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31

2 most common causes of acute pancreatitis

Biliary tract disease and alcoholism. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 884

32

A 32 y/o male presented with abdominal pain, nausea, and vomiting. Pain was described as constant and intense with radiation to the upper back. Lab result showed elevated plasma amylase. The clinical impression is:

Acute pancreatitis (TOPNOTCH)

33

Morphology: mild inflammation, interstitial edema, and focal fat necrosis in the pancreas and peripancreatic fat.

Acute interstitial pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887

34

Morphology: pancreatic substance is red-black form hemorrhage and contains interspersed foci of yellow-white, chalky fat necrosis. Peritoneal cavity contains serous, turbid, brown-tinged fluid containing globules of fat.

Acute necrotizing pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887

35

Morphology: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within the substance of the gland.

Hemorrhagic pancreatitis (TOPNOTCH)

36

Clinical features include intermittent or persistent abdominal pain, intestinal malabsorption, and diabetes. It is characterized by irreversible injury of the pancreas.

Chronic pancreatitis. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 889

37

A 53 y/o male, smoker, presented with abdominal pain, weight loss, and jaundice since 1 month. The abdominal CT revealed a mass on the pancreas. What part of the pancreas is most likely affected?

Head of the pancreas. Obstructive jaundice is associated with most cases of carcinoma of the head of the pancreas. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P. 894

38

Migratory thrombophlebitis occuring in pancreatic cancer due to elaboration of PAF and procoagulants from the carcinoma or its necrotic products.

Trosseau sign(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 894

39

Most patients with this disease present with abdominal pain and weight loss, sometimes accompanied by jaundice and DVT, and succumb to the disease within 1 to 2 years.

Pancreatic cancer(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 895

40

Poorly defined cyst with a necrotic brown-black wall, lacks epithelial lining. It is usually solity and may be situated within the pancreas or in the lesser omental sac or in the retroperitoneum. Formed when areas of intrapancreatic or peripancreatic hemorrhagic fat necrosis are walled off by fibrous tissue and granulation tissue.

Pancreatic pseudocysts(TOPNOTCH)Robbins Basic Pathology, 9th ed., pg. 890

41

A 44 year old alcoholic woman has been having intermittent postprandial epigastric pain of 5 years. An imaging study done showed a solitary 3 cm cyst at the anterior portion of his pancreatic head. Fearing the worst, she opts to undergo a Whipple procedure, and the definitive specimen showed a cyst with a smooth internal surface and surrounding fibrosis. Microscopic examination showed a cyst wall lined by fibrin, granulation tissue, and chronic inflammation. There is no epithelial lining observed. The cyst (A) is a common sequela of acute pancreatitis (B) is hormonally responsive to estrogen (C) is a precursor to pancreatic adenocarcinoma (D) is known to harbor K-RAS mutations

is a common sequela of acute pancreatitis (pancreatic pseudocyst) is (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 680.

42

Which of the following is associated with an increased risk of pancreatic carcinoma? (A) smoking (B) chronic pancreatitis (C) diabetes mellitus (D) all of the above

all of the above is (TOPNOTCH) Robbins Basic Pathology, 8th ed., 683