Exocrine pancreas and gall bladder Flashcards
what is the main metabolic etiology of acute pancreatitis?
alcoholism
what is the main mechanical etiology of acute pancreatitis?
gall stones
what are the vascular etiologies of acute pancreatitis?
shock
atheroembolism
vasculitis
what are the infectious etiologies of acute pancreatitis?
mumps
coxsackievirus
mycoplasma pneumo
activation of what enzyme leads to activation of many other pancreatic enzymes?
trypsin
which ion is responsible for activation of acute pancreatitis?
calcium
what is the clinical presentation of acute pancreatitis?
acute epigastric pain with radiation to back
shock
what are the lab findings for acute pancreatitis?
elevation of serum amylase first 24 hrs
rising serum lipase 72-96 hrs
hypocalcemia (saponification)
if amylase remains elevated for a long time in acute pancreatitis, what should you start thinking of?
pancreatic pseudocyst
following shock, what condition results from emergent acute pancreatitis?
ARDS
how does pancreatic saponification occur?
- fat necrosis
- fatty acids liberated by lipases and proteases from damaged acini
- complex with calcium to form insoluble soaps
what characterizes acute INTERSTITIAL pancreatitis?
inflammation and edema
what may result from necrotizing or hemorrhagic pancreatitis?
shock and acute tubular necrosis - loss of blood volume
what is a pancreatic pseudocyst?
collection of blood, debris, tissue, fluid that forms 1-4 weeks after onset
is chronic pancreatitis reversible or irreversible?
irreversible
what is the most common etiology of chronic pancreatitis?
alcohol abuse
which genes are responsible for familial pancreatitis?
PRSS-1 and SPINK-1
what are the pathogenic events of chronic pancreatitis?
fibrosis
ductal obstruction by concretions
toxic-metabolic (alcoholic)
inspissated pancreatic secretions are seen in what type of pancreatitis?
chronic
what are the sequalae of progressive inflammatory chronic pancreatitis?
diabetes
steatorrhea
calcifications
what are the neoplastic pancreatic cysts?
serous cystadenomas
mucinous cystic neoplasms
intraductal papillary mucinous cystic neoplasms
congenital pancreatic cysts result from what disease? what are the features?
von hippel-lindau
cysts in pancreas, liver, kidneys
angiomas in retina and cerebellum or brain stem
where are pancreatic pseudocysts usually located?
tail
what are the cystic pancreatic tumors?
microcystic serous cystadenomas
mucinous cystic tumors
solid pseudopapillary tumor
intraductal papillary mucinous neoplasms
what are the features of pancreatic serous cystadenomas? what type of lesion is it?
small
clear, straw colored fluid
honeycomb appearance
neoplastic pancreatic cyst
what are the features of pancreatic mucinous cysteadenomas? what type of lesion is it?
large
ovarian like stroma
tenacious mucin
neoplastic pancreatic cyst
what is the presentation of intraductal papillary mucinous neoplasms (IPMNs)? what type of lesion is it?
men
head of pancreas
cystic pancreatic tumor
what are the features of IPMNs? what type of lesion is it?
finger like projections into ducts
cystic pancreatic tumor
where do IPMNs arise? what type of lesion is it?
ducts
cystic pancreatic tumor
what is the 5 year survival rate of pancreatic cancer?
less than 5%
where does pancreatic cancer usually begin?
ducts
what is the strongest environmental risk factor for pancreatitic cancer?
smoking
what is the most commonly activated oncogene in 90% of pancreatic cancers?
K-RAS
in what part of the pancreas do most pancreatic cancers start?
head
what is removed in the whipple procedure?
head of pancreas
duodenum
gall bladder and common bile duct
what are the three types of gall stones?
cholesterol
pigmented
mixed
what makes up pigmented gall stones?
bilirubin calcium salts
what are the four contributing factors for cholelithiasis?
supersaturation
gall bladder hypomotility
crystal nucleation
accretion within mucous layer
what is the main risk factor for pigmented gall stones?
calcium precipitation of bilirubin
what is the presentation for gall stones?
spasmodic, colicky pain
RUQ pain
pain after fatty meal
what does strawberry gall bladder suggest?
high fat diet, hyperlipidemia
what is the most common cause of acute calculous cholecystitis?
gall stone obstruction at neck or cystic duct
what characterizes acute cholecystitits histologically?
neutrophils in epithelium
rokitansky-aschoff sinuses are seen in what condition? what causes it?
chronic cholecystitis
inflammation, pulling down of gall bladder wall
what type of carcinoma is gall bladder carcinoma?
adenocarcinoma
