Chapter 15: The Pancreas

Question 1

Developmental malformation in which the head of the pancreas forms a ring around the duodenum
Risk of duodenal obstruction

Answer 1

Annular pancreas

Question 2

Inflammation and hemorrhage of pancreas due to autodigestion of pancreatic parenchyma by pancreatic enzymes
What types of necrosis?
Most commonly due to Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia/lipidemia, Drugs like sulfa drugs (Remember GET SMASHED)

Answer 2

Acute Pancreatitis

liquefactive hemorrhagic necrosis of the pancrease and fat necrosis of the peripancreatic fat

Question 3

S/S: epigastric abdominal pain that radiates to the back
Nausea and vomiting
Periumbilical and and flank hemorrhage (necrosis spreads into the periumbilical soft tissue and retroperitoneum)
Lab findings?

Answer 3

Acute pancreatitis

Elevated serum lipase and amylase (lipase is more specific for pancreatic damage)

Hypocalcemia (Ca is consumed during saponification in fat necrosis)

Question 4

Complications of acute pancreatitis?

Answer 4

Shock (due to hemorrhage and fluid sequestration)
Pancreatic pseudocyst
Pancreatic abscess
DIC and ARDS

Question 5

formed by fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes, lined by granulation tissue not epithelium
S/S: abdominal mass w/persistently elevated serum amylase
Rupture/hemorrhage associated with release of enzymes into abd cavity and hemorrhage

Answer 5

Pancreatic pseudocyst

Question 6

Often due to E. coli, presents with abdominal pain, high fever, persistenly elevated amylase

Answer 6

Pancreatic abscess

Question 7

Fibrosis of pancreatic parenchyma, most often secondary to recurrent acute pancreatitis
Chronic inflammation, atrophy, calcification
Due to EtOH (adults) and Cystic fibrosis (Kids) or idiopathic

Answer 7

Chronic pancreatitis

Question 8

S/S: Epigastric abdominal pain that radiates to the back
Pancreatic insufficiency - malabsorption, steatorrhea and fat soluble vitamin def (ADEK).
Can you use amylase and lipase as serological markers?
Dystrophic calcification of pancreatic parenchyma on imaging; contrast studies reveal a “chain of lakes” pattern due to dilatation of pancreatic ducts
2ndary DM - late complication due to destruction of islets
Increased risk for pancreatic adenocarcinoma

Answer 8

Chronic pancreatitis

Can’t use amylase and lipase reliably, may or may not be elevated so not useful

Question 9

Adenocarcinoma arising from the pancreatic ducts
Seen in 70s
Two major risk factors?
Prognosis?

Answer 9

Pancreatic adenocarcinoma
1) Smoker
2) chronic pancreatitis (esp >20 yrs)
3) diabetes
4) Age >50
5) Jewish and AA males
Very aggressive, Average prognosis 1 year survival is 10%

Question 10

Tumor arising from pancreatic ducts
Disorganized glandular structure w/cellular infiltration
Already metastasized usually at presentation
Tumors more common in pancreatic head (=> obstructive jaundice)
Tumor marker associations?

Answer 10

Pancreatic adenocarcinoma

CA19-9
CEA is less specific

Question 11

S/S:
Epigastric abdominal pain radiating to back and weight loss (but mostly painless jaundice)
Obstructive jaundice with pale stools and palpable gallbladder (What sign?)
Associated with tumors that arise in the head of the pancreas (most common location)
2ndary DM if arise in body or tail
Pancreatitis
Migratory thrombophlebitis (syndrome?)
Treatment?

Answer 11

Pancreatic adenocarcinoma

1) Courvoisier sign
2) Redness and tenderness on palpation of extremities (Trousseau syndrome)

Treat: Whipple (removal of heak and neck of pancreas, proximal duodenum, and gallbladder), chemo, radiation