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Robbins Ch. 19 the Pancreas Review Questions

Robbins Ch. 19 the Pancreas Review Questions

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Published by PA2014
In-class review questions
Robbins and Cotran 8th ed.
In-class review questions
Robbins and Cotran 8th ed.

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Categories:Types, School Work
Published by: PA2014 on Jul 31, 2013
Copyright:Attribution Non-commercial


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 What is the main pancreatic duct?
Duct of Wirsung
 What does the Duct of Wirsung drainto?
ampulla of Vater
 What is the accessory duct?
Duct of Santorini
Does the duct of Santorini drainproximal or distal to ampulla of  Vater?
 What type of cell make up exocrinepancreas?
acinar cells
These exocrine enzymes, how are they secreted?
inactive form
 What is pancreatitis?
inflammation of pancreas associated with injury to exocrine parenchyma
 Why do we see acute pancreatitis?
 biliary tract disease and alcoholism, and gallstones
How would you treat acutepancreatitis?
restrict oral intake of food; Will be supported with IV fluids, etc
 What is the difference betweenchronic and acute pancreatitis?
acute is reversible and chronic is not
Cysts in kidney, liver, and pancreasfrequently co-exist in what condition?
polycystic disease
Pancreatic Pseudocysts lack what?
a true epithelial lining
 Which of the following are you morelikely to find cancer in
serous or mucinous cystadenomas - mucinous cystadenomas
 What type of pancreatic cancershould be suspected if the patientdevelops metastatic fat necrosis dueto lipase release?
acinar cell carcinoma
 Are intra-ductal papillary muncinousneoplasms benign orcancerous/malignant?
 When digestive enzymes come down, what is the main enzyme that needs to be activated?
 What activates trypsin?
 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 pancreaticprimordium) 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 drainsonly 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 thepancreatic secretions passing through the minor papilla predisposes individuals to thedevelopment of chronic pancreatitis
Diagnosis of acute pancreatitis (labtests for...)
amylase (first), then lipase
 What is the most common cause of chronic pancreatitis?
alcoholism/long-term alcohol abuse
Robbins Ch. 19 The Pancreas
Study online at
Know how chronicpancreatitisdevelops(proposed list) pg896
1) Ductal obstruction by concretions2) Toxic effects3) Oxidative stress
PANCREATICCARCINOMA -Morphology (pg902-903 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 invasive2) 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 notimpinge 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 themicroscopiccharacteristics of pancreaticcarcinoma (frommorphology -- blue box)?
- Microscopically, the appearance is usually a moderately to poorly differentiated adenocarcinoma formingabortive tubular structures or cell clusters and showing an aggressive, deeply infiltrative growth pattern. Densestromal 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-differentiatedcarcinomas are the exception
>> What are theless 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 19-13Carcinoma of thepancreas. (pg 902)
- A) A cross-section through the tail of the pancreas showing normal pancreatic parenchyma and a normalpancreatic duct (left), an ill-defined mass in the pancreatic substance (center) with narrowing of the pancreaticduct, 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 someinflammatory cells.

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