exocrine pancreas Flashcards
What is annular pancreas?
developmental malformation where the pancreas forms a ring around the duodenum, leading to a risk of duodenal obstruction
What is the definition of acute pancreatitis? What is the process? What are the pathologic processes?
inflammation and hemorrhage of the pancrease d/t autodigestion of pancreatic parenchyma by pancreatic enzymes. premature activation of trypsin causes activation of other enzymes.
liquifactive necrosis and fat necrosis.
What are the common causes of acute pancreatitis?
alcohol and gallstones.
alcohol contracts sphincter of Oddi, so pancreatic drainage is low.
gallstones can also do this: you block the ability of the pancreas to drain.
What are less common causes of acute pancreatitis?
trauma (esp. automobile accidents in kids), hypercalcemia (Ca activates enzymes) and hyperlipidemia
drugs (sulfa, steroids)
scorpion stings
mumps
rupture of a posterior duodenal ulcer.
(in FA, they say GET SMASHD as a mnemonic, which includes gallstones and ethanol)
presentation of acute pancreatitis
epigastric ab pain radiating to the back, nausea and vomiting, periumbilical and flank hemorrhage, elevation of lipase and amylase (lipase is more specific- amylase elevation also seen with salivary problems), and HYPOCALCEMIA
complications of acute pancreatitis
shock (from extensive hemorrhage), pancreatic pseudocyst (fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes. lined by granulation tissue, not epithelium. presents as an abdominal mass with persistently elevated serum amylase. rupture is associated with the release of enzymes into the abdominal cavity and hemorrhage), pancreatic abscess (often from E. coli; often also see elevated amylase), DIC, ARDS.
What is the path features of chronic pancreatitis? What are the common causes?
fibrosis of pancreatic parenchyma secondary to recurrent acute pancreatitis. pancreas is often calcified.
most commonly due to alcohol in adults and cystic fibrosis in kids. many cases are idiopathic.
clinical features of chronic pancreatitis
epigastric abdominal pain radiating to the back, pancreatic insufficiency (malabsorption with steatorrhea and deficiency of fat-soluble vitamins, normal or low amylase and lipase levels), dystrophic calcification of the pancreas, secondary DM (late in the course), incr. risk of pancreatic CA
What kind of cancer is pancreatic carcinoma? Risk factors?
adenocarcinoma arising from the pancreatic ducts. usually in elderly. risks: chronic pancreatitis and smoking (also DM, and jewish and african american men)
clinical features of pancreatic carcinoma; distinguish between different locations of pancreatic cancer
epigastric abdominal pain and weight loss, migratory thrombophlebitis redness and tenderness on paplation of the extremities)!!
may arise in HEAD or BODY
in HEAD, see obstructive jaundice with pale stools and a palpable gall bladder. Obstructive jaundice would have a palpable, non-tender gall bladder.
in BODY or TAIL see secondary DM
may lead to pancreatitis (if it blocks the pancreatic duct)
What tumor marker is associated with pancreatic cancer?
CA-19-9. also CEA, but that is less specific (also seen in colon cancers)
