Flashcards in EXAM #3: PANCREATITIS Deck (45)
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1
Q
What is the most common etiology of metabolic acute pancreatitis?
A
Alcoholism
2
Q
What are the genetic underpinnings of acute pancreatitis?
A
PRSS1= trypsinogen mutation
SPINK1= mutation in trypsin inhibitor mutation
SPINK1= mutation in trypsin inhibitor mutation
3
Q
What are the most common causes of mechanically induced acute pancreatitis?
A
1) Gallstones
2) Trauma
2) Trauma
4
Q
What are the vascular etiologies of acute pancreatitis?
A
1) Shock
2) Atheroembolism
3) Vascuitis
2) Atheroembolism
3) Vascuitis
5
Q
What are the infectious etiologies of acute pancreatitis?
A
1) Mumps
2) Coxsackievirus
3) Mycoplasma peumonia
2) Coxsackievirus
3) Mycoplasma peumonia
6
Q
How is acute pancreatitis initiated?
A
Trypsin activation leading to autodigestion of the pancreas
7
Q
What is the specific serum enzyme that is indicative of acute pancreatitis?
A
Lipase
8
Q
How does acute pancreatitis present?
A
- Constant epigastric pain radiating to the back
- Shock
*Full-blown acute pancreatitis is a medical emergency*
- Shock
*Full-blown acute pancreatitis is a medical emergency*
9
Q
What causes hypocalcemia seen in acute pancreatitis?
A
Consumption of Ca++ in soponification of peripancreatic fat
****This is associated with a POOR prognosis
****This is associated with a POOR prognosis
10
Q
What serum lab elevation is indicative of a pancreatic pseudocyst?
A
Amylase
11
Q
Outline the spectrum of severity in pancreatitis.
A
1) Acute INTERSTITIAL= trivial inflammation and edema
2) Acute NECROTIZING= extensive necrosis
3) HEMORRHAGIC
2) Acute NECROTIZING= extensive necrosis
3) HEMORRHAGIC
12
Q
How do you differentiate between a perforate ulcer and pancreatitis?
A
Serum lipase
13
Q
What is a pancreatic pseudocyst?
A
Collection of blood, debris, tissue, and fluid WITHOUT a true epithelial lining
14
Q
List the complications of acute pancreatitis.
A
1) Shock
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction
2) ARDS
3) Acute renal failure
4) DIC
5) Pancreatic abscess
6) Pancreatic pseudocyst
7) Duodenal obstruction
15
Q
What is the main difference between acute and chronic pancreatitis?
A
- Acute is reversible
- Chronic is irreversible
****Chronic is caused by relapsing acute pancreatitis*****
- Chronic is irreversible
****Chronic is caused by relapsing acute pancreatitis*****
16
Q
What factors drive the fibrosis seen in chronic pancreatitis?
A
TGF-B
PDGF
*Both are induced by chronic inflammation
PDGF
*Both are induced by chronic inflammation
17
Q
In the US, what is the most common cause of chronic pancreatitis?
A
Long-term alcohol abuse
18
Q
What is the role of CFTR mutations in chronic pancreatitis?
A
CF can lead to early onset pancreatitis (+ lung disease)
- CFTR decreased bicarbonate
- Less bicarbonate lead to "slugging" of exocrine pancreas
- CFTR decreased bicarbonate
- Less bicarbonate lead to "slugging" of exocrine pancreas
19
Q
What is the relationship between alcohol and ductal plugs in alcohol induced chronic pancreatitis?
A
- Alcohol causes increased protein secretion in exocrine pancreas
- Proteins can form "ductal plugs"
- Ductal plugs may calcify
- Proteins can form "ductal plugs"
- Ductal plugs may calcify
20
Q
What are the buzzwords for the histologic appearance of chronic pancreatitis?
A
1) Acinar drop out
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ ductal plugs
2) Inflammatory infiltrate
3) Fibrosis
4) Protein/ ductal plugs
21
Q
What are the sequela of chronic pancreatitis?
A
1) DM--from fibrosis involving the endocrine pancreas
2) Steatorrhea/ fat malabsorption
3) Calcification of the pancreas
2) Steatorrhea/ fat malabsorption
3) Calcification of the pancreas
22
Q
What disease is associated with congenital pancreatic cysts?
A
Von-Hippel-Lindau Disease
23
Q
What are the clinical features of Von-Hippel Lindau Disease?
A
- Mutation in chromosome 3
- Renal cell carcinoma and pheochromocytoma are common
- CYSTS in pancreas, liver, and kidneys
- Angiomas in retina, cerebellum, and brainstem
- Renal cell carcinoma and pheochromocytoma are common
- CYSTS in pancreas, liver, and kidneys
- Angiomas in retina, cerebellum, and brainstem
24
Q
What are the three major types of cystic neoplasia involving the pancreas?
A
1) Microcystic serous cystadenomas
2) Mucinous cystic tumors
3) Solid pseudopapillary tumor
2) Mucinous cystic tumors
3) Solid pseudopapillary tumor
25
Q
What are the clinical features of microcystic serous cystadenomas?
A
- Seen in elderly women
- Benign
*Cuboidal epithelum with serous fluid
- Benign
*Cuboidal epithelum with serous fluid
26
Q
What are the clinical features of mucinous cystic tumors?
A
- Seen in young women
- Malignant
*Columnar epithelium with mucinous fluid
- Malignant
*Columnar epithelium with mucinous fluid
27
Q
What are Intraductal Papillary Mucinous Neoplasms?
A
- Intrapapillary mucinous neoplasms are tumors (neoplasms) that grow within the pancreatic ducts (intraductal)
- characterized by the production of thick fluid (mucous) by the tumor cells
- characterized by the production of thick fluid (mucous) by the tumor cells
28
Q
Where do IPMNs commonly occur?
A
Head of the pancreas
29
Q
IPMNs: benign or malignant?
A
Can be benign, borderline malignant, or malignant
*Penetration of the basement membrane= malignant*
*Penetration of the basement membrane= malignant*
30
Q
What is the 4th leading cause of death in the US?
A
Pancreatic cancer
31
Q
What is the typical presentation of pancreatic cancer?
A
- Abdominal pain
- Weight loss/ constitutional signs
- Jaundice
- Weight loss/ constitutional signs
- Jaundice
32
Q
What tumor markers can be associated with pancreatic cancer?
A
CEA
CA19-9
CA19-9
33
Q
What modifiable factor increases the risk of pancreatic cancer x3?
A
Smoking
34
Q
What nonmodifiable factor increases the risk of pancreatic cancer?
A
Hereditary pancreatitis + Peutz-Jegher's Syndrome i.e. the following mutations:
- STK11
- PRSS1
- SPINK1
- CFTR
- STK11
- PRSS1
- SPINK1
- CFTR
35
Q
What genetic mutation is highly associated with the development of pancreatic cancer?
A
K-RAS
36
Q
What part of the pancreas is most commonly involved in pancreatic cancer?
A
Head
37
Q
What surgical procedure is used to treat pancreatic cancer?
A
Whipple procedure
38
Q
What are the three types of gallstones?
A
1) Cholesterol
2) Pigmented/ bilirubin stones
3) Mixed
2) Pigmented/ bilirubin stones
3) Mixed
39
Q
What causes cholesterol stones?
A
Supersaturation of cholesterol in the bile
40
Q
What commonly causes acute cholecystitis?
A
Obstruction of neck of the gallbladder or cystic duct
41
Q
What causes chronic cholecystitis?
A
Long-standing inflammation of GB
*May or may not be associated with a history of acute cholecystitis
*May or may not be associated with a history of acute cholecystitis
42
Q
What is a Porcelian Gallbladder?
A
Calcified Gallbladder that is AT RISK FOR CACINOMA
43
Q
What are the major complications of cholecystitis?
A
1) Bacterial superinfection
2) Perforation/ abscess formation
3) Fistula formation
2) Perforation/ abscess formation
3) Fistula formation
44
Q
What type of cancer is carcinoma of the gallbladder?
A
Adenocarcinoma
45
Q
What do you need to remember about carcinoma of the gallbladder?
A
Indistinguishable from cholelithiasis; thus, it is diagnosed late
