Chronic Pancreatitis, Pancreatic Cancer B&B

Question 1

what are the most common causes of chronic pancreatitis in adults vs children?

Answer 1

chronic pancreatitis occurs from recurrent bouts of acute pancreatic

adults - alcohol
children - cystic fibrosis

Question 2

what is the characteristic symptom and characteristics CT scan finding of chronic pancreatitis?

Answer 2

chronic abdominal pain that waxes and wanes - may be worse after meals and cause people to not eat

CT scan shows calcification of the pancreas (bright white spots)

Question 3

Pt w/ PMH of chronic pancreatitis is found to have upper GI bleeding and gastric varices on imaging. What blood vessel was affected to cause this bleeding?

Answer 3

fibrosis of chronic pancreatitis caused fibrosis and thrombosis of the splenic vein which runs just above the pancreas

splenic vein comes off portal vein and has small connections to the left gastric vein (coronary vein), which become engorged —> gastric varices

spleen will also become enlarged

Question 4

what type of cancer develops in the pancreas, and where is it typically located?

Answer 4

adenocarcinoma at the head of the pancreas

very poor prognosis

Question 5

pt presents w/ fatigue and gradual onset of painless jaundice - what should you be most worried about?

Answer 5

pancreatic cancer (adenocarcinoma) - occurs at head of pancreas and obstruct bile flow

may also see dark urine, clay-colored stools, steatorrhea + enlarged, non-tender gallbladder (Courvoisier’s sign)

poor prognosis

Question 6

enlarged, non-tender gallbladder + jaundice =

Answer 6

Courvoisier’s sign - indicative of pancreatic cancer (adenocarcinoma), which obstructs bile flow

Question 7

of what is migratory superficial thrombophlebitis (Trousseau’s syndrome) indicative, and why does this occur?

Answer 7

classic finding of pancreatic cancer due to hypercoagulable state

migratory thrombosis/inflammation of veins just below skin + redness/induration

Question 8

which of the following is NOT considered a definite risk factor for pancreatic cancer?
a. age >50
b. smoking
c. diabetes
d. chronic pancreatitis
e. alcohol

Answer 8

strongest risk factors = age >50 and smoking

also diabetes and chronic pancreatitis (>20 years)

NOT strongly associated with alcohol (mixed data)

Question 9

which gene mutations are associated with pancreatic cancer? (3)

Answer 9

1. K-RAS - most frequent, also part of adenoma-carcinoma sequence for colon cancer

2.BRCA2 - esp. in Ashkenazi Jews

3. SMAD4 - tumor suppressor

Question 10

which 2 tumor markers can be measured in serum of patients with pancreatic cancer?

Answer 10

1. CA-19-9 - useful for monitoring treatment
2. CEA (carcino-embryonic antigen)

neither is great for diagnosis (poor sensitivity/specificity)

Question 11

what is the Whipple Procedure?

Answer 11

head of pancreas (where pancreatic cancer occurs!) + gallbladder + proximal duodenum removed

stomach, bile duct, and tail of pancreas are all directly connected to small bowel

[part of treatment for pancreatic cancer]