Pancreatic Pathology

Question 1

What is acute pancreatitis?

Answer 1

• auto-digestion of the pancreas via inappropriate activation of the pancreatic proteolytic enzymes

Question 2

Symptoms of Acute Pancreatitis

Answer 2

• epigastric deep, searing pain that radiates to the back; anorexia, nausea

Question 3

What are two major clinical signs of acute pancreatitis? What are they caused by? How patients usually present?

Answer 3

• Cullen’s sign: bruising around the umbilicus
• Grey-Turner’s sign: bruising around the flanks
• they are caused by retroperitoneal hemorrhage
• patients complain of epigastric pain that radiates to the back; anorexia and nausea, as well

Question 4

What is the best investigation for diagnosing acute pancreatitis?

Answer 4

• look at the patient’s lipase levels (and amylase)
• these levels should be at least 3x greater than the upper limit of normal
• (lipase is very unique to the pancreas)

Question 5

What are the causes of pancreatitis? Which are the two most common?

Answer 5

• “I.G.E.T.S.M.A.S.H.E.D.”
• idiopathic, gallstones (2nd most), ethanol (most common), trauma, steroids, mumps/malignancy, autoimmune, scorpion sting, hypertriglycerides/hypercalcemia, ERCP (a surgical procedure), drugs (sulfa drugs)

Question 6

What are some complication of acute pancreatitis?

Answer 6

• Ca2+ deficiency (due to a saponification reaction: activated lipase increases amount of free fatty acids which bind to calcium, forming an insoluble complex)
• DIC (disseminated intravascular coagulation) resulting in Grey-Turner’s and Cullen’s signs
• shock due to massive exudation of plasma
• MODS (especially ARDS, which is the major cause of death in these patients; many patients will be short of breath)
• pancreatic pseudocysts (these can rupture and hemorrhage; cause obstruction; get infected)

Question 7

What are 2 developmental malformations of the pancreas?

Answer 7

• annular pancreas: ventral pancreatic bud encircles the 2nd part of the duodenum, resulting in a ring that can cause duodenal obstruction
• pancreas divisum: failure of the ventral and dorsal pancreatic buds to fuse

Question 8

What type of necrosis is seen in acute pancreatitis?

Answer 8

• both liquifactive and fat necrosis
• liquifactive from the actual pancreas because of the enzymes
• fat from the surround peri pancreatic fat

Question 9

What is the major cause of chronic pancreatitis in adults? In children?

Answer 9

• adults: alcoholism and idiopathic

- children: cystic fibrosis

Question 10

What are some complications of chronic pancreatitis?

Answer 10

• pancreatic insufficiency: steatorrhea, malabsorption, fat-soluble vitamin deficiency, diabetes mellitus, pancreatic adenocarcinoma
• (because of the insufficiency, amylase and lipase levels may no longer be elevated)

Question 11

What is the mortality rate associated with acute pancreatitis?

Answer 11

• a massive 20-25% due to the multi organ failure that can result