Acute and Chronic Pancreatitis

Question 1

The pathophysiology of Pancreatitis starts with what?

Answer 1

Intracellular activation of enzymes

From here, this causes an inflammatory process and enzyme injury

Question 2

We know that zymogen granules within the pancreatic acinar cells contain dangerous proteases which will damage the cell if they are released in their active form. What protective mechanisms exist to ensure this doesn’t happen?

Answer 2

• Inactive Proenzymes- these enzymes are not acitvated until they are in the duodenum for the most part.
• Membrane bound
• Separate pathways
• Trypsin inhibitor

Question 3

Earliest event in acute pancreatitis?

Answer 3

Conversion of pancreatic zymogens to their active forms within acinar cells.

Question 4

How do zymogens come to become active within the acinar cell?

Answer 4

1) Secretion is blocked
2) Co-localization of lysosomes and Zymogen granules in an attempt to destroy the ZGs.
3) Zymogens become active and you have autodigestion

Question 5

How does inflammation outside of the pancreas develop?

Answer 5

1) Proteases activate complement
2) C3a and C5a bring in macrophages and neutrophils
3) Inflammatory cells release cytokines like IL-1, TNF, PAF
4) Vascular injury and inflammation

Question 6

How does acute pancreatitis present clinically

Answer 6

Pain, Nausea, vomitting

Question 7

Pancreatitis associated with what type of necrosis

Answer 7

Fat and coagulative

Question 8

What are two proteins, produced by the liver, that serve as a systemic containment response

Answer 8

• Circulating Alpha1- antitrypsin (inactivates circulating proteases)
• Circulating alpha macroglobulin
  (binds to circulating trypsin, facilitates monocyte clearance of macoglobulin-trypsin complexes)

Question 9

See slide on failure of containment

Answer 9

Inflammatory, vascular, respiratory, and metabolic effects.

Question 10

Main causes of acute pancreatitis?

Answer 10

Gallstones and alcohol

Question 11

Main symptoms of acute pancreatitis?

Answer 11

Abdominal pain and nausea

Question 12

Dx of Acute pancreatitis?

Answer 12

Elevated Serum lipase and amylase (MORE THAN 3x upper limit), inflamed pancreas on CT

Question 13

Management of acute pancreatitis?

Answer 13

IV fluids, pain meds, remove stones if they are the causative agent. wait

Question 14

Factors suggesting gallstones as the cause?

Answer 14

• Female
• Over 50
• Amylase very high (over 4,000)
• AST over 100
• Alk phos over 300

Question 15

Predictors of poor outcome?

Answer 15

Admission hematocrit over 44 with failure to decrease after 24 hours

Admission BUN over 25 with an increase after 24 hours

Question 16

Pathophysiology of chronic pancreatitis

Answer 16

recurrent injury with tissue destruction and fibrosis

Question 17

Cause of chronic pancreatitis

Answer 17

Most commonly chronic alcoholism

Question 18

Symptoms of chronic pancreatitis

Answer 18

chronic abdominal pain, diarrhea, steatorrhea

Question 19

Diagnosis of chronic pancreatitis

Answer 19

imaging studies

Question 20

Management of chronic pancreatitis

Answer 20

pain meds, insulin, enzyme supplements

Question 21

Clinical pres of chronic pancreatitis

Answer 21

• chronic abdominal pain
• malabsorption
• diabetes

Question 22

Know about steatorrhea in chronic pancreatitis

Answer 22

ok….fat malabsorption, due to lipase deficiency, treated by reducing dietary fat intake,

Question 23

Diabetes in chronic pancreatitis

Answer 23

severe disease, no insulin or glucagon,