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x Pathoma > 11. Exocrine Pancreas, Gallbladder, Liver Patholog > Flashcards

11. Exocrine Pancreas, Gallbladder, Liver Patholog Flashcards

1
Q

What is an annular pancreas?

A

developmental malformation in which the pancreas forms a ring around the duodenum

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2
Q

what is the problem with an annular pancreas?

A

there is a risk of duodenal obstruction since it is encircled

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3
Q

what is acute pancreatitis?

A

inflammation, hemorrhage of the pancreas

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4
Q

what happens to the pancreas in acute pancreatitis?

A

autodigestion of the pancreatic parenchyma, by pancreatic enzymes

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5
Q

in acute pancreatitis, why is the panc parenchyma digested by enzymes?

A

normally the enzymes are secreted in inactive form; with pancreatitis, they are prematurely activated within the pancreas and begin digestion

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6
Q

what is the first enzyme activated in acute pancreatitis?

A

trypsin

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7
Q

what does the autodigestion of pancreatic parenchyma lead to?

A

liquefactive hemorrhagic necrosis (hemorrhagic due to high vascularity) and fat necrosis of the peripancreatic fat

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8
Q

what are the most common 2 causes of acute pancreatitis? what are other causes?

A

most common: alcohol, gallstones
other causes: trauma, hypercalcemia, hyperlipidemia, drugs, scorpion stings, mumps, rupture of a posterior duodenal ulcer

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9
Q

how does alcohol cause acute pancreatitis?

A

creates contraction of sphincter of Oddi (where panc enters duodenum), increases risk of activation of enzymes while still in the pancreas

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10
Q

how do gallstones cause acute pancreatitis?

A

same mech as alcohol: contraction of sphincter of Oddi (where panc enters duodenum), increases risk of activation of enzymes while still in the pancreas

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11
Q

how can trauma lead to acute pancreatitis?

A

happens esp in kids with seatbelt across abdomen: pancreas is compressed

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12
Q

how does hypercalcemia lead to acute pancreatitis?

A

remember that Ca is an enzyme activator; leads to premature enzyme activation

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13
Q

what are some clinical features of acute pancreatitis?

A

epigastric abd pain, radiates to back
nausea, vomiting
periumbilical and flank hemorrhage

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14
Q

why does acute pancreatitis present with periumbilical and flank hemorrhage?

A

necrosis spreads into the periumbilical soft tissue and retroperitoneum

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15
Q

what labs will be elevated with acute pancreatitis?

A

serum lipase, serum amylase

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16
Q

why will serum lipase and serum amylase be elevated with acute pancreatitis? which is more specific for pancreatic damage?

A

both produced by pancreas. lipase is more specific; amylase also from salivary glands

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17
Q

why can acute pancreatitis present with hypocalcemia?

A

calcium is consumed during fat necrosis and saponification

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18
Q

Hypocalcemia indicates what kind of prognosis with acute pancreatitis?

A

poor prognosis; indicates that there is widespread necrosis of peripancreatic fat

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19
Q

what are some complications of acute pancreatitis?

A
  • shock
  • pancreatic pseudocyst
  • pancreatic abscess
  • DIC
  • ARDS
20
Q

how can acute pancreatitis result in shock?

A

due to peripancreatic hemorrhage (highly vascularized) and fluid sequestration due to tissue damage

21
Q

how can acute pancreatitis result in a pancreatic pseudocyst?

A

fibrous tissue surrounds the liquefactive necrosis and pancreatic enzymes; not a true cyst because only fibrous tissue rather than real cyst lining (?)

22
Q

how will a pancreatic pseudocyst present? what can happen?

A

presents as abdominal mass with persistently elevated serum amylase.
can result in rupture and release of enzymes into abdominal cavity. also, can hemorrhage

23
Q

why is serum amylase persistently elevated with a pancreatic pseudocyst?

A

normally serum amylase will return to normal with resolution of the acute pancreatitis. in this case, it stays elevated. Sattar did not clarify

24
Q

what can cause a pancreatic abscess? how does it present?

A

E Coli; presents as abd pain, high fever, persistently elevated serum amylase (in face of recent acute pancreatitis)

25
Q

how can acute pancreatitis cause DIC?

A

enzymes from the panc are released into the blood, cause activation of coag factors

26
Q

how can acute pancreatitis result in ARDS?

A

from widespread damage to the alveolar-capillary interface due to panc enzymes in bloodstream

27
Q

what is chronic pancreatitis?

A

recurrent bouts of acute pancreatitis result in fibrosis of the panc.

28
Q

what are the most common causes of chronic pancreatitis?

A

alcohol (adults), cystic fibrosis (kids)

often idiopathic

29
Q

how does cystic fibrosis result in chronic pancreatitis?

A

increases secretions from the panc, leading to decr ability for them to drain

30
Q

what are clinical features of chronic pancreatitis?

A
  • epigastric abd pain radiating to back
  • pancreatic insufficiency
  • pancreatic calcification visible on imaging
  • secondary T1DM
31
Q

what results from pancreatic insufficiency?

A

malabsorption with steatorrhea, deficiencies in ADEK

32
Q

why are serum amylase and lipase decreased with pancreatic insufficiency?

A

panc is not producing these; has been largely destroyed by fibrosis

33
Q

what does chronic pancreatitis reveal on imaging?

A

dystrophic calcification of parenchyma. contrast studies reveal a ‘chain of lakes’ pattern due to dilatation of panc ducts

34
Q

why can chronic pancreatitis lead to secondary T1DM?

A

late complication, due to destruction of islets

35
Q

chronic pancreatitis is a risk factor for what type of cancer?

A

pancreatic carcinoma

36
Q

pancreatic carcinoma arises from what structure? what is the most common population affected?

A

arises from pancreatic ducts

elderly: age age is 70

37
Q

what is a classic appearance of pancreatic carcinoma?

A

thin elderly person with onset of T1DM late in life (70s).

38
Q

what are the major risk factors for pancreatic carcinoma?

A

smoking, chronic pancreatitis

39
Q

clinical features of pancreatic carcinoma?

A

epigastric abd pain, wt loss
obstructive jaundice, pale stools, palpable gallbladder
secondary T1DM
migratory thrombophlebitis

40
Q

what is the serological marker for pancreatic carcinoma?

A

CA 19-9

41
Q

what is obstructive jaundice? why pale stools, palpable gallbladder?

A

blocked the flow of bile; bili leaks into blood. no bili in stool –> pale stool.
palpable gallbladder due to backup pressure and expansion

42
Q

secondary T1DM is associated with tumors that occur where in the pancreas?

A

where the islet cells reside: body/tail

43
Q

what is migratory thrombophlebitis?

A

Trousseau sign, occurs in 10% of panc carcinoma pts

presents as swelling, erythema, tenderness in extremities

44
Q

what is the surgical treatment of pancreatic carcinoma?

A

en bloc removal of head/neck of pancreas, prox duodenum, gallbladder. Whipple procedure

45
Q

pancreatic carcinoma: prognosis?

A

1 year survival is < 10%

x Pathoma (19 decks)

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