stroma within the pancreatic substance; there are some inflammatory cells.

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What is the most common congenital anomaly of the pancreas?

Pancreas divisum List the two most common causes of Acute Pancreatitis.

- Biliary tract disease - Alcoholism

True or False? Acute necrotizing pancreatitis is the most severe form of acute pancreatitis.

False (Hemorrhagic pancreatitis is the most severe form)

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Why are pancreatic pseudocysts not true cysts?

They lack a true epithelial lining

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List the four types of cystic neoplasms of the pancreas

- Serous cystadenoma - Mucinous cystic neoplasm - tail B/M - Intraductal papillary mucinous neoplasms (IPMNs) - head B/M - Solid-pseudopapillary neoplasm

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What is the precursor lesion to pancreatic carcinoma?

PanINs (Pancreatic intraepithelial neoplasias)

What is the greatest environmental influence predisposing an individual to pancreatic carcinoma?

Smoking

What malignant pancreatic neoplasm occurs primarily in children between the ages of 1 and 15?

Pancreatoblastoma

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List the four structures that you would receive in a Whipple's specimen.

- Head of the pancreas - Duodenum - Distal common bile duct - Ampulla of Vater 35.

What are the margins on a whipple specimen?

- Pancreatic head (submit enface for FS) - Duodenal: proximal and distal - Ducts: CBD, PD, trace to AoV