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Year 2 Gastrointestinal > Exocrine pancreas and gall bladder > Flashcards

Exocrine pancreas and gall bladder Flashcards

1
Q

what is the main metabolic etiology of acute pancreatitis?

A

alcoholism

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2
Q

what is the main mechanical etiology of acute pancreatitis?

A

gall stones

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3
Q

what are the vascular etiologies of acute pancreatitis?

A

shock
atheroembolism
vasculitis

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4
Q

what are the infectious etiologies of acute pancreatitis?

A

mumps
coxsackievirus
mycoplasma pneumo

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5
Q

activation of what enzyme leads to activation of many other pancreatic enzymes?

A

trypsin

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6
Q

which ion is responsible for activation of acute pancreatitis?

A

calcium

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7
Q

what is the clinical presentation of acute pancreatitis?

A

acute epigastric pain with radiation to back

shock

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8
Q

what are the lab findings for acute pancreatitis?

A

elevation of serum amylase first 24 hrs
rising serum lipase 72-96 hrs
hypocalcemia (saponification)

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9
Q

if amylase remains elevated for a long time in acute pancreatitis, what should you start thinking of?

A

pancreatic pseudocyst

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10
Q

following shock, what condition results from emergent acute pancreatitis?

A

ARDS

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11
Q

how does pancreatic saponification occur?

A
  1. fat necrosis
  2. fatty acids liberated by lipases and proteases from damaged acini
  3. complex with calcium to form insoluble soaps
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12
Q

what characterizes acute INTERSTITIAL pancreatitis?

A

inflammation and edema

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13
Q

what may result from necrotizing or hemorrhagic pancreatitis?

A

shock and acute tubular necrosis - loss of blood volume

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14
Q

what is a pancreatic pseudocyst?

A

collection of blood, debris, tissue, fluid that forms 1-4 weeks after onset

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15
Q

is chronic pancreatitis reversible or irreversible?

A

irreversible

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16
Q

what is the most common etiology of chronic pancreatitis?

A

alcohol abuse

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17
Q

which genes are responsible for familial pancreatitis?

A

PRSS-1 and SPINK-1

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18
Q

what are the pathogenic events of chronic pancreatitis?

A

fibrosis
ductal obstruction by concretions
toxic-metabolic (alcoholic)

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19
Q

inspissated pancreatic secretions are seen in what type of pancreatitis?

A

chronic

20
Q

what are the sequalae of progressive inflammatory chronic pancreatitis?

A

diabetes
steatorrhea
calcifications

21
Q

what are the neoplastic pancreatic cysts?

A

serous cystadenomas
mucinous cystic neoplasms
intraductal papillary mucinous cystic neoplasms

22
Q

congenital pancreatic cysts result from what disease? what are the features?

A

von hippel-lindau

cysts in pancreas, liver, kidneys
angiomas in retina and cerebellum or brain stem

23
Q

where are pancreatic pseudocysts usually located?

A

tail

24
Q

what are the cystic pancreatic tumors?

A

microcystic serous cystadenomas
mucinous cystic tumors
solid pseudopapillary tumor
intraductal papillary mucinous neoplasms

25
Q

what are the features of pancreatic serous cystadenomas? what type of lesion is it?

A

small
clear, straw colored fluid
honeycomb appearance

neoplastic pancreatic cyst

26
Q

what are the features of pancreatic mucinous cysteadenomas? what type of lesion is it?

A

large
ovarian like stroma
tenacious mucin

neoplastic pancreatic cyst

27
Q

what is the presentation of intraductal papillary mucinous neoplasms (IPMNs)? what type of lesion is it?

A

men
head of pancreas

cystic pancreatic tumor

28
Q

what are the features of IPMNs? what type of lesion is it?

A

finger like projections into ducts

cystic pancreatic tumor

29
Q

where do IPMNs arise? what type of lesion is it?

A

ducts

cystic pancreatic tumor

30
Q

what is the 5 year survival rate of pancreatic cancer?

A

less than 5%

31
Q

where does pancreatic cancer usually begin?

A

ducts

32
Q

what is the strongest environmental risk factor for pancreatitic cancer?

A

smoking

33
Q

what is the most commonly activated oncogene in 90% of pancreatic cancers?

A

K-RAS

34
Q

in what part of the pancreas do most pancreatic cancers start?

A

head

35
Q

what is removed in the whipple procedure?

A

head of pancreas
duodenum
gall bladder and common bile duct

36
Q

what are the three types of gall stones?

A

cholesterol
pigmented
mixed

37
Q

what makes up pigmented gall stones?

A

bilirubin calcium salts

38
Q

what are the four contributing factors for cholelithiasis?

A

supersaturation
gall bladder hypomotility
crystal nucleation
accretion within mucous layer

39
Q

what is the main risk factor for pigmented gall stones?

A

calcium precipitation of bilirubin

40
Q

what is the presentation for gall stones?

A

spasmodic, colicky pain
RUQ pain
pain after fatty meal

41
Q

what does strawberry gall bladder suggest?

A

high fat diet, hyperlipidemia

42
Q

what is the most common cause of acute calculous cholecystitis?

A

gall stone obstruction at neck or cystic duct

43
Q

what characterizes acute cholecystitits histologically?

A

neutrophils in epithelium

44
Q

rokitansky-aschoff sinuses are seen in what condition? what causes it?

A

chronic cholecystitis

inflammation, pulling down of gall bladder wall

45
Q

what type of carcinoma is gall bladder carcinoma?

A

adenocarcinoma

Year 2 Gastrointestinal (38 decks)

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