What is annular pancreas?
- Developmental malformation where pancreas forms ring around duodenum.
- Risk of duodenal obstruction
Describe acute pancreatitis
Acute pancreatitis is reversible enzymatic digestion of pancreas with hemorrhagic damage
(pancreas has lots of blood supply).
-
acute pancreatitis, it’s etiology
Etiology
○ EtOH and gallstones cause >75% of cases
EtOh causes contraction of sphincter of oddi which slows drainage of pancreatic
enzymes –> risking premature activation of enzymes in pancreas
○other
Trauma (ex - automobile accident)
Hypercalcemia (Ca is activator of enzymes)
Hyperlipidemia (
Cystic fibrosis (In CF, low bicarb and water drainage to pancreatic ducts; slow flow
and thick enzyme –> enzyme activation)
Drugs, scorpion venom
Mumps
Rupture of duodenal ulcer
acute pancreatitis pathophysiology
Activation of trypsinogen is the first step that cause activation of other enzymes
acute pancreatitis presentation.
○ Epigastric pain radiating to back (pancreas is secondary retroperitoneal organ)
○ Nausa, vomiting
○ Periumbilical and flank hemorrhage
How do you diagnose acute pancreatitis?
- Elevated lipase (3 times normal) - most commonly used in diagnosis
- Elevated amylase
- Hypocalcemia - fat necrosis of peripancreatic fat uses up Ca in blood - poor prognotic indicator
What is complication of acute pancreatitis?
Shock - pancreas is very vascular so damage can lead to tons of hemorrhage
Pancreatic pseudocyst -
Pt has abdominal mass with persistent increased in amylase after acute pancreatitis.
Pseudocyst rupture cause release of enzyme and digestion and hemorrhage of gut.
○ Usually due to E.Coli. Pt presents with persistently increased amylase.
- Pancreatic abscess
- DIC - enzymes get on blood, digest coagulation factors
- ARDS - enzymes get to blood, go to lungs and damage alveoli-capillary interface
What causes chronic pancreatitis
Chronic pancreatitis is fibrosis of pancreatic parenchyma which occurs after multiple bouts of
acute pancreatitis
-
chronic pancreatitis Etiology
EtOH (most common in adults)
○ Cystic fibrosis (most common in kids)
○ Idiopathic
These etiologies cause repeated attack to pancreas. Other etiology of acute pancreatitis (ex -
hypercalcemia, scorpion bite etc happen only once or so.
What are features of chronic pancreatitis?
- Epigastric pain radiating to back
○ Leads to malabsorption with steatorrhea
○ Fat soluble vitamin deficiency - Pancreatic insufficiency (small fibrosed pancreas)
- Dystrophic calcification of pancreas
- 20 DM in late phase - due to damage of islet cells
- High risk of pancreatic carcinoma
Why are serum lipase and amylase not good marker for chronic pancreatitis?
Because in chronic pancreatitis, pancreas don’t produce much enzyme so enzymes aren’t
elevated in blood.
Describe pancreatic adenocarcinoma, it’s risk factor and patient population
It’s adenocarcinoma arising from pancreatic ducts
- Most commonly seen in elderly
○ Smoking and chronic pancreatitis
- Major risk factor (HY) -
What is presentation of pancreatic adenocarcinoma?
f tumor in head of pancreas - obstructive jaundice with pale stool, palpable gallbladder (blocking
of common bile duct)
If tumor in body or tail or pancreas - 20 DM
- Acute pancreatitis - due to obstruction of duct
Migratory thrombophelebitis
Swelling, erythema and tenderness of extremities
- Serum tumor marker is CA 19-9
What is prognosis and treatment of pancreatic adenocarcinoma?
Very poor - prognosis (1 year survival <10%)
- Treatment is whipple procedure - take out head & neck of pancreas, duodenum and gall bladder
