Back
ditki Logo
medical & biological sciences

Pancreatitis & Pancreatic Cancer for the USMLE Step 3

Start your One-Week Free Trial
Already subscribed? Log in »
Pancreatitis & Pancreatic Cancer for the USMLE Step 3
Overview
  • Pancreatitis refers to inflammation of the pancreas and can be classified into:
    • Acute pancreatitis: Reversible, sudden inflammation.
    • Chronic pancreatitis: Irreversible fibrosis and progressive loss of function.
Acute Pancreatitis
#
Etiology
  • Common causes include:
    • Gallstones: Cause bile duct obstruction.
    • Alcohol abuse: Toxic to pancreatic cells.
  • Other causes: Hypertriglyceridemia, hypercalcemia, medications (e.g., thiazides), and post-ERCP.
#
Pathophysiology
  • Premature activation of pancreatic enzymes within the pancreas leads to autodigestion, inflammation, and necrosis.
#
Clinical Presentation
  • Severe epigastric pain: Radiates to the back.
  • Nausea and vomiting.
  • In severe cases, Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (flank bruising) indicate hemorrhagic pancreatitis.
Cullen's Sign; Grey Turner's Sign
#
Diagnosis
  • Requires 2 of 3 criteria:
    • Characteristic abdominal pain.
    • Serum lipase or amylase >3 times normal (lipase is more specific).
    • Imaging (CT or ultrasound) showing inflammation or necrosis.
  • CT scan: Used to assess complications like necrosis or pseudocysts.
#
Management
  • Supportive care:
    • IV fluids, pain management, and NPO (nothing by mouth) for pancreatic rest.
  • ERCP: For biliary pancreatitis (gallstones).
  • Antibiotics: Only if necrosis is confirmed as infected.
Chronic Pancreatitis
#
Etiology
  • Most commonly due to chronic alcohol use.
  • Other causes: Cystic fibrosis in children, autoimmune, and genetic factors.
#
Pathophysiology
  • Chronic inflammation leads to fibrosis, loss of exocrine function (pancreatic enzymes), and endocrine function (insulin).
#
Clinical Presentation
  • Chronic epigastric pain: Radiates to the back, worsened by eating.
  • Pancreatic insufficiency: Steatorrhea (fat malabsorption) and diabetes.
#
Diagnosis
  • CT scan: Shows pancreatic calcifications, atrophy, or ductal dilation.
  • Fecal elastase: Measures exocrine function and is reduced in pancreatic insufficiency.
#
Management
  • Pancreatic enzyme replacement: Treats steatorrhea and malabsorption.
  • Pain control: NSAIDs or opioids for chronic pain.
  • Surgical intervention for complications or severe pain.
    • --
Pancreatic Cancer
Overview
  • Pancreatic adenocarcinoma is the most common form of pancreatic cancer, typically presenting late with a poor prognosis.
Risk Factors
  • Smoking, chronic pancreatitis, diabetes mellitus, and genetic mutations (e.g., BRCA1, BRCA2) increase the risk.
  • Obesity and high-fat diets are also risk factors.
Clinical Presentation
  • Painless jaundice: Classic symptom due to bile duct obstruction.
  • Weight loss, anorexia, and fatigue.
  • Abdominal pain: Often epigastric, radiating to the back.
  • New-onset diabetes: Particularly in older adults.
Diagnosis
  • CT scan with contrast: Preferred first test to identify masses and assess metastasis.
  • Endoscopic ultrasound (EUS): For biopsy and tumor staging.
  • CA 19-9: Tumor marker used for monitoring but not specific.
Management
#
Surgical
  • Pancreaticoduodenectomy (Whipple procedure): The only potential curative option for tumors in the pancreatic head, feasible in only about 20% of cases.
  • Distal pancreatectomy: For tumors in the body or tail of the pancreas.
#
Chemotherapy
  • Gemcitabine or FOLFIRINOX regimens are used in advanced or metastatic disease.
#
Palliative Care
  • Biliary stenting: For relief of jaundice in unresectable cases.
  • Pain management: Often requires opioids for cancer-related pain.
Key Points
  • Acute pancreatitis is most often caused by gallstones or alcohol, presenting with severe epigastric pain and elevated lipase.
  • Chronic pancreatitis results in fibrosis, leading to steatorrhea, malabsorption, and diabetes.
  • Pancreatic adenocarcinoma often presents with painless jaundice, weight loss, and is usually diagnosed late.
  • CT scan is the primary diagnostic tool for both pancreatitis and pancreatic cancer.
  • Whipple procedure is the only curative option for pancreatic cancer, but most patients present with advanced, unresectable disease.

Related Tutorials