Goljan Pancreatic disorders Flashcards

1
Q

What are embryologic abnormalities of the pancreas?

A

annular pancreas;

aberrant pancreatic tissue (heterotopic rest, choristoma)

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2
Q

How does annular pancreas lead to a GI disorder?

A

dorsal and ventral buds form ring around duodenum => small bowel destruction

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3
Q

Where are the most common locations for aberrant pancreatic tissue?

A

wall of stomach;
duodenum; jejunum;
Meckel diverticulum

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4
Q

What do the major pancreatic duct and CBD share?

A

confluent in terminal part and empty into duodenum via ampulla of Vater

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5
Q

How does the major pancreatic duct lead to the pathogenesis of acute pancreatitis?

A

stone obstruct terminal part of CBD=>
increased back pressure refluxes bile into major pancreatic duct=>
bile activates proenzymes causing acute pancreatitis

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6
Q

Major causes of acute pancreatitis?

A

alcohol abuse and gallstones

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7
Q

For acute pancreatitis to occur, what must happen?

A

activation of pancreatic proenzymes causing autodigestion of pancreas

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8
Q

What are the 5 primary mechanisms of activation of proenzymes causing acute pancreatitis?

A

obstruction of main pancreatic duct / terminal CBD;
injury of acinar cells;
metabolic activation of proenzymes

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9
Q

What can cause obstruction of the main pancreatic duct or terminal CBD leading to acute pancreatitis?

A

gallstones;

alcohol thickens ductal secretions => increases duct permeability to enzymes

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10
Q

Injury to acinar cells can occur via 3 types: chemical, infectious, mechanical. Name agents from each category

A

C: thiazides, alcohol, triglyceride;

I: CMV, mumps, coxsackievirus;

M: seat belt trauma (kids), posterior penetration of duodenal ulcer

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11
Q

what are metabolic causes of proenzyme activation?

A

hypercalcemia;
ischemia;
shock

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12
Q

What is very important in the activation of proenzymes?

A

activation of trypsin

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13
Q

If proenzymes are activated prematurely, what are the possible damages?

A

proteases damage acinar cell structure;
lipases and phospholipases produce enzymatic fat necrosis;
elastases damage vessel walls and produce hemorrhage;
activated enzymes circulate in blood

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14
Q

Define 3rd space fluid

A

sequestered fluid that is unavailable for maintenance of volume in vascular compartment (nonfxnal ECF)

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15
Q

What does 3rd space fluid refer to in acute pancreatitis?

A

peripancreatic collection of fluid that commonly occurs as pancreas autodigests itself => hypovolemic shock

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16
Q

If acute pancreatitis improves, what are the possible effects of the 3rd space fluid?

A

gains entry back into the vascular compartment and may cause fluid overload