Acute pancreatitis

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Acute pancreatitis



Acute pancreatitis


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USMLE® Step 1 questions

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High Yield Notes

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Acute pancreatitis

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USMLE® Step 1 style questions USMLE

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A 44-year-old man comes to the emergency department with abdominal pain and nausea for the past 24 hours. The pain started a few hours after dinner, and he describes it as a constant pain in the upper part of his abdomen that radiates to his back and flanks. The patient also reports nausea, intermittent vomiting, and abdominal distention. Family history is significant for recurrent episodes of pancreatitis in his father and paternal uncle. He reports drinking an average of 2 alcoholic drinks per week. His temperature is 37.7ºC (99.9ºF), pulse is 92/min, respirations are 20/min, peripheral oxygen saturation is 96%, and blood pressure is 149/94 mmHg. He appears distressed and anxious. Abdominal examination shows tenderness and rigidity over the epigastric and periumbilical regions. Bowel sounds are diminished. No bruising of the umbilicus or flanks are seen. Which of the following laboratory results is the most specific in diagnosing this patient’s condition?  

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Acute pancreatitis p. 406

associations p. 730

DIC and p. 730

hyperparathyroidism p. 344

necrosis and p. 207

Acute respiratory distress syndrome (ARDS) p. NaN

acute pancreatitis p. 406

Cholelithiasis p. 405

acute pancreatitis p. 405


acute pancreatitis p. 406

Hypercalcemia p. 615

acute pancreatitis and p. 406

Hypertriglyceridemia p. 92

acute pancreatitis and p. 406

Hypocalcemia p. 337, 615

acute pancreatitis and p. 406

Mumps p. 167

acute pancreatitis with p. 406

Necrosis p. 207

acute pancreatitis p. 406

Organ failure, in acute pancreatitis p. 406

Protease inhibitors

acute pancreatitis p. 406


acute pancreatitis p. 406

Sulfa drugs p. 253

acute pancreatitis p. 406


Content Reviewers

Acute pancreatitis is the sudden inflammation and hemorrhaging of the pancreas due to destruction by its own digestive enzymes—a process fittingly called autodigestion.

Most of the time the disease is actually relatively mild, but it can easily become severe, so it's critical to diagnose and treat it quickly.

The pancreas is a long, skinny gland the length of a dollar bill and is located in the upper abdomen, or the epigastric region, behind the stomach.

It plays endocrine roles—for example, alpha and beta cells make hormones like insulin and glucagon that are secreted into the bloodstream, but it also plays exocrine roles— for example, acinar cells make digestive enzymes that are secreted into the duodenum to help digest food.

These pancreatic digestive enzymes break down macromolecules like carbohydrates, lipids and proteins found in food, but these macromolecules are also found in the cells of the pancreas.

To protect the pancreas, the acinar cells manufacture inactive forms of the enzymes called proenzymes, or zymogens.

These zymogens are normally activated by proteases which cleave off a polypeptide chain, which is kind of like pulling the pin on a grenade.

For additional security, the zymogens are kept away from sensitive tissues in storage vesicles called zymogen granules, and are packaged with protease inhibitors that prevent enzymes from doing damage if they become prematurely active.

To digest a meal, these zymogens are released into the pancreatic duct, and delivered to the small intestine where they are activated by the protease trypsin.

Trypsin is a pancreatic digestive enzyme that is produced as the zymogen trypsinogen.

Normally, trypsinogen isn’t activated until it is cleaved by protease enteropeptidase which is found in the duodenum. But if trypsinogen and these zymogens become activated too early, then it can cause acute pancreatitis, and this might happen as a result of any injury to the acinar cells, or anything that prevents the normal secretion of the proenzymes into the duodenum.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Acute Pancreatitis" The American Journal of Nursing (1935)
  4. "Practice Guidelines in Acute Pancreatitis" The American Journal of Gastroenterology (2006)
  5. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  6. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)

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