Pancreas Flashcards
- inflammation and hemorrhage of the pancreas
- essentially a retroperitoneal burn; pancreatic fluid flows into the abdomen, causing renal or pulmonary failure
- loss of cell polarity: instead of going to apex, get injected into the basolateral surface, invade the tissue
- Not an infectious reaction; DON’T TREAT WITH ANTIBIOTICS initially: may cause severe necrotizing pancreatitis
Acute Pancreatitis/Interstitial Pancreatitis
- 3x normal elevation of amylase and lipase
- elevation of lipase is mor specific to pancreatitis
Diagnosis of Acute Pancreatitis
- Shock: due to peripancreatic hemorrhage and fluid sequestration
- Pancreatic pseudocyst: presents as abdominal mass, with persistently elevated serum amylase
- Pancreatic abscess: often due to E.coli
- DIC and ARDS: pancreatic enzymes can chew up coagulation factors and alveolar interface
Complications of Acute Pancreatitis
loops of dilated bowel, seen in complicated acute pancreatitis
Sentinel Sign
Periumbilical ecchymoses, seen in complicated acute pancreatitis
Cullen’s Sign
Flank ecchymoses, seen in complicated acute pancreatitis
Turner’s Sign
- When acute pancreatitis involves the blood supply
- Can be exacerbated by treating with antibiotics
Necrotizing Pancreatitis
- currently most commonly due to GM POS. without RESISTANCE OR FUNGAL SUPERINFECTION
- ABCESS - WELL-DEFINED COLLECTION OF PUS OCCURRING AFTER 4 WEEKS
- hold antibiotics pending bacterial identification.
Infection in Acute Pancreatitis
Most commonly due to obstruction of biliary ducts:
- CHOLEDOCHOLITHIASIS 45% (gallstone in biliary ducts)
- AMPULLARY OR PANCREATIC TUMORS
- WORMS (Ascaris) OR FOREIGN BODIES IN AMPULLA
- PANCREAS DIVISUM
- CHOLEDOCHOCOELE
- PERIAMPULLARY DIVERTICULUM
- HYPERTENSIVE SPHINCTER OF ODDI
Drugs: Alcohol is most common
IDIOPATHIC
TRAUMA METABOLIC ABNORMALITIES - hypertrgliceridemia - hypercalcemia INHERITED INFECTION VASCULAR ABNORMALITIES MISCELLANEOUS CONDITIONS
Causes of Acute pancreatitis
congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts
PANCREAS DIVISUM
- Fibrosis of pancreatic parenchyma, mostly due to recurrent acute pancreatitis
- chronic inflammation, atrophy, calcification of the pancreas
- Can localize and mimic a tumor mass
HIstology:
- acinar atrophy, but
- lobular architecture is maintained
Chronic pancreatitis
- Alcohol abuse
- idiopathic
- Cystic fibrosis in children
Major causes of chronic pancreatitis
- Epigastric abdominal pain that radiates to the back
- Pancreatic insufficiency, resulting in malabsorption with steatorrhea and fat-soluble vitamin deficiencies
- amylase and lipase are not useful serologic markers (less elevated compared to acute)
- Dystrophic claicfication of pancreas on imaging
- “Chain of lakes” pattern due to dilatation of pancreatic ducts
- Secondary diabetes mellitis: late complication due to destruction of islet cells
- increased risk for pancreatic carcinoma
Clinical features of Chronic Pancreatitis
- Adenocarcinoma arising from the pancreatic ducts (vs. acini)
- very aggressive
- prognosis averages
Pancreatic Carcinoma
- smoking
- chronic pancreatitis
- Age > 50
- Jewish and African-American males
Risk factors for Pancreatic carcinoma
