Pancreatitis 1 Flashcards
The pancreas is mostly composed of endocrine or exocrine function?
exocrine function (mostly acinar cells)
What is pancreas divisum?
Failure of fusion of the fetal duct systems of the dorsal and ventral
pancreatic primordia
Main pancreatic duct (Wirsung) is short
Bulk of the pancreas (formed by the dorsal pancreatic primordium) drains through minor sphincter
Most common significant congenital anomaly of the pancreas is what?
pancreas divisum
What complication does pancreas divisum predispose a patient to?
chronic pancreatitis
What gene is affected in agenesis of the pancreas?
IPF1 gene mutations on chromosome 13q12.1
or caused by homozygous germline mutations in PDX1, a gene encoding a homeobox transcription factor critical for pancreatic development
What is agenesis of the pancreas?
Partial agenesis of the pancreas is characterized by the congenital absence of a critical mass of pancreatic tissue
What is annular pancreas?
and like ring of normal pancreatic tissue encircles the second portion of the duodenum, can cause duodenal obstruction
What is ectopic pancreas?
in 2% of the population; pancreas in different sites of the GI.
What are the favorite sites for ectopic pancreas?
favored sites: stomach, duodenum, jejunum, Meckel diverticulum, and ileum
What are congenital cysts?
part of polycystic disease (also in kidney and liver)
Is acute pancreatitis reversible?
yes; organ can return to normal if underlying cause of inflammation is removed
Is chronic pancreatitis irreversible or reversible?
irreversible destruction of the exocrine pancreatic parenchyma due to scarring
What is the cause of 80% of the cases of acute pancreatitis?
biliary tract disease or alcoholism
What is the most common cause of pancreatitis in children?
seat belt trauma
Why is pancreatic pain often referred to the back?
because of the retroperitoneal location of the pancreas
What are some DD’s of acute pancreatitis?
ruptured acute appendicitis, perforated peptic ulcer, acute cholecystitis with rupture, occlusion of mesenteric vessels with infarction of bowel
What are some major complications associated with acute pancreatitis?
DIC, ARDS, peripheral vascular collapse (shock), hypoxemia (because circulating pancreatic phospholipase destroys surfactant), shock, hypocalcemia tetany (because calcium binds to fatty acids decreasing the ionized calcium).
How can acute pancreatitis cause third spacing and concurrently pulmonary edema?
- In acute pancreatitis – the pancreas autodigests itself, causing peripancreatic collection of fluid leading to
Hypovolemic shock - If conditions improve, the third space fluid gains entry back into the vascular compartment and may cause
Fluid Overload
What. sign is indicated in this picture and why does it occur?
Grey-Turner sign
purplish discoloration in loins due to tracking of hemorrhagic necrotic pancreatic material along retroperitoneal planes
What sign is being represented here and why?
Cullen sign
hemorrhagic discoloration around the umbilicus due to tracking of hemorrhagic necrotic pancreatic tissue around the falciform and umbilical ligaments
What is a pancreatic pseudocyst given the name pseudocyst?
Because it lacks an epithelial lining
Instead liquefied areas of necrotic pancreatic tissue become walled off by fibrous tissue stones from a cystic space
How would you diagnose that an individual has a pancreatic pseudocyst?
- Diagnosis: abdominal mass with persistence of serum amylase >10 days
How would you treat a pancreatic pseudocyst?
- If <5 cm, observe/follow with CT scan, most resolve without surgery
- If >5 cm, treat with CT- or US-guided percutaneous drainage
How can the enlarged inflamed pancreas in pancreatic pseudocyst be visualized?
enlarged inflamed pancreas can be visualized by CT/MRI
What is the most specific and sensitive marker of acute pancreatitis?
serum lipase
Why is serum lipase the most specific and sensitive marker of acute pancreatitis as opposed to serum amylase?
serum amylase has a short half-life and may return to normal in 3-5 days, whereas lipase levels remain elevated for 8 to 14 days.
When may serum amylase levels be diagnostic of pancreatic pseudocyst?
Persistent increase in serum amylase for more than 7 days
Is serum lipase excreted in urine?
no
Serum lipase is more specific for which condition?
acute pancreatitis but not useful in chronic pancreatitis
What does SIT stand for?
serum immunoreactive trypsin
Which test is an excellent screen for diagnosing acute pancreatitis?
SIT
Is SIT increased or decreased in chronic pancreatitis?
decreased
What is decreased fecal elastase sensitive/specific for?
pancreatic exocrine dysfunction
What is the purpose of Ranson criteria?
to determine prognosis in acute pancreatitis
A Ranson criteria score of <3 indicates what?
0.9% mortality rate
A Ranson criteria score of <3 indicates what?
0.9% mortality rate
A ranson criteria of > 6
100% mortality rate
Can CFTR mutations cause chronic pancreatitis?
yes
What is the most common cause of chronic pancreatitis in children?
cystic fibrosis
What is the most common cause of chronic pancreatitis in developing countries?
malnutrition is a common cause
What can attacks caused by chronic pancreatitis be precipitated by?
alcohol abuse, overeating, opiates/other drugs
How can diagnosis of one with chronic pancreatitis be made?
calcifications within the pancreas by CT or ultrasonography
wt loss and hypoalbuminemic edema from malabsorption
Under microscopy, what may be visualized inflammation one has chronic pancreatitis?
Micro: Parenchymal fibrosis, acinar loss, ductal dilatation with relative sparing of the islets of Langerhans initially
Upon seeing gross morphology of a patient with chronic pancreatitis, what may be witnessed?
gland is hard with dilated ducts and calcified concretions
What is the chief distinction between acute and chronic pancreatitis?
irreversible impairment in pancreatic function in chronic pancreatitis
Major complications from acute pancreatitis?
Major complications that result from chronic pancreatitis?
