Goljan Pancreatic disorders

Question 1

What are embryologic abnormalities of the pancreas?

Answer 1

annular pancreas;

aberrant pancreatic tissue (heterotopic rest, choristoma)

Question 2

How does annular pancreas lead to a GI disorder?

Answer 2

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

Question 3

Where are the most common locations for aberrant pancreatic tissue?

Answer 3

wall of stomach;
duodenum; jejunum;
Meckel diverticulum

Question 4

What do the major pancreatic duct and CBD share?

Answer 4

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

Question 5

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

Answer 5

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

Question 6

Major causes of acute pancreatitis?

Answer 6

alcohol abuse and gallstones

Question 7

For acute pancreatitis to occur, what must happen?

Answer 7

activation of pancreatic proenzymes causing autodigestion of pancreas

Question 8

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

Answer 8

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

Question 9

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

Answer 9

gallstones;

alcohol thickens ductal secretions => increases duct permeability to enzymes

Question 10

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

Answer 10

C: thiazides, alcohol, triglyceride;

I: CMV, mumps, coxsackievirus;

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

Question 11

what are metabolic causes of proenzyme activation?

Answer 11

hypercalcemia;
ischemia;
shock

Question 12

What is very important in the activation of proenzymes?

Answer 12

activation of trypsin

Question 13

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

Answer 13

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

Question 14

Define 3rd space fluid

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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