Pancreatitis: Pathology review

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Pancreatitis: Pathology review



Pancreatitis: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 58-year-old woman with a history of chronic alcohol use disorder comes to the office because of diarrhea, generalized weakness, and a 6.8-kg (15-lb) weight loss over the past 6 months. She reports intermittent dull upper abdominal pain that will last for days at a time and is not improved with antacids. After meals, she feels that her abdomen is distended. She characterizes her multiple daily bowel movements as greasy, foul-smelling, and oily. She recently was the driver involved in a minor traffic accident, which she attributes to worsening eyesight at night. Her temperature is 37.0°C (98.6°F), pulse is 78/min, respirations are 16/min, and blood pressure is 135/85 mmHg. Abdominal examination shows resonance to percussion throughout and a mildly tender epigastrium. Bowel sounds are hyperactive. Laboratory values show the following:  
 Laboratory value  Result 
 Calcium, serum  7.6 mg/dL 
 Partial thromboplastin time  60 seconds 
 Prothrombin time  28 seconds 

Which of the following is the most likely etiology of this patient's diarrhea?


While in the Emergency Department, two individuals came in with severe epigastric pain. Michael who is 45, complains of pain that radiates to his back, vomiting, and nausea.

All of these symptoms appeared after he came home from partying at the bar a few hours ago.

On the clinical examination, there’s epigastric tenderness without guarding or rebound, decreased bowel sounds, and purple discoloration around the periumbilical region. He also tends to bend over to relieve the pain.

Anna, who is 29 years old, on the other hand, says the pain started abruptly and that it doesn’t radiate anywhere. She also noticed it gets worse after her meals. On examination, she presents with epigastric pain, scleral icterus, and fever.

Both were admitted and started on IV fluids.

Blood tests were ordered, which revealed lipase and amylase levels that were 3 times more than normal.

Ok, so from what we can gather, both people have acute pancreatitis.

Let’s begin with a bit of physiology. The pancreas is located in the epigastric region, behind the stomach, and it is mostly a retroperitoneal organ.

It has both endocrine functions, by releasing hormones like insulin and glucagon, and exocrine functions by secreting enzymes needed for food digestion.

The exocrine pancreas releases digestive enzymes through smaller ducts which drain in the main pancreatic duct.

The main pancreatic duct, which travels through the length of the pancreas, joins the common bile duct at the ampulla of Vater and drains into the duodenum.

Now, the main pancreatic enzymes include pancreatic amylase which breaks down carbohydrates; trypsin and chymotrypsin, which break down proteins; and lipase which breaks down lipids.

To protect the pancreas from destroying itself, the acinar cells of the pancreas manufacture zymogen, or the inactive form, of trypsin, called trypsinogen.


Pancreatitis refers to inflammation of the pancreas, an organ located behind the stomach that produces hormones and enzymes that help the body digest food. Pancreatitis can be acute or chronic.

Acute pancreatitis occurs when there is a sudden and severe inflammation, which usually resolves within a few days with proper treatment. It is commonly caused by gallstones and alcohol, and typically presents with epigastric pain that radiates to the back, nausea, vomiting, and decreased bowel sounds.

Chronic pancreatitis occurs when there is a long-term inflammation that can cause permanent damage to the pancreas and lead to serious complications. It is usually due to long-term alcohol use, genetic diseases like SPINK1 mutations and cystic fibrosis, pancreatic duct obstruction due to tumors, and autoimmune conditions.

People with chronic pancreatitis may be initially asymptomatic for a long time, but they might develop epigastric pain that radiates to the back, steatorrhea, fat-soluble vitamin deficiency like vitamin A, D, or E; diabetes, and unintentional weight loss.


  1. "Fundamentals of Pathology" H.A. Sattar (2017)
  2. "Robbins Basic Pathology" Elsevier (2017)
  3. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  4. "Chronic Pancreatitis: Challenges and Advances in Pathogenesis, Genetics, Diagnosis, and Therapy" Gastroenterology (2007)
  5. "Acute pancreatitis" The Lancet (2015)
  6. "The Epidemiology of Pancreatitis and Pancreatic Cancer" Gastroenterology (2013)
  7. "Laparostomy management using the ABThera™ open abdomen negative pressure therapy system in a grade IV open abdomen secondary to acute pancreatitis" International Wound Journal (2012)
  8. "Drug-Induced Acute Pancreatitis" Baylor University Medical Center Proceedings (2008)

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