Flashcards in Pancreatic Pathology Deck (11)
What is acute pancreatitis?
- auto-digestion of the pancreas via inappropriate activation of the pancreatic proteolytic enzymes
Symptoms of Acute Pancreatitis
- epigastric deep, searing pain that radiates to the back; anorexia, nausea
What are two major clinical signs of acute pancreatitis? What are they caused by? How patients usually present?
- Cullen's sign: bruising around the umbilicus
- Grey-Turner's sign: bruising around the flanks
- they are caused by retroperitoneal hemorrhage
- patients complain of epigastric pain that radiates to the back; anorexia and nausea, as well
What is the best investigation for diagnosing acute pancreatitis?
- look at the patient's lipase levels (and amylase)
- these levels should be at least 3x greater than the upper limit of normal
- (lipase is very unique to the pancreas)
What are the causes of pancreatitis? Which are the two most common?
- idiopathic, gallstones (2nd most), ethanol (most common), trauma, steroids, mumps/malignancy, autoimmune, scorpion sting, hypertriglycerides/hypercalcemia, ERCP (a surgical procedure), drugs (sulfa drugs)
What are some complication of acute pancreatitis?
- Ca2+ deficiency (due to a saponification reaction: activated lipase increases amount of free fatty acids which bind to calcium, forming an insoluble complex)
- DIC (disseminated intravascular coagulation) resulting in Grey-Turner's and Cullen's signs
- shock due to massive exudation of plasma
- MODS (especially ARDS, which is the major cause of death in these patients; many patients will be short of breath)
- pancreatic pseudocysts (these can rupture and hemorrhage; cause obstruction; get infected)
What are 2 developmental malformations of the pancreas?
- annular pancreas: ventral pancreatic bud encircles the 2nd part of the duodenum, resulting in a ring that can cause duodenal obstruction
- pancreas divisum: failure of the ventral and dorsal pancreatic buds to fuse
What type of necrosis is seen in acute pancreatitis?
- both liquifactive and fat necrosis
- liquifactive from the actual pancreas because of the enzymes
- fat from the surround peri pancreatic fat
What is the major cause of chronic pancreatitis in adults? In children?
- adults: alcoholism and idiopathic
- children: cystic fibrosis
What are some complications of chronic pancreatitis?
- pancreatic insufficiency: steatorrhea, malabsorption, fat-soluble vitamin deficiency, diabetes mellitus, pancreatic adenocarcinoma
- (because of the insufficiency, amylase and lipase levels may no longer be elevated)