Exocrine Pancreas Flashcards
What is annular pancreas? What does it increase the risk of?
Developmental malformation in which the pancreas forms a ring around the duodenum. Risk of duodenal obstruction
What is acute pancreatitis, what causes it and what does it result in?
Inflammation and hemorrhage of the pancreas. Due to autodigestion of pancreatic parenchyma by pancreatic enzymes. Premature activation of trypsin leads to activation of other pancreatic enzymes. Results in liquefactive hemorrhagic necrosis of the pancreas and fat necrosis of the peripancreatic fat.
What causes acute pancreatitis?
Most common are Alcohol and gallstones. Other causes include trauma, hypercalcemia, hyperlipedemia, drugs, scorpion stings, mumps and rupture of a posterior duodenal ulcer.
A patient presents with epigastric abdominal pain that radiates to the back. He also has nausea and vomiting. Lab values show an elevated serum lipase and amylase. What does this patient have? What is the more specific marker for his ailment? What would happen to his Calcium levels? Why? Would he have hemorrhage? Why?
Acute pancreatitis. Lipase is more specific marker for pancreatic damage. Hypocalcemia because calcium is consumed during saponification in fat necrosis. Periumbilical and flank hemorrhage (necrosis spreads into the periumbilical soft tissue and retroperitoneum).
A patient presents with epigastric abdominal pain that radiates to the back. He also has nausea and vomiting. Lab values show an elevated serum lipase and amylase. What does this patient have? What is the more specific marker for his ailment? What would happen to his Calcium levels? Why? Would he have hemorrhage? Why?
Acute pancreatitis. Lipase is more specific marker for pancreatic damage. Hypocalcemia because calcium is consumed during saponification in fat necrosis. Periumbilical and flank hemorrhage (necrosis spreads into the periumbilical soft tissue and retroperitoneum).
What are 4 complications of acute pancreatitis?
- Shock 2. Pancreatic pseudocyst 3. Pancreatic abscess 4. DIC and ARDS
From what is pancreatic pseudocyst formed in acute pancreatitis? How does it present? What values are elevated? What does its rupture cause?
Formed by fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes. Presents as an abdominal mass with persistently elevated serum amylase. Rupture is associated with release of enzymes into the abdominal cavity and hemorrhage.
A patient presents with abdominal pain, high fever and persistently elevated amylase. What does he have and what organism causes it?
Pancreatic abscess due to E coli.
A patient presents with epigastric abdominal pain that radiates to the back. He also has nausea and vomiting. Lab values show an elevated serum lipase and amylase. What does this patient have? What is the more specific marker for his ailment? What would happen to his Calcium levels? Why? Would he have hemorrhage? Why?
Acute pancreatitis. Lipase is more specific marker for pancreatic damage. Hypocalcemia because calcium is consumed during saponification in fat necrosis. Periumbilical and flank hemorrhage (necrosis spreads into the periumbilical soft tissue and retroperitoneum).
What are 4 complications of acute pancreatitis?
- Shock 2. Pancreatic pseudocyst 3. Pancreatic abscess 4. DIC and ARDS
From what is pancreatic pseudocyst formed in acute pancreatitis? How does it present? What values are elevated? What does its rupture cause?
Formed by fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes. Presents as an abdominal mass with persistently elevated serum amylase. Rupture is associated with release of enzymes into the abdominal cavity and hemorrhage.
A patient presents with abdominal pain, high fever and persistently elevated amylase. What does he have and what organism causes it?
Pancreatic abscess due to E coli.
A patient presents with epigastric abdominal pain that radiates to the back. Imaging shows dystrophic calcification of pancreatic parenchyma. Contrast imaging shows a dilatation of pancreatic ducts. What does he have? How is his pancreatic function? Which marker (amylase or lipase) is useful for this? What other complication will he develop later on? What is he at increased risk for?
Chronic pancreatitits which is fibrosis of pancreatic parenchyma secondary to recurrent acute pancreatitis. Pancreatic insufficiency which results in malabsorption with steatorrhea and fat soluble vitamin deficiencies. Neither marker is useful. Contrast studies show ‘chain of lakes’. He will develop secondary diabetes mellitus due to destruction of islets. Increased risk for pancreatic carcinoma.
What is pancreatic carcinoma? Which age group is it seen in? What are major risk factors?
Adenocarcioma arising from pancreatic ducts. Most commonly seen in the elderly (average age is 70 years). Major risk factors are smoking and chronic pancreatitis.
A 72 year old patient presents with epigastric abdominal pain. She has lost 15 lbs recently.
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