Ch. 15 Pancreas

Question 1

• Congenital anomaly with head of pancreas surrounds the 2nd portion of duodenum
• associated with__________
• infants present with_____ disorders and ______ retardation

Answer 1

• Dx: Annular Pancreas
• duodenal atresia
• feeding disorders and growth retardation

Question 2

-Patient has epigastric pain radiating to the back, elevated amylase and lipase, hypocalcemia, and signs of shock

What is it?

What are some potential causes of this?

If this patient also has a left pleural effusion, what would the cause be?

A late complication of this is_________

Answer 2

• Dx: Acute Pancreatitis
• Potential causes: Cholelithiasis, Alcoholism, viruses (mumps, coxsackie, CMV and HIV), Drugs (immunosuppresive, antineoplastic, estrogens, sulfonamides and diuretics), trauma/ischemia, and obesity
• local irritation below diaphragm causes left sided pleural effusion
• pancreatic pseudocysts

Question 3

• Patient has recurrent epigastric pain, weight loss, and foul smelling diarrhea
• What does this patient have?
• Potential causes?
• What is seen on x-ray in this patient?
• What is the reason for the foul smelling stool?
• What is the patient at risk for later in the course?

Answer 3

• Dx: Chronic Pancreatitis
• Potential Causes: Alcoholism, Obstruction of ducts, injury to acinar cells (hemochromatosis), Chronic renal failure, autoimmune, cystic fibrosis, hereditary from mutation in cationic trypsinogen gene
• calcification in abdomen
• steatorrhea from fat malabsorption
• anemia, osteomalacia, tendency to bleed

Question 4

What are the components of a pancreatic pseudocyst?

If left untreated, what can happen?

Answer 4

• blood, inflammatory cells, debris and fluid with pancreatic enzymes all line by connective tissue
• infection, abscess formaton, enlarge, rupture

Question 5

-Patient has weight loss, vague abdominal pain, jaundice, thromboembolism

What does this patient have?

What is the most likely location of the mass?

What are the risk factors?

What type of cell does this arise from?

What is the cause of the jaundice in this patient?

Answer 5

• Dx: Pancreatic Adenocarcinoma
• Head> body>tail
• Risk factors: smoking, diets high in meat, fat and nitrates, increased BMI, diabetes mellitus and chronic pancreatitis
• Arises from ductal cells
• Jaundice caused by obstruction of common bile duct by tumor

Question 6

What is Courvoisier sign?

What is Trousseau syndrome?

Answer 6

• dilation of the gall bladder from common bile duct obstruction by tumor
• venous thrombosis and hypercoaguability associated with malignancy

Question 7

• Patient has long standing peptic ulcer disease, resistant to treatment, multiple ulcers throughout duodenum and jejunum
• What is the underlying cause?
• What hormone would be high in the blood?
• What type of cell is secreting the hormone and where is it located?

Answer 7

• Dx: Zollinger Ellison Syndrome from Gastrinoma
• gastrin
• G-cell is secreting gastrin and is located in pancreas, or duodenum (occasionally)

Question 8

• Patient has pallor, fatigue, necrotizing erythematous skin rash, mild anemia, hyperglycemia
• What type of PNET is responsible for this?
• What hormone is in excess and what type of cell is it secreted from?

Answer 8

• Dx: Glucagonoma
• oversecretion of glucagon from the pancreatic alpha cells

Question 9

• Patient has episodic hunger and fainting spells, irritability, hypoglycemia
• What type of PNET is responsible for this?
• What hormone is in excess and what type of cell is it secreted from?

Answer 9

• Dx: insulinoma
• oversectretion of insulin from the pancreatic beta cells

Question 10

• Patient has intractable watery diarrhea, continous thirst, achlorhydria, hypokalemia, mild acidosis
• What type of PNET is responsible for this?
• How does the hormone cause the diarrhea?

Answer 10

• Dx: VIPoma
• VIP stimulates adenylyl cyclase causing increased production of cAMP leading to increased secretion of K and water

Question 11

• Patient has RUQ pain, weight loss, dry mout, increased urine, foul smelling fatty stools, and mild diabetes mellitus
• What type of PNET is responsible for this?
• What are the effects of the hormone hypersecretion on the pancreas?

Answer 11

• Dx: Somatostatinoma
• somatostatin inhibits the secretion of hormones by endocrine pancreas and GI tract, also inhibts GH secretion

Question 12

• Patient has recurrent epigastric pain and nausea, flushing of the face, hypotension, periorbital edem, elevated urine metanephrines
• What type of pancreatic tumor would cause these symptoms?

Answer 12

Dx: Pancreatic Carcinoid tumor

Question 13

• Patient has hx of acromegaly, recurrent epigastric pain, dark, tarry stools, hypercalcemia, hyperlipidemia, elevated PTH and gastrin
• What syndrome accounts for all of these symptoms?

Answer 13

-Dx: MEN1: pituitary adenoma (acromegaly), parathyroid adenoma (hypercalcemia) and adenoma of endocrine pancreas (gastrinoma)