CH11 - Exocrine Pancreas, Gallbladder, and Liver Pathology Flashcards Preview

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Flashcards in CH11 - Exocrine Pancreas, Gallbladder, and Liver Pathology Deck (216)
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1

What is annular pancreas?

Developmental malformation in which the pancreas forms a ring around the duodenum

2

In annular pancreas what is there a risk of?

duodenal obstruction

3

What is acute pancreatitis?

Inflammation and hemorrhage of the pancreas

4

What is acute pancreatitis due to?

autodigestion of pancreatic parenchyma by pancreatic enzymes

5

What does premature activation of trypsin lead to?

activation of other pancreatic enzymes

6

What does acute pancreatitis result in?

liquefactive hemorrhagic necrosis of the pancreas and fat necrosis of the peripancreatic fat

7

What is acute pancreatitis most commonly due to?

alcohol and gallstones;

8

Beside alcohol and gallstones what are some other causes of acute pancreatitis?

include trauma, hypercalcemia, hyperlipidemia, drugs, scorpion stings, mumps, and rupture of a posterior duodenal ulcer

9

What are the clinical features for acute pancreatitis?

1) Epigastric abdominal pain that radiates to the back 2) Nausea and vomiting 3) Periumbilical and flank hemorrhage 4) Elevated serum lipase and amylase - lipase is more specific for pancreatic damage 5) Hypocalcemia - calcium is consumed during saponification in fat necrosis

10

In acute pancreatitis why is there periumbilical and flank hemorrhage?

necrosis spreads into the periumbilical soft tissue and retroperitoneum

11

In acute pancreatitis why is there elevated serum lipase and amylase?

lipase is more specific for pancreatic damage

12

What are the complications for acute pancreatitis?

1. Shock 2. Pancreatic pseudocyst 3. Pancreatic abscess 4. DIC and ARDS

13

In acute pancreatitis why is shock one of the complications?

Its due to peripancreatic hemorrhage and fluid sequestration

14

In acute pancreatitis what happens in pancreatic pseudocyst?

Its formed by fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes

15

How does a pancreatic pseudocyst present?

as an abdominal mass with persistently elevated serum amylase

16

What happens when a pancreatic pseudocyst ruptures?

it is associated with release of enzymes into the abdominal cavity and hemorrhage.

17

What is pancreatic abscess often due to?

Ecoli

18

How does pancreatic abscess present?

with abdominal pain, high fever, and persistently elevated amylase

19

What happens in chronic pancreatitis?

Fibrosis of pancreatic parenchyma, most often secondary to recurrent acute pancreatitis

20

What is chronic pancreatitis most commonly due to?

Alcohol in adults and cystic fibrosis in children, many cases are idiopathic.

21

What does acute pancreatitis leading to pancreatic insufficiency result in?

malabsorption with steatorrhea and fat soluble vitamin deficiencies. Amylase and lipase are not useful serologic markers of chronic pancreatitis.

22

What are the clinical features of acute pancreatitis?

1. epigastric abdominal pain that radiates to the back 2. Pancreatic insufficiency 3. Dystrophic calcification of pancreatic parenchyma on imaging, contrast studies reveal a [chain of lakes] pattern due to dilatation of pancreatic ducts. 4. Secondary diabetes mellitus 5. Increased risk for pancreatic carcinoma

23

In acute pancreatitis why is there a chain of lakes pattern on contrast studies?

It is due to the dilation of pancreatic ducts and dystrophic calcification of pancreatic parenchyma

24

How is secondary diabetes mellitus related to acute pancreatitis?

It?s a late complication due to destruction of the islets

25

What is pancreatic carcinoma?

Adenocarcinoma arising from the pancreatic ducts

26

What is pancreatic carcinoma most commonly seen in?

the elderly (average age is 70 years)

27

What are the major risk factors for pancreatic carcinoma?

smoking and chronic pancreatitis.

28

What are the clinical features for pancreatic carcinoma?

They usually occur late in disease. 1. Epigastric abdominal pain and weight loss 2. Obstructive jaundice with pale stools and palpable gallbladder 3. Secondary diabetes mellitus 4. Pancreatitis 5. Migratory thrombophlebitis (Trousseau sign) 6. Serum tumor marker is CA 19-9

29

What tumor is secondary diabetes mellitus associated with?

It?s associated with tumors that arise in the body or tail

30

How does Trousseau sign present?

as swelling, erythema, and tenderness in the extremities (seen in 10% of patients)