GI - Pathology (Pancreas) Flashcards
Pg. 368-369 in First Aid 2014 Sections include: -Acute pancreatitis -Chronic pancreatitis -Pancreatic adenocarcinoma
What is acute pancreatitis?
Autodigestion of pancreas by pancreatic enzymes
What are 12 causes of pancreatitis?
Causes: (1) idiopathic (2) Gallstones (3) Ethanol (4) Trauma (5) Steroids (6) Mumps (7) Autoimmune disease (8) Scorpion sting (9) Hypercalcemia/(10)Hypertriglyceridemia (> 1000 mg/dL) (11) ERCP (12) Drugs (e.g., sulfa drugs); Think: “GET SMASH(H)ED”
Give an example of drugs that cause pancreatitis.
Drugs (e.g., sulfa drugs)
What are 3 symptoms of the clinical presentation of acute pancreatitis?
Clinical presentation: (1) epigastric abdominal pain radiating to back (2) anorexia (3) nausea
What are 2 labs used to test for acute pancreatitis? Which is more specific?
Increased amylase, lipase (higher specificity)
What are 8 complications that may result from acute pancreatitis?
Can lead to (1) DIC (2) ARDS (3) diffuse fat necrosis (4) hypocalcemia (Ca2+ collects in pancreatic calcium soap deposits) (5) Pseudocyst formation (6) Hemorrhage (7) Infection and (8) Multiorgan failure
Why are pancreatic pseudocysts considered to be “pseudo”? What is a complication that may result from them?
Pancreatic pseudocyst (lined by granulation tissue, not epithelium; can rupture and hemorrhage)
What may be seen on CT of acute pancreatitis?
Acute exudative pancreatitis with extensive fluid collections surrounding pancreas
What characterizes chronic pancreatitis?
Chronic inflammation, atrophy, calcification of pancreas
What are 2 major causes of chronic pancreatitis?
Major causes are alcohol abuse and idiopathic
What are 4 complications/risks of chronic pancreatitis?
Can lead to (1) pancreatic insufficiency => steatorrhea, (2) fat-soluble vitamin deficiency, (3) diabetes mellitus, and (4) increased risk of pancreatic adenocarcinoma
Again, what are the 2 important labs for acute pancreatitis? How do these usually present in chronic pancreatitis?
Amylase and lipase may or may not be elevated (almost always elevated in acute pancreatitis)
What is the average prognosis of pancreatic adenocarcinoma?
Prognosis averages 1 year
Describe the level of aggression of pancreatic adenocarcinoma, including its characteristic histology and the state the cancer is in at time of presentation.
Very aggressive tumor arising from pancreatic ducts (disorganized glandular structure with cellular infiltration); already metastasized at presentation
Where are pancreatic adenocarcinoma tumors more common? What symptom/sign does this cause?
Tumors more common in pancreatic head (=> obstructive jaundice)
With what tumor marker is pancreatic adenocarcinoma associated? With what other less specific tumor marker is it also associated?
Associated with CA19-9 tumor marker (also CEA, less specific)
What are 5 risk factors for adenocarcinoma?
Risk factors: (1) Tobacco use (2) Chronic pancreatitis (especially > 20 years) (3) Diabetes (4) Age > 50 years (5) Jewish and African-American males
What are 4 ways in which pancreatic adenocarcinoma often presents?
(1) Abdominal pain radiating to back (2) Weight loss (due to malabsorption and anorexia) (3) Migratory thrombophlebitis - redness and tenderness on palpation of extremities (Trousseau syndrome) (4) Obstructive jaundice with palpable nontender gallbladder (Courvoisier sign)
What are the treatment options for Pancreatic adenocarcinoma?
Treatment: Whipple procedure, Chemotherapy, Radiation therapy
Why is pancreatic adenocarcinoma associated with weight loss?
Weight loss (due to malabsorption and anorexia)
How does migratory thrombophletis present in pancreatic adenocarcinoma? What is the name of this syndrome?
Migratory thrombophlebitis - redness and tenderness on palpation of extremities (Trousseau syndrome)
What is Courvoisier sign, and to what condition does it correlate?
Obstructive jaundice with palpable, nontender gallbladder (Courvoisier sign); Pancreatic adenocarcinoma
