acute and chronic pancreatitis

Question 1

an inflammatory process, autodigestion of the pancreas by activated pancreatic enzymes

Answer 1

acute pancreatitis

Question 2

acute pancreatitis

1. what happens
2. two events
3. cytokine activation leads to
4. leakage of activated enzymes to
5. common cause
6. presence of ARDS/DAD
7. procedure that reduces the incidence of gallstone pancreatitis

Answer 2

1. inappropriate activation of pancreatic enzymes within the pancreas
2. causes: (A) stimulate pancreatic enzyme synthesis and (b) blocks secretion from acinar cells
3. inflammation
4. leakage of activated enzymes into interstitial spaces
5. alcohol and gallstone obs of common duct
6. poor prognosis
7. cholecystectomy

Question 3

pancreas divisum

Answer 3

no connections to the body of the pancreas

• normal variant
• impaired duct drainage in a minority

Question 4

autoimmune sclerosing pancreatitis

Answer 4

periductal inflammation and fibrosis leading to irregular narrowed, “beaded” pancreatic duct

Question 5

autoimmune sclerosing pancreatitis Ig elevation

Answer 5

IgG4

Question 6

autoimmune sclerosing pancreatitis treatment

Answer 6

steroid responsive

Question 7

hypertriglyceridemic pancreatitis

Answer 7

rare cause of acute pancreatitis and may cause chronic pancreatitis

• will have very high triglycerides levels >1,000

Question 8

diagnosis of acute pancreatitis

Answer 8

ultrasound is the best, but we will also see elevated serum amylase and lipase with pain, N/V and epigastric tenderness

Question 9

degree of severity in amylase or lipase in acute pancreatitis indicates the severity of disease

Answer 9

nope

Question 10

complication of acute pancreatitis

Answer 10

necrotizing

Question 11

Ranson’s and BISAP

Answer 11

measurement of prognosis of acute pancreatitis

Question 12

causes of mortality in acute pancreatitis:

1. early <1 week
2. late >1 week

Answer 12

1. early <1 week: systemic inflammatory response syndrome and multiorgan failure
2. late >1 week: multiorgan failure and pancreatic infection/sepsis

Question 13

grey turner sign in acute pancreatitis

Answer 13

retroperitoneal hemorrhage

Question 14

abscess develops in acute pancreatitis

Answer 14

after 1-2 weeks in an area of necrosis

Question 15

localized collections of pancreatic secretions with blood and debris but with no epithelial lining

Answer 15

pseudocysts

Question 16

pseudocyts:

1. occurs
2. suspect when

Answer 16

1. may occur after acute pancreatitis and become a late problem
2. suspect if the serum amylase does not return to normal or with persistent pain

Question 17

acute pancreatitis treatment that is urgent

Answer 17

aggressive fluid and electrolyte replacement

Question 18

permanent, irreversible damage to the pancreas with fibrosis and destruction of the exocrine and endocrine cells. the pancreatic ducts are irregular with dilation or narrow segments and we may find calcified stones in the ducts as well

Answer 18

chronic pancreatitis

Question 19

why does chronic pancreatitis occur?

Answer 19

due to repeated ductal obstruction leading to injuries over time but it can also be genetic like from cystic fibrosis

Question 20

in cystic fibrosis the pancreas is similar to alcohol caused

Answer 20

proteinaceous plugs and atrophy

Question 21

in chronic pancreatitis is there sparing of the islets?

Answer 21

yep

Question 22

features of chronic pancreatitis

Answer 22

1. pain
2. calcification
3. pancreatic insufficiency: malabsorption and diabetes

Question 23

steatorrhea in chronic pancreatitis

Answer 23

due to decreased concentration of lipase and colipase and the decrease of duodenal pH leading to inactivation of pancreatic lipase

Question 24

best diagnostic test for chronic pancreatitis

Answer 24

tube test but it is uncomfortable, expensive and difficult to obtain

Question 25

last resort for treatment in pancreatitis

Answer 25

nerve block of the celiac plexus