Patho of Exocrine Pancreas [2]

Question 1

Exocrine fxn of pancreas

Answer 1

synth of enzymes needed for digestion of fats, proteins, and carbs

neutralizes gastric acid and chyme

Question 2

What enzyme is released by the duodenum in response to drop in pH?

Answer 2

secretin: most imp for stimulus of NaHCO3 + CCK

Secretin and CCK both inhibit gastric acid/fluid production and delay gastric emptying until the intestine is ready for more

Question 3

Acute pancreatitis

-Pathophys

Answer 3

acute inflammation with acute abdominal pain (often goes to the back) + elevated pancreatic enzymes in serum
- self limited

Trypsinogen+proenzymes are prematurely activated within the pancrease → autodigestion of gland → leakage of enzymes, complications, inflammatory cascade, death

Question 4

1 cause of acute pancreatitis world wide, and in america

Answer 4

alcohol abuse

US: Gallstones - Obstruction of duct

Question 5

Presentation of acute pancreatitis

Answer 5

sudden abdominal/epigastric pain (radiating to back)
nause/vomiting
tachycardia
low grade fever
abdominal guarding
loss of bowel sounds (ileus: gut paralysis)
jaundice

Question 6

Pancreatic pseudocyst
what is it
tx?

Answer 6

Can follow acute or chronic pancreatitis

Collection of pancreatic fluid/necrotic debris around wall of granulation tissue but lack epithelial lining
- majority will resolve with time

If it persists → chronic pain, infxn, obstruction → drain it

Question 7

Testing for acute pancreatitis

Answer 7

Serum enzymes (amylase and lipase)

• should be elevated 3x (enzyme leaks out into blood)
• high sensitivity

US for GB stones
CT for edema, calcifications, fluid collection

Question 8

Tx for acute pancreatitis

Answer 8

Basic management
admit to hospital → NPO
IV narcs for pain
Surgery consult if GS (ERCP)
If severe → feeding tube, IV nutrition, pancreatic debridement, pseudocyst drainage
Avoid alcohol

Question 9

Chronic pancreatitis

-Pathophys

Answer 9

Permanent loss of pancreatic fxn → chronic inflammation, ductal obstruction, chronic pain, malabsorption

Permanent destruction of pancreatic parenchyma
(can b due to acute pancreatitis → fibrosis) → ductal strictures, ductal/parenchymal calcifications or stones

Question 10

1 cause of chronic pancreatitis

Answer 10

alcohol

#2 is idiopathic

Question 11

Chronic pancreatitis presentation

Answer 11

abdominal pain

• chronic epigastric pain radiates to back
• worse after meals

Steatorrhea

Hypo or Hyperglycemia
- brittle diabetes from loss of islets

Question 12

Chronic pancreatitis: below is the pathophys, describe the features
Ductal strictures/stones -
Pancreatic pseudocysts -
Acinar destruction -

Answer 12

Ductal strictures/stones - chronic pain, exocrine failure
Pancreatic pseudocysts - pain, nausea/vomiting, jaundice, feber
Acinar destruction - exocrine failure

Question 13

Most common type of pancreatic cancer

Answer 13

ADENOCARCINOMA (dx very late, very hard to tx)

• must do CT to find
• 4th leading cause of cancer death in US

5yr survival is 5%

Question 14

Presentation of pancreatic cancer

Answer 14

early:
jaundice
dark urine
pruritus

Late:
abdominal/back pain
weight loss
n/v
hormonal excess

Question 15

Pancreatic Neuroendocrine tumor (NET)

Answer 15

slow growing
favorable prognosis
islet cell origin
sx: of hormone excess
- insulin, glucagon, somatostatin, gastrin, VIP

Dx and tx same as adenocarcinoma

Question 16

autoimmune pancreatitis (AIP)

Answer 16

diffuse or focal enlargement of pancreatic parenchyma by infiltration of IgG-4 → narrowing of pancreatic duct and/or bile duct, plasma cells and lymphocytes

(mimics pancreatic cancer -
males 40-70 w/
- alcohol, hyperlipidemia, pancreatitis hx
Assoc. w/ other Autoimmune disorders

Question 17

AIP presentation

Answer 17

chronic abdominal pain
jaundice [cholestasis]
weight loss
pancreatitis

(mimics panc cancer)

Question 18

Dx of AIP

Answer 18

CT/MRI
Serum IgG-4
EUS
ERCP