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17 Cards in this Set
- Front
- Back
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Acute Pancreatitis
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acute onset of epigastric abdominal pain from enzymatic necrosis and inflammation
results in an elevation of pancreatic enzymes in blood and urine lipase -> fat necrosis if vasculature is involved -> hemorrhagic pancreatitits |
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Signs and symptoms of Acute Pancreatitis
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Abdominal pain is the big one
-epigastrium radiating to the back Patients can be in shock if vasculature has been comprimised and bradykinin and prostaglandin release (vasodilators) |
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Pathogenesis of Acute Pancreatitis
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GET SMASHeD
gallstones ethanol trauma steroids mumps autoimmue disease scorpion stings hyperlipidemia Drugs -leads to autodigestion |
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Mechanisms of Pancreatic Injury
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gallstone blocks duct - causes edema - impairs blood flow - ischemic injury of acinar cells
direct injury defective transport of enzymes |
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Morphology of Acute Pancreatitis
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see necrosis of blood vessels, interstitial hemorrhage, necrosis of fat by lipolyc enzymes - Look like white deposits
pseudocysts - liquified tissue and material walled off by fibrous tissue |
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Lab Values in Acute Pancreatitis
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increase in serum amylase (2-3 days)
increase in serum lipase (7-10 days) patients are hypocalcemic CT is best way to assess pacreas - see calcification and pseudocysts when they recover - do workup for gallstones |
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Clinical course of Acute Pancreatitis
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pancreatic necrosis is medical emergency
needs to be differentiate from appendicitis cholecystitis with rupture perforated peptic ulcer bowel infarction 5% of patients will die of shock if untreated in the first week |
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Chronic Pancreatitis
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repeated bouts of mild pancreatic inflammation - leads to loss of parenchyma - replaced by fibrous tissue
middle aged male - alcoholics hypercalcemia and hyperlipoproteinemia |
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Signs and Symptoms of Chronic Pancreatitis
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repeated attacks of abdominal pain - or can be persistent - radiating to back
recurrent attacks of jaundice random episodes of indigestion |
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Pathogenesis of Chronic Pancreatitis
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ductal obstruction by concreations
interstitial fat necrosis and hemorrhage |
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Morphology of Chronic Pancreatitis
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fibrosis and atrophy of exocrine pancreas
- islets may be spared - chronic inflammatory inflitrate - protein plugs - psuedocysts |
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Diagnosis of Chronic Pancreatitis
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high index of suspicion
mild amylase and lipase elevations CT shows calcification and psuedocysts test function by injections of secretin and CCK |
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Complications of Chronic Pancreatitis
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psuedocyst formation
pancreatic exocrine insufficiency chronic malabsorption DM Chronic Ab. Pain |
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Carcinoma of Pancreas
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increased in smokers
mutations in Kras and p53 arise in exocrine pancreas |
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Signs and Symtoms of Pacnreatic Carcinoma
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usually remain silent until bile duct becomes blocked
"painless jaundice" can erode nerves causing pain, in late stages tumor arises in head of pancreas most often Migratory Thrombophlebitis (Trousseau's sign) |
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Morphology of Pancreatic Carcinoma
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ductal origin - mucin or non-mucin producing
most often in the head of pancreas will remain silent, longer in tail node invovled, mets to liver and bone |
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Labs and Prognosis of Pancreatic Carcinoma
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many markers - no single one used
poor prognosis - live less than a year can use whipple procedure, depending on tumor location |
