Pancreas pathology

Question 1

Define the pathophysiology of acute pancreatitis.


Answer 1

Pancreatic enzymes become activated, leading to autodigestion of the pancreas


Question 2

List five causes of acute pancreatitis.


Answer 2

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmunity, Scorpions, Hypercalcemia/triglyceridemia, ERCP, Drugs (sulfa) (GET SMASHED)


Question 3

You become concerned for acute pancreatitis when an alcoholic man complains of severe abdominal pain that radiates where?


Answer 3

Epigastric pain that radiates to the back


Question 4

A patient has acute epigastric pain radiating to the back. What two values will be elevated, characterizing his disorder?


Answer 4

Amylase and lipase levels will likely be elevated (the patient has acute pancreatitis)


Question 5

Which has higher specificity for acute pancreatitis: amylase or lipase?


Answer 5

Lipase (amylase can be elevated in other disorders such as mumps)


Question 6

A 67-year-old woman is admitted with acute pancreatitis. For what major complications should you be vigilant?


Answer 6

DIC, ARDS, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage, infection, multisystem organ failure


Question 7

How does acute pancreatitis lead to hypocalcemia?


Answer 7

Ca2+ collects in pancreatic soap deposits, causing hypocalcemia


Question 8

A man has a CT done for persistent pain after acute pancreatitis. The pathologic structures (arrows in image) are lined by what tissue type?


Answer 8

Granulation tissue (these are pancreatic pseudocysts)


Question 9

A man with nausea and epigastric abdominal pain radiating to the back asks about major complications from his illness. What do you tell him?


Answer 9

Pancreatic pseudocysts (if he has them) can rupture and hemorrhage


Question 10

Laparotomy of a patient with abdominal pain reveals chalky white deposits. What are some causes of this condition?


Answer 10

Causes include gallstones, ethanol, trauma, steroids, mumps, autoimmune disease (remember GET SMAshed) (this is acute pancreatitis)

Question 11

Chronic calcifying pancreatitis is strongly associated with what etiology? What is another common cause?


Answer 11

Idiopathic; alcoholism


Question 12

In an alcoholic woman with chronic pancreatitis, what symptoms would raise your suspicion for pancreatic insufficiency?


Answer 12

Steatorrhea, fat-soluble vitamin deficiency, diabetes mellitus


Question 13

An increased risk of pancreatic cancer is associated with which kind of pancreatitis (acute or chronic)?


Answer 13

Chronic


Question 14

In a patient just admitted to your service, how can amylase and lipase levels differentiate chronic pancreatitis from acute pancreatitis?


Answer 14

Amylase and lipase levels might be normal in chronic pancreatitis but are almost always elevated in acute pancreatitis


Question 15

A patient with a symptomatic CFTR mutation complains of greasy, foul-smelling stools. Is screening for diabetes merited?


Answer 15

Yes (patient has cystic fibrosis and may be developing steatorrhea from pancreatic insufficiency), screening for diabetes is reasonable

Question 16

You diagnose a woman with pancreatic adenocarcinoma and she immediately asks about the prognosis. How do you respond?


Answer 16

The prognosis is poor—average survival is ~1 year after diagnosis, as it has typically already metastasized at the time of diagnosis


Question 17

A patient presents with weight loss, night sweats, and painless jaundice. Where is the tumor most likely located?


Answer 17

The pancreatic head (jaundice with a nontender, palpable gallbladder is the Courvoisier sign, associated with pancreatic adenocarcinoma)


Question 18

A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be expected?


Answer 18

Increased alkaline phosphatase and bilirubin levels, indicating obstructive jaundice


Question 19

Obstructive jaundice with a palpable, nontender gallbladder on abdominal exam is known as what?


Answer 19

Courvoisier sign (associated with pancreatic adenocarcinoma, but also possibly due to other acute distal bile duct obstructions)


Question 20

You find redness and tenderness on palpation of the extremities in a patient with pancreatic adenocarcinoma. What is this sign called?


Answer 20

Trousseau syndrome, or migratory thrombophlebitis


Question 21

What two ethnic groups have an increased risk for pancreatic cancer?


Answer 21

Jewish and African-American male groups


Question 22

Which two tumor markers are commonly associated with pancreatic cancer? Which is more specific for the disease?


Answer 22

CA 19-9 (more specific) and carcinoembryonic antigen (CEA is less specific)


Question 23

Which is most likely to be a risk factor for pancreatic cancer: alcohol, cigarettes, or sulfa drugs?


Answer 23

Cigarettes


Question 24

What causes the weight loss associated with pancreatic adenocarcinoma?


Answer 24

Malabsorption and anorexia due to the disorganized glandular structure of the pancreas