Medical Aspects of Pancreatic Disorders

Question 1

Acute Pancreatitis

• Pathogenosis
• Et

Answer 1

• Activation of proenzymes (ex Trypsinogen) inside pacreatic acinar cells
• Et: Gallstone/obstruction, EtOH, HyperTGCs, drugs, Post-Op, Hypercalcemia, Scorpion Venum, Viral, LSP, Trauma, congenital/hereditary

Question 2

Pancreas divisum

• S/S
• LabDx

Answer 2

• S/S: Severe, peristent epigastric pain DEC by sitting/leading forward; Dyspnea: Rarely: No Ab pain w/ Dyspnea; Cullen’ Sign; Grey Turner’s sign
• LabDx: INC Serum Amylase + Lipase; INC WBC/CRP
  Criteria: >3 of Clinical presentation, Elevated enzymes, + findings on imaging

Question 3

AP imaging

Answer 3

Plain Films: exlcude other et

US: inflammation is Hypoechoic; best to evaluate biliary tract for stones

CT: Focal pancreatic lesions; areas of perfusion

Question 4

Ransons Criteria

Answer 4

• differentiate between mild and severe pancreatitis

- Disadvantage is that it includes 11 criteria that must be monitored over 48 hrs

Question 5

Pancratitis Tx

Answer 5

• Fluid replacement
• Pain Control
• Monitoring
• Enteral nutrition
• Treat underlying cause

Question 6

Chronic Pancreatitis

• Et
• S/S
• LabDx

Answer 6

• Et. 70% EtOH, 20% Idiopathic; 10% other (Hereditary; HyperTGC, etc)**NOT Galstone/biliary
• S/S: Ab Pain; Pan insufficiency; Fat malabs; WL; Diabetes
• LabDx: Direct/indirect measurement of pancreas fxn; Steatorrhea; Imaging;

Question 7

Ductal Adenocarcinoma

• Prevalence
• Presentation
• Genetics
• Prognosis

Answer 7

• Most common exocrine neoplasm
• S/S: Ab pain, Jaundice, WL; Double Duct sign on Imaging
• Tumor marker CA19-9
• Poor prognosis

Question 8

Whipple’s Triad of NETs

Answer 8

1. Hypoglycemiaduring fasting
2. Hypoglycemia w/ BG < 50
3. releif of S/S after exogenous glucose

Question 9

Gastrinoma Triangle

Answer 9

– Superiorly: confluence of the cystic and common bile duct
– Inferiorly: junction of the second and third portions of the duodenum
– Medially: junction of the neck and body of the pancreas

Question 10

Glucagonoma S/S

Answer 10

severe dermatitis - “necrolytic migratory erythema” ,mild diabetes, stomatitis, anemia and weight loss

Question 11

WDHA syndrome ak.a. Verner-Morrison Syndrome

Answer 11

• VIPoma

- S/S: Watery Diarrhea, Hypokalemia, A/hypochlorhydria

Question 12

Somatostainoma

• S/S
• A/S

Answer 12

• S/S: steatorrhea, D

Question 13

CF

• Genetics
• S/s

Answer 13

• G: CFTR mutation leading to abnormal chlorida + Bicarb secretion
• S/S: Pancreatic insufficiency + fat mabsoprtion; pancreatitis; DM;