EXAM #3: PANCREATITIS Flashcards Preview

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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
3
Q
What are the most common causes of mechanically induced acute pancreatitis?
A
1) Gallstones
2) Trauma
4
Q
What are the vascular etiologies of acute pancreatitis?
A
1) Shock
2) Atheroembolism
3) Vascuitis
5
Q
What are the infectious etiologies of acute pancreatitis?
A
1) Mumps
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*
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
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
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
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*****
16
Q
What factors drive the fibrosis seen in chronic pancreatitis?
A
TGF-B
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
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
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
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
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
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
25
Q
What are the clinical features of microcystic serous cystadenomas?
A
- Seen in elderly women
- 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
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
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*
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
32
Q
What tumor markers can be associated with pancreatic cancer?
A
CEA
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
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
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
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
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