Acute Pancreatitis
The following statements are true of acute pancreatitis EXCEPT one:
What our notes say
- The following statements are true of acute pancreatitis EXCEPT one: (Internal Medicine 4th Year 1st Semester CAT: HIV and the gut, liver disease and )
- Discuss the early management of acute pancreatitis (8 marks) (Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology,)
- Topics tested: jaundice and liver tests, alcoholic liver disease, hepatitis B and C, primary biliary cirrhosis, NASH, Child-Pugh score, GI bleeding, acute pancreatitis, bone marrow failure, haemophilia and myelodysplasia. (Internal Medicine CAT 1 (MBChB 4), 2022: liver, pancreas and bone marrow, 30 MCQ)
- Acute pancreatitis typically gives a sentinel loop or colon cut-off sign. (Internal Medicine CAT 1 (MBChB 4), 2022: liver, pancreas and bone marrow, 30 MCQ)
- Probable diagnosis: acute pancreatitis (alcohol-induced). (Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019)
- Topics tested: HIV-related mouth, oesophageal and bowel disease, hepatitis B and C, non-alcoholic fatty liver disease, portal hypertension and varices, liver function tests, acute pancreatitis, cholera, peptic ulcer disease, and causes of rectal bleeding. (Internal Medicine 4th Year 1st Semester CAT: HIV and the gut, liver disease and )
Study material on Acute Pancreatitis
- Pancreatic Disorders: A Comprehensive Review
- Internal Medicine CAT 1 (MBChB 4), 2022: liver, pancreas and bone marrow, 30 MCQs and 2 short answers
- Internal Medicine 4th Year 1st Semester CAT: HIV and the gut, liver disease and pancreatitis, 30 MCQs and 2 short answers
- Clinical Enzymes: Functions and Applications
- Clinical Enzymology and Biomarkers
- Gastrointestinal and liver
- Pancreatic Disorders: A Comprehensive Review
- Pancreatic Disorders: A Comprehensive Review
- CLINICAL BIOCHEMISTRY MCQs
Practice questions on Acute Pancreatitis
A patient develops acute pancreatitis. Areas of fat necrosis in the peritoneum appear as chalky-white deposits. This appearance is due to:
- Deposition of fibrin from vascular injury
- Accumulation of cholesterol crystals
- Formation of calcium soaps (saponification)
- Infiltration by neutrophils with myeloperoxidase
Answer: C. In fat necrosis, pancreatic lipases break down triglycerides to fatty acids, which combine with calcium to form calcium soaps—visible as chalky-white areas. This is saponification. This type of necrosis is specific to enzymatic fat breakdown, distinguishing it from other forms. ---
In acute pancreatitis, which histological finding distinguishes it from chronic pancreatitis?
- Extensive parenchymal fibrosis
- Neutrophilic inflammation and enzymatic fat necrosis
- Atrophy of acini
- Ductal squamous metaplasia
Answer: B. Acute pancreatitis is characterized by edema, proteolysis, fat necrosis, and acute inflammation (neutrophils). Chronic pancreatitis is defined by irreversible fibrosis and atrophy. ---
In acute pancreatitis, which histological finding distinguishes it from chronic pancreatitis?
- Presence of fibrosis
- Necrotic acini with preservation of ducts
- Atrophy of islets of Langerhans
- Protein plugs in ducts
Answer: B. Acute pancreatitis shows necrotic acini but ducts are characteristically preserved. Chronic pancreatitis shows fibrosis and protein plugs. ---
A patient with acute pancreatitis develops chalky-white areas in the peritoneal cavity. What is the mechanism of this pathologic finding?
- Dystrophic calcification of necrotic tissue
- Release of pancreatic lipases causing fat necrosis with saponification
- Liquefactive necrosis of adipose tissue
- Bacterial infection of peritoneal fat
Answer: B. In acute pancreatitis, pancreatic enzymes leak and liquefy fat cell membranes, releasing triglycerides. Pancreatic lipases split these into fatty acids, which combine with calcium to produce grossly visible chalky-white areas (fat saponification), characteristic of fat necrosis. ---
Which is MORE sensitive AND specific for acute pancreatitis — amylase or lipase?
- Amylase (rises earlier and stays elevated longer)
- Lipase (more sensitive AND more specific; remains elevated longer than amylase)
- Both are equivalent
- Neither; CT is the only reliable test
Answer: B. Lipase: more sensitive (~95%) and more specific for acute pancreatitis than amylase. Lipase remains elevated 7–14 days vs amylase 3–5 days. Amylase is elevated in non-pancreatic conditions (salivary glands, perforated ulcer, renal failure). Lipase is preferred. ---
A patient with acute pancreatitis develops chalky-white areas in the peritoneal cavity. What is the mechanism of this pathologic finding?
- Coagulative necrosis of fat cells
- Liquefactive necrosis of pancreatic acinar cells
- Enzymatic digestion of adipose tissue by activated pancreatic enzymes (saponification)
- Accumulation of inflammatory exudate
Answer: C. In acute pancreatitis, activated pancreatic enzymes (lipases) escape into the surrounding tissues and digest adipose tissue. The released fatty acids combine with calcium ions to form insoluble calcium soaps, resulting in the characteristic chalky-white 'fat saponification' areas.