GI - Pathology (Pancreas)

Question 1

What is acute pancreatitis?

Answer 1

Autodigestion of pancreas by pancreatic enzymes

Question 2

What are 12 causes of pancreatitis?

Answer 2

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”

Question 3

Give an example of drugs that cause pancreatitis.

Answer 3

Drugs (e.g., sulfa drugs)

Question 4

What are 3 symptoms of the clinical presentation of acute pancreatitis?

Answer 4

Clinical presentation: (1) epigastric abdominal pain radiating to back (2) anorexia (3) nausea

Question 5

What are 2 labs used to test for acute pancreatitis? Which is more specific?

Answer 5

Increased amylase, lipase (higher specificity)

Question 6

What are 8 complications that may result from acute pancreatitis?

Answer 6

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

Question 7

Why are pancreatic pseudocysts considered to be “pseudo”? What is a complication that may result from them?

Answer 7

Pancreatic pseudocyst (lined by granulation tissue, not epithelium; can rupture and hemorrhage)

Question 8

What may be seen on CT of acute pancreatitis?

Answer 8

Acute exudative pancreatitis with extensive fluid collections surrounding pancreas

Question 9

What characterizes chronic pancreatitis?

Answer 9

Chronic inflammation, atrophy, calcification of pancreas

Question 10

What are 2 major causes of chronic pancreatitis?

Answer 10

Major causes are alcohol abuse and idiopathic

Question 11

What are 4 complications/risks of chronic pancreatitis?

Answer 11

Can lead to (1) pancreatic insufficiency => steatorrhea, (2) fat-soluble vitamin deficiency, (3) diabetes mellitus, and (4) increased risk of pancreatic adenocarcinoma

Question 12

Again, what are the 2 important labs for acute pancreatitis? How do these usually present in chronic pancreatitis?

Answer 12

Amylase and lipase may or may not be elevated (almost always elevated in acute pancreatitis)

Question 13

What is the average prognosis of pancreatic adenocarcinoma?

Answer 13

Prognosis averages 1 year

Question 14

Describe the level of aggression of pancreatic adenocarcinoma, including its characteristic histology and the state the cancer is in at time of presentation.

Answer 14

Very aggressive tumor arising from pancreatic ducts (disorganized glandular structure with cellular infiltration); already metastasized at presentation

Question 15

Where are pancreatic adenocarcinoma tumors more common? What symptom/sign does this cause?

Answer 15

Tumors more common in pancreatic head (=> obstructive jaundice)

Question 16

With what tumor marker is pancreatic adenocarcinoma associated? With what other less specific tumor marker is it also associated?

Answer 16

Associated with CA19-9 tumor marker (also CEA, less specific)

Question 17

What are 5 risk factors for adenocarcinoma?

Answer 17

Risk factors: (1) Tobacco use (2) Chronic pancreatitis (especially > 20 years) (3) Diabetes (4) Age > 50 years (5) Jewish and African-American males

Question 18

What are 4 ways in which pancreatic adenocarcinoma often presents?

Answer 18

(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)

Question 19

What are the treatment options for Pancreatic adenocarcinoma?

Answer 19

Treatment: Whipple procedure, Chemotherapy, Radiation therapy

Question 20

Why is pancreatic adenocarcinoma associated with weight loss?

Answer 20

Weight loss (due to malabsorption and anorexia)

Question 21

How does migratory thrombophletis present in pancreatic adenocarcinoma? What is the name of this syndrome?

Answer 21

Migratory thrombophlebitis - redness and tenderness on palpation of extremities (Trousseau syndrome)

Question 22

What is Courvoisier sign, and to what condition does it correlate?

Answer 22

Obstructive jaundice with palpable, nontender gallbladder (Courvoisier sign); Pancreatic adenocarcinoma