What is an annular pancreas? What is the patient at risk for?
pancreas forms a ring around the duodenum
at risk for duodenal obstruction
What kind of necrosis in acute pancreatitis?
liquefactive necrosis of pancreatic parencyhma
fat necrosis of surrounding fat
What are the most common causes of acute pancreatitis?
alcohol and gallstones
What are some other causes of acute pancreatitis?
- drugs - thiazides
- scorpion stings - lol random
- rupture of posterior duodenal ulcer
What is the clinical presentation of acute pancreatitis?
epigastric pain that radiates to the back
n/v , elevation of lipase and amylase
hypocalcemia - saponification uses up ca
What is the microscopic appearance of the pancreas in acute pancreatitis?
- acinar cell necrosis
- intense acute inflamm.
- foci of necrotic adipocytes - patchy
What are some complications of acute pancreatitis?
- hypovolemic shock
- pancreatic pseudocysts
- pancreatic abscess - ecoli
- DIC and ARDs
What are the most common causes of chronic pancreatitis?
alcohol and CF
What is the clinical presentation of chronic pancreatitis?
chronic epigastric pain radiating to back
steatorrhea and malabsorption of ADEK
Why arent amylase and lipase good markers for chronic pancreatitis?
they are totally destroyed by this point
What are some unfortunate complications of chronic pancreatitis?
inc risk for pancreatic carcinoma
What is the appearance of the pancreas in chronic pancreatitis?
parenchyma is firm and cut surface lacks lobules
shrunken, fibrotic, infiltrates of lymphocytes
ducts are dilated with proteinaceous material
pseduocysts are present
What are the risk factors for pancreatic carcinoma?
- chronic pancreatitis
What are some gene mutations involved in the development of pancreatic carcinoma?
kras –> p16 –> p53, BRCA2, DPC4/SMAD4
Where is the most common site of pancreatic carcinoma?
the head of the pancreas
What is a common site of metastasis of pancreatic cancer?
Why is persistent pain a common finding in pancreatic carcinoma?
If pancreatic carcinoma occurs in the head, describe some clinical findings?
obstructive jaundice with pale stools and palpable GB
If pancreatic carcinoma occurs in the body or tail, describe some clinical findings?
What is the treatment for pancreatic carcinoma?
removes head and neck, duodenum, GB
What is a paraneoplastic syndrome that can occur with acinar cell carcinoma?
sc fat necrosis, polyarthralgia, eosinophilia
all due to hypersecretion of lipase
What inc risk for serous cystadenomas?
What are the common mutations associated with pNETs?
MEN1 and VHL
What do pNETs stain positive for?
chromogranin A and synaptophysin