EXAM #3: PANCREATITIS Flashcards
What is the most common etiology of metabolic acute pancreatitis?
Alcoholism
What are the genetic underpinnings of acute pancreatitis?
PRSS1= trypsinogen mutation
SPINK1= mutation in trypsin inhibitor mutation
What are the most common causes of mechanically induced acute pancreatitis?
1) Gallstones
2) Trauma
What are the vascular etiologies of acute pancreatitis?
1) Shock
2) Atheroembolism
3) Vascuitis
What are the infectious etiologies of acute pancreatitis?
1) Mumps
2) Coxsackievirus
3) Mycoplasma peumonia
How is acute pancreatitis initiated?
Trypsin activation leading to autodigestion of the pancreas
What is the specific serum enzyme that is indicative of acute pancreatitis?
Lipase
How does acute pancreatitis present?
- Constant epigastric pain radiating to the back
- Shock
Full-blown acute pancreatitis is a medical emergency
What causes hypocalcemia seen in acute pancreatitis?
Consumption of Ca++ in soponification of peripancreatic fat
**This is associated with a POOR prognosis
What serum lab elevation is indicative of a pancreatic pseudocyst?
Amylase
Outline the spectrum of severity in pancreatitis.
1) Acute INTERSTITIAL= trivial inflammation and edema
2) Acute NECROTIZING= extensive necrosis
3) HEMORRHAGIC
How do you differentiate between a perforate ulcer and pancreatitis?
Serum lipase
What is a pancreatic pseudocyst?
Collection of blood, debris, tissue, and fluid WITHOUT a true epithelial lining
List the complications of acute pancreatitis.
1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction
What is the main difference between acute and chronic pancreatitis?
- Acute is reversible
- Chronic is irreversible
Chronic is caused by relapsing acute pancreatitis*
What factors drive the fibrosis seen in chronic pancreatitis?
TGF-B
PDGF
*Both are induced by chronic inflammation
In the US, what is the most common cause of chronic pancreatitis?
Long-term alcohol abuse
What is the role of CFTR mutations in chronic pancreatitis?
CF can lead to early onset pancreatitis (+ lung disease)
- CFTR decreased bicarbonate
- Less bicarbonate lead to “slugging” of exocrine pancreas
What is the relationship between alcohol and ductal plugs in alcohol induced chronic pancreatitis?
- Alcohol causes increased protein secretion in exocrine pancreas
- Proteins can form “ductal plugs”
- Ductal plugs may calcify
What are the buzzwords for the histologic appearance of chronic pancreatitis?
1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ ductal plugs
What are the sequela of chronic pancreatitis?
1) DM–from fibrosis involving the endocrine pancreas
2) Steatorrhea/ fat malabsorption
3) Calcification of the pancreas
What disease is associated with congenital pancreatic cysts?
Von-Hippel-Lindau Disease
What are the clinical features of Von-Hippel Lindau Disease?
- Mutation in chromosome 3
- Renal cell carcinoma and pheochromocytoma are common
- CYSTS in pancreas, liver, and kidneys
- Angiomas in retina, cerebellum, and brainstem
What are the three major types of cystic neoplasia involving the pancreas?
1) Microcystic serous cystadenomas
2) Mucinous cystic tumors
3) Solid pseudopapillary tumor
What are the clinical features of microcystic serous cystadenomas?
- Seen in elderly women
- Benign
*Cuboidal epithelum with serous fluid
What are the clinical features of mucinous cystic tumors?
- Seen in young women
- Malignant
*Columnar epithelium with mucinous fluid
What are Intraductal Papillary Mucinous Neoplasms?
- Intrapapillary mucinous neoplasms are tumors (neoplasms) that grow within the pancreatic ducts (intraductal)
- characterized by the production of thick fluid (mucous) by the tumor cells
Where do IPMNs commonly occur?
Head of the pancreas
IPMNs: benign or malignant?
Can be benign, borderline malignant, or malignant
Penetration of the basement membrane= malignant
What is the 4th leading cause of death in the US?
Pancreatic cancer
What is the typical presentation of pancreatic cancer?
- Abdominal pain
- Weight loss/ constitutional signs
- Jaundice
What tumor markers can be associated with pancreatic cancer?
CEA
CA19-9
What modifiable factor increases the risk of pancreatic cancer x3?
Smoking
What nonmodifiable factor increases the risk of pancreatic cancer?
Hereditary pancreatitis + Peutz-Jegher’s Syndrome i.e. the following mutations:
- STK11
- PRSS1
- SPINK1
- CFTR
What genetic mutation is highly associated with the development of pancreatic cancer?
K-RAS
What part of the pancreas is most commonly involved in pancreatic cancer?
Head
What surgical procedure is used to treat pancreatic cancer?
Whipple procedure
What are the three types of gallstones?
1) Cholesterol
2) Pigmented/ bilirubin stones
3) Mixed
What causes cholesterol stones?
Supersaturation of cholesterol in the bile
What commonly causes acute cholecystitis?
Obstruction of neck of the gallbladder or cystic duct
What causes chronic cholecystitis?
Long-standing inflammation of GB
*May or may not be associated with a history of acute cholecystitis
What is a Porcelian Gallbladder?
Calcified Gallbladder that is AT RISK FOR CACINOMA
What are the major complications of cholecystitis?
1) Bacterial superinfection
2) Perforation/ abscess formation
3) Fistula formation
What type of cancer is carcinoma of the gallbladder?
Adenocarcinoma
What do you need to remember about carcinoma of the gallbladder?
Indistinguishable from cholelithiasis; thus, it is diagnosed late
