Pancreas + Peritoneum Path - Nelson Flashcards Preview

Gastrointestinal - Week 4 > Pancreas + Peritoneum Path - Nelson > Flashcards

Flashcards in Pancreas + Peritoneum Path - Nelson Deck (30)
Loading flashcards...
1
Q

What is angiodysplasia?

A

Lesion of malformed submucosa and mucosa blood vessels

2
Q

HLA DQ2/DQ8

Knee jerk?

A

Celiac disease

3
Q

Describe the 4 types of diarrhea…

Secretory:
Osmotic:
Malabsorption:
Exudative:

A

Secretory: Ex. is cholera (toxin constantly activating cAMP with toxin causing Cl and H2O to go into the lumen)
Osmotic: Osmotic forces from unabsorbed lumenal solutes (like lactase deficiency)
Malabsorption: Global fail of nutrient absorption w/ steatorrhea (celiac, pancreatic insufficiency)
Exudative: Inflammatory process with bloody stools

4
Q

Pathophysiology of celiac sprue?

A

Eat gluten -> immune enteropathy in genetically predisposed -> Damages small bowel, villous atrophy, crypt elongation -> surface area loss leads to global malabsorption issues

Primarily this is a cytotoxic t-cell response

5
Q

What do you see on upper Gi endoscopy with a celiac disease patient?

A

Scalloped duodenal folds

6
Q

What is abetalipoproteinemia?

A

Autosomal recessive disease. A mutation in MTP, protein that normally allows transepithelial transport of TG’s and phospholipids

They accumulate in the cell cytoplasm.

Presents with fat soluble vitamin deficiency, lipid membrane defects in RBCs (burr/spur cells), diarrhea, FTT, steatorrhea

7
Q

What is Whipple Disease?

A

Systemic infection of Tropheryma Whippelii. Foamy macrophages accumulate filled with pathogen in the small bowel (duodenum usually)

Get diarrhea, weight loss, malabsorption and abdominal pain
(before this you get sx of infection: arthritis, fever, lymphadeno, neuro, endocarditis, pulm disease)

8
Q

How is fatty tissue and pacnreatic parenchyma injured in acute pancreatitis?

A

Inappropriately-released active pancreatic enzyme cause AUTODIGESTION.

Causes edema, fat necrosis, inflammation, proteolysis of parenchyma, and blood vessel destruction

9
Q

What does fat necrosis look like grossly?

A

Yellow/White chalky Ca deposit

10
Q

What kind of pancreatitis presents with a white fibrotic mass (sort of like pancreatic cancer) and microscopically as periductal lymphoplasmacytic inflammation?

A

Type 1 autoimmune pancreatitis

11
Q

How would you treat autoimmune pancreatitis doc?

A

Glucocorticoids

12
Q

Why do some consider IgG4-related disease to be similar to sarcoidosis?

A

Like sarcoidosis, it has been described in virtually every organ system, linked by the same histopatholgical features

13
Q

You are reading a patient chart and see that they’ve had a pancreatic pseudocyst.
What are the two ways they could have gotten one?

What is a good way to tell a psuedocyst from cancer histologically?

A

Acute Pancreatitis
OR
Trauma

Pseudocyst lacks an epithelial wall like a cancer would have. It is lined by fibrin and granulation tissue

14
Q

What does a gross specimen of serous cystadenoma look like?

A

Small 1-3mm cysts containing clear fluid, surrounded by cuboidal cells

15
Q

Mucinous cystic neoplasms generally occur in middle-aged women as a slow-growing painless mass.
Where in the pancreas do they occur?

A

Tail or body

Large multiloculated cysts filled with mucin

16
Q

Intraductal Papillary Mucinous Neoplasms (IPMN’s) - Arise specifically from pancreatic ducts, which means it communicates with the pancreatic duct system.

What part of the pancreas do IPMN’s affect?

A

The head of the pancreas

17
Q

Why on earth would someone compare IPMNs to bronchiectasis?

A

Similar to mucus-blockage which causes dilation of the lung airways, IPMNs cause the pancreatic duct system to widen due to mucus

18
Q

Pancreatic cancer is the 4th leading cause of cancer deaths, usually caused by ductal adenocarcinoma.

Your patient has a friend who died of this and he wants some advice on risk factors to avoid:

A

Risk factors:

smoking, obesity, inactivity, diabetes, pancreatitis,

19
Q

Where do ductal adenocarcinomas occur in the pancreas?

Why are they often unresectable?

A

The head of the pancreas

Often unresectable because they have already spread once they’ve been detected

20
Q

Typical presentation of ductal adenocarcinoma?

A
  • 80% in people over 60

- Obstructive jaundice, weight loss, and belly pain

21
Q

What is the whipple procedure and what is it used for?

A

Use for pancreatic cancer

Basically you chop out the stomach, duodenum, gallbladder, common bile duct, and head of the pancreas.
Then you attach the hepatic duct to the jejunum as well as what’s left of the stomach. The pancreas is attached proximal to the hepatic duct

22
Q

What type of pancreatic tumor occurs in young women?

What type occurs in kids?

A

Young women:
-Solid-pseudopapillary tumor

Children:
-Pancreatoblastoma
(blast - kids)

23
Q

What is the difference in gross appearance of a pancreatic neuroendocrine tumor vs a pancreatic adenocarcinoma?

A

Pancreatic neuroendocrine

  • body or tail
  • well-circumscribed tumor

Pancreatic Adenocarcinoma

  • head of pancreas
  • ill defined
24
Q

Which has a better clinical course? Pancreatic neuroendocrine or adenocarcinomas?

A

Neuroendocrine usually better because they have longer course (5-10yrs), often adenocarcinomas invade adjacent tissue before they are discovered. (1-2 yrs)

25
Q

What types of syndromes can pancreatic neuroendocrine tumor produce through abnormal hormone secretion?

A

Hyperinsulin secretion: hypoglycemia

Zollinger-Ellison Syndrome: Increased gastric secretion and ulcers

VIP secretion: watery diarrhea

26
Q

Most common complication of ascites?

A

Spontaneous bacterial peritonitis

27
Q

To find the SAAG, you measure the concentration albumin in serum and subtract albumin in the ascites fluid.

What does a SAAG below 1.1 and a SAAG above 1.1 indicate?

A

Below 1.1
Exudative = malignancy, inflammation, TB, pancreatitis, nephrotic syndrome

Above 1.1
Transudate = cirrhosis, metastasis, budd-chiari, cardiac disease

28
Q

What is budd-chiari syndrome?

A

Budd–Chiari syndrome is a condition caused by occlusion of the hepatic veins that drain the liver.
It presents with the classical triad of abdominal pain, ascites and liver enlargement.

29
Q

Looking at your patient’s CT you see that there appears to be a mass in the peritoneum. You believe it is a metastatic tumor. What would be your first two bets for the origin of the metastasis?

A

Ovarian cancer and pancreatic cancer

30
Q

A 25 year old recent;y passed currant jelly stool. He complains of abdominal pain. On imaging study you see dilated loops of bowel with air-fluid level.

What is it?

A

Intussusception

Also target sign from the right angle