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Flashcards in Pancreatic Pathology Deck (11)
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1
Q

What is acute pancreatitis?

A
  • auto-digestion of the pancreas via inappropriate activation of the pancreatic proteolytic enzymes
2
Q

Symptoms of Acute Pancreatitis

A
  • epigastric deep, searing pain that radiates to the back; anorexia, nausea
3
Q

What are two major clinical signs of acute pancreatitis? What are they caused by? How patients usually present?

A
  • 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
4
Q

What is the best investigation for diagnosing acute pancreatitis?

A
  • 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)
5
Q

What are the causes of pancreatitis? Which are the two most common?

A
  • “I.G.E.T.S.M.A.S.H.E.D.”
  • idiopathic, gallstones (2nd most), ethanol (most common), trauma, steroids, mumps/malignancy, autoimmune, scorpion sting, hypertriglycerides/hypercalcemia, ERCP (a surgical procedure), drugs (sulfa drugs)
6
Q

What are some complication of acute pancreatitis?

A
  • 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)
7
Q

What are 2 developmental malformations of the pancreas?

A
  • 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
8
Q

What type of necrosis is seen in acute pancreatitis?

A
  • both liquifactive and fat necrosis
  • liquifactive from the actual pancreas because of the enzymes
  • fat from the surround peri pancreatic fat
9
Q

What is the major cause of chronic pancreatitis in adults? In children?

A
  • adults: alcoholism and idiopathic

- children: cystic fibrosis

10
Q

What are some complications of chronic pancreatitis?

A
  • 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)
11
Q

What is the mortality rate associated with acute pancreatitis?

A
  • a massive 20-25% due to the multi organ failure that can result