Exocrine pancreas and gall bladder

Question 1

what is the main metabolic etiology of acute pancreatitis?

Answer 1

alcoholism

Question 2

what is the main mechanical etiology of acute pancreatitis?

Answer 2

gall stones

Question 3

what are the vascular etiologies of acute pancreatitis?

Answer 3

shock
atheroembolism
vasculitis

Question 4

what are the infectious etiologies of acute pancreatitis?

Answer 4

mumps
coxsackievirus
mycoplasma pneumo

Question 5

activation of what enzyme leads to activation of many other pancreatic enzymes?

Answer 5

trypsin

Question 6

which ion is responsible for activation of acute pancreatitis?

Answer 6

calcium

Question 7

what is the clinical presentation of acute pancreatitis?

Answer 7

acute epigastric pain with radiation to back

shock

Question 8

what are the lab findings for acute pancreatitis?

Answer 8

elevation of serum amylase first 24 hrs
rising serum lipase 72-96 hrs
hypocalcemia (saponification)

Question 9

if amylase remains elevated for a long time in acute pancreatitis, what should you start thinking of?

Answer 9

pancreatic pseudocyst

Question 10

following shock, what condition results from emergent acute pancreatitis?

Answer 10

ARDS

Question 11

how does pancreatic saponification occur?

Answer 11

1. fat necrosis
2. fatty acids liberated by lipases and proteases from damaged acini
3. complex with calcium to form insoluble soaps

Question 12

what characterizes acute INTERSTITIAL pancreatitis?

Answer 12

inflammation and edema

Question 13

what may result from necrotizing or hemorrhagic pancreatitis?

Answer 13

shock and acute tubular necrosis - loss of blood volume

Question 14

what is a pancreatic pseudocyst?

Answer 14

collection of blood, debris, tissue, fluid that forms 1-4 weeks after onset

Question 15

is chronic pancreatitis reversible or irreversible?

Answer 15

irreversible

Question 16

what is the most common etiology of chronic pancreatitis?

Answer 16

alcohol abuse

Question 17

which genes are responsible for familial pancreatitis?

Answer 17

PRSS-1 and SPINK-1

Question 18

what are the pathogenic events of chronic pancreatitis?

Answer 18

fibrosis
ductal obstruction by concretions
toxic-metabolic (alcoholic)

Question 19

inspissated pancreatic secretions are seen in what type of pancreatitis?

Answer 19

chronic

Question 20

what are the sequalae of progressive inflammatory chronic pancreatitis?

Answer 20

diabetes
steatorrhea
calcifications

Question 21

what are the neoplastic pancreatic cysts?

Answer 21

serous cystadenomas
mucinous cystic neoplasms
intraductal papillary mucinous cystic neoplasms

Question 22

congenital pancreatic cysts result from what disease? what are the features?

Answer 22

von hippel-lindau

cysts in pancreas, liver, kidneys
angiomas in retina and cerebellum or brain stem

Question 23

where are pancreatic pseudocysts usually located?

Answer 23

tail

Question 24

what are the cystic pancreatic tumors?

Answer 24

microcystic serous cystadenomas
mucinous cystic tumors
solid pseudopapillary tumor
intraductal papillary mucinous neoplasms

Question 25

what are the features of pancreatic serous cystadenomas? what type of lesion is it?

Answer 25

small clear, straw colored fluid honeycomb appearance neoplastic pancreatic cyst

Question 26

what are the features of pancreatic mucinous cysteadenomas? what type of lesion is it?

Answer 26

large ovarian like stroma tenacious mucin neoplastic pancreatic cyst

Question 27

what is the presentation of intraductal papillary mucinous neoplasms (IPMNs)? what type of lesion is it?

Answer 27

men head of pancreas cystic pancreatic tumor

Question 28

what are the features of IPMNs? what type of lesion is it?

Answer 28

finger like projections into ducts cystic pancreatic tumor

Question 29

where do IPMNs arise? what type of lesion is it?

Answer 29

ducts cystic pancreatic tumor

Question 30

what is the 5 year survival rate of pancreatic cancer?

Answer 30

less than 5%

Question 31

where does pancreatic cancer usually begin?

Answer 31

ducts

Question 32

what is the strongest environmental risk factor for pancreatitic cancer?

Answer 32

smoking

Question 33

what is the most commonly activated oncogene in 90% of pancreatic cancers?

Answer 33

K-RAS

Question 34

in what part of the pancreas do most pancreatic cancers start?

Answer 34

head

Question 35

what is removed in the whipple procedure?

Answer 35

head of pancreas duodenum gall bladder and common bile duct

Question 36

what are the three types of gall stones?

Answer 36

cholesterol pigmented mixed

Question 37

what makes up pigmented gall stones?

Answer 37

bilirubin calcium salts

Question 38

what are the four contributing factors for cholelithiasis?

Answer 38

supersaturation gall bladder hypomotility crystal nucleation accretion within mucous layer

Question 39

what is the main risk factor for pigmented gall stones?

Answer 39

calcium precipitation of bilirubin

Question 40

what is the presentation for gall stones?

Answer 40

spasmodic, colicky pain RUQ pain pain after fatty meal

Question 41

what does strawberry gall bladder suggest?

Answer 41

high fat diet, hyperlipidemia

Question 42

what is the most common cause of acute calculous cholecystitis?

Answer 42

gall stone obstruction at neck or cystic duct

Question 43

what characterizes acute cholecystitits histologically?

Answer 43

neutrophils in epithelium

Question 44

rokitansky-aschoff sinuses are seen in what condition? what causes it?

Answer 44

chronic cholecystitis inflammation, pulling down of gall bladder wall

Question 45

what type of carcinoma is gall bladder carcinoma?

Answer 45

adenocarcinoma