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gastrointestinal system > EXAM #3: PANCREATITIS > Flashcards

EXAM #3: PANCREATITIS Flashcards

1
Q

What is the most common etiology of metabolic acute pancreatitis?

A

Alcoholism

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2
Q

What are the genetic underpinnings of acute pancreatitis?

A

PRSS1= trypsinogen mutation

SPINK1= mutation in trypsin inhibitor mutation

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3
Q

What are the most common causes of mechanically induced acute pancreatitis?

A

1) Gallstones

2) Trauma

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4
Q

What are the vascular etiologies of acute pancreatitis?

A

1) Shock
2) Atheroembolism
3) Vascuitis

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5
Q

What are the infectious etiologies of acute pancreatitis?

A

1) Mumps
2) Coxsackievirus
3) Mycoplasma peumonia

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6
Q

How is acute pancreatitis initiated?

A

Trypsin activation leading to autodigestion of the pancreas

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7
Q

What is the specific serum enzyme that is indicative of acute pancreatitis?

A

Lipase

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8
Q

How does acute pancreatitis present?

A
  • Constant epigastric pain radiating to the back
  • Shock

Full-blown acute pancreatitis is a medical emergency

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9
Q

What causes hypocalcemia seen in acute pancreatitis?

A

Consumption of Ca++ in soponification of peripancreatic fat

**This is associated with a POOR prognosis

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10
Q

What serum lab elevation is indicative of a pancreatic pseudocyst?

A

Amylase

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11
Q

Outline the spectrum of severity in pancreatitis.

A

1) Acute INTERSTITIAL= trivial inflammation and edema
2) Acute NECROTIZING= extensive necrosis
3) HEMORRHAGIC

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12
Q

How do you differentiate between a perforate ulcer and pancreatitis?

A

Serum lipase

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13
Q

What is a pancreatic pseudocyst?

A

Collection of blood, debris, tissue, and fluid WITHOUT a true epithelial lining

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14
Q

List the complications of acute pancreatitis.

A

1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction

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15
Q

What is the main difference between acute and chronic pancreatitis?

A
  • Acute is reversible
  • Chronic is irreversible

Chronic is caused by relapsing acute pancreatitis*

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16
Q

What factors drive the fibrosis seen in chronic pancreatitis?

A

TGF-B
PDGF

*Both are induced by chronic inflammation

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17
Q

In the US, what is the most common cause of chronic pancreatitis?

A

Long-term alcohol abuse

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18
Q

What is the role of CFTR mutations in chronic pancreatitis?

A

CF can lead to early onset pancreatitis (+ lung disease)

  • CFTR decreased bicarbonate
  • Less bicarbonate lead to “slugging” of exocrine pancreas
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19
Q

What is the relationship between alcohol and ductal plugs in alcohol induced chronic pancreatitis?

A
  • Alcohol causes increased protein secretion in exocrine pancreas
  • Proteins can form “ductal plugs”
  • Ductal plugs may calcify
20
Q

What are the buzzwords for the histologic appearance of chronic pancreatitis?

A

1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ ductal plugs

21
Q

What are the sequela of chronic pancreatitis?

A

1) DM–from fibrosis involving the endocrine pancreas
2) Steatorrhea/ fat malabsorption
3) Calcification of the pancreas

22
Q

What disease is associated with congenital pancreatic cysts?

A

Von-Hippel-Lindau Disease

23
Q

What are the clinical features of Von-Hippel Lindau Disease?

A
  • Mutation in chromosome 3
  • Renal cell carcinoma and pheochromocytoma are common
  • CYSTS in pancreas, liver, and kidneys
  • Angiomas in retina, cerebellum, and brainstem
24
Q

What are the three major types of cystic neoplasia involving the pancreas?

A

1) Microcystic serous cystadenomas
2) Mucinous cystic tumors
3) Solid pseudopapillary tumor

25
Q

What are the clinical features of microcystic serous cystadenomas?

A
  • Seen in elderly women
  • Benign

*Cuboidal epithelum with serous fluid

26
Q

What are the clinical features of mucinous cystic tumors?

A
  • Seen in young women
  • Malignant

*Columnar epithelium with mucinous fluid

27
Q

What are Intraductal Papillary Mucinous Neoplasms?

A
  • 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
28
Q

Where do IPMNs commonly occur?

A

Head of the pancreas

29
Q

IPMNs: benign or malignant?

A

Can be benign, borderline malignant, or malignant

Penetration of the basement membrane= malignant

30
Q

What is the 4th leading cause of death in the US?

A

Pancreatic cancer

31
Q

What is the typical presentation of pancreatic cancer?

A
  • Abdominal pain
  • Weight loss/ constitutional signs
  • Jaundice
32
Q

What tumor markers can be associated with pancreatic cancer?

A

CEA

CA19-9

33
Q

What modifiable factor increases the risk of pancreatic cancer x3?

A

Smoking

34
Q

What nonmodifiable factor increases the risk of pancreatic cancer?

A

Hereditary pancreatitis + Peutz-Jegher’s Syndrome i.e. the following mutations:

  • STK11
  • PRSS1
  • SPINK1
  • CFTR
35
Q

What genetic mutation is highly associated with the development of pancreatic cancer?

A

K-RAS

36
Q

What part of the pancreas is most commonly involved in pancreatic cancer?

A

Head

37
Q

What surgical procedure is used to treat pancreatic cancer?

A

Whipple procedure

38
Q

What are the three types of gallstones?

A

1) Cholesterol
2) Pigmented/ bilirubin stones
3) Mixed

39
Q

What causes cholesterol stones?

A

Supersaturation of cholesterol in the bile

40
Q

What commonly causes acute cholecystitis?

A

Obstruction of neck of the gallbladder or cystic duct

41
Q

What causes chronic cholecystitis?

A

Long-standing inflammation of GB

*May or may not be associated with a history of acute cholecystitis

42
Q

What is a Porcelian Gallbladder?

A

Calcified Gallbladder that is AT RISK FOR CACINOMA

43
Q

What are the major complications of cholecystitis?

A

1) Bacterial superinfection
2) Perforation/ abscess formation
3) Fistula formation

44
Q

What type of cancer is carcinoma of the gallbladder?

A

Adenocarcinoma

45
Q

What do you need to remember about carcinoma of the gallbladder?

A

Indistinguishable from cholelithiasis; thus, it is diagnosed late

gastrointestinal system (42 decks)

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