Exocrine Pancreas

Question 1

What is annular pancreas?

Answer 1

Developmental malformation in which the head of the pancreas wraps around the duodenum and forms a ring; risk of duodenal obstruction

Question 2

What is acute pancreatitis?

Answer 2

Inflammation and hemorrhage of the pancreas due to premature activation of trypsin leading to activation of other pancreatic enzymes resulting in autodigestion.

Question 3

What are the implications of acute pancreatitis?

Answer 3

• Liquefactive hemorrhagic necrosis of the pancreas

- Peripancreatic fat necrosis

Question 4

What are the common causes of acute pancreatitis? List 10

Answer 4

-Alcohol, gallstones, post-ERCP, trauma, MUMPS, Drugs, scorpion stings, rupture of posterior duodenal ulcer, hypercalcemia and hyperlipidemia

Question 5

How does alcohol cause acute pancreatitis?

Answer 5

Alcohol causes contraction at the sphincter of Audi at the ampulla that enters into the duodenum leading to decrease drainage of the pancreas increasing the risk of premature activation of the pancreatic enzymes

Question 6

How do gallstones cause acute pancreatitis?

Answer 6

A gallstone can obstruct the sphincter of Audi at the ampulla that enters into the duodenum leading to decrease drainage of the pancreas increasing the risk of premature activation of the pancreatic enzymes

Question 7

How does hypercalcemia lead to acute pancreatitis?

Answer 7

Calcium activated enzymes. An increase level of calcium in the blood increases the risk of premature activation of pancreatic enzymes.

Question 8

What are clinical features of acute pancreatitis?

Answer 8

Nausea, vomiting, epigastric pain that radiated to the back, elevated serum lipase and amylase (>3xULN), Hypocalcemia (From calcium consumption during saponification in fat necrosis), periumbilical and flank hemorrhage (from necrosis spreading into the periumbilical soft tissue and retroperitoneum)

Question 9

What are complications of acute pancreatitis?

Answer 9

• Shock (due to hemorrhage and fluid sequestration)
• Pancreatic pseudocyst (Formed by fibrous tissue surrounding liquefactive necrosis, presents as abd mass with persistently elevate amylase, rupture is associated with hemorrhage and release of pancreatic enzymes.
• Pancreatic abscess - usually due to E. Coli. presents with abd pain, high fever, and persistently elevated amylase
• DIC and ARDS

Question 10

What are the causes of chronic pancreatitis?

Answer 10

Fibrosis of pancreatic parenchyma is commonly caused by recurrent bouts of acute pancreatis typically from alcohol, or cystic fibrosis. Cystic fibrosis causes thick secretions slows ability of pancreas to drain leading to increased risk of premature pancreatic enzymes activation. Many cases are idiopathic aswell

Question 11

What are clinical features of chronic pancreatitis?

Answer 11

• Epigastric abd pain radiating to the back
• Pancreatic insufficiency results in malabsorption with steatorrhea and fat soluble vitamin deficiencies (A,E,D, and K)
• Dystrophic calcification of pancreas
• Secondary diabetes mellitus form destruction of islets
• Increased risk for pancreatic carcinoma

Question 12

What is pancreatic carcinoma?

Answer 12

Adenocarcinoma arising from the pancreatic ducts, most commonly seen in the elderly (average age 70), with risk factors of smoking, african american race and chronic pancreatitis.

Question 13

What are the clinical features of pancreatic carcinoma?

Answer 13

• Epigastric pain
• Weight loss
• Obstructive jaundice and pale stool if of the pancreatic head
• Diabetes mellitus if in the body or tail of the pancreas.
• Pancreatitis
• Elevated tumor marker CA 19-9
• Migratory Thrombophlebitis (Trousseau syndrome): A blood clot that moves around the body often linked to underlying cancer, especially pancreas and lung

Question 14

What is the treatment for pancreatic carcinoma?

Answer 14

Whipple Procedure -Removal of the head and neck of the pancreas, proximal duodenum and gallbladder. Very poor prognosis; 1 yr survival of <10%