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Old 10-13-2012
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Arrow Billy Step1 Questions # 28

A 63-year-old man who had worsening congestive heart failure with cardiac dysrhythmias in the last year of his life died
of pneumonia. At autopsy, his pancreas is grossly small and densely fibrotic. Microscopic examination shows extensive
atrophy of the acini with abundant collagenous interstitial fibrosis, but the islets of Langerhans appear normal. Inspissated
proteinaceous secretions are present in branches of the pancreatic duct. The heart weighs 500 g, and all four chambers
are dilated. What condition is most likely to account for these findings?


□ (A) αl-Antitrypsin deficiency
□ (B) Hypercholesterolemia
□ (C) Chronic alcoholism
□ (D) Blunt trauma to the abdomen
□ (E) Cholelithiasis
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Old 10-14-2012
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c) chronic alcoholism??
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Old 10-14-2012
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c a antitrypsin deficiency
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i m btw c and a....maybe c? because no emphysema mentioned? dont really know
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i would go with A, Alpha 1 antitrypsin deficiency
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Old 10-14-2012
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□ (C) Chronic alcoholism
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Old 10-14-2012
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Correct Answer C is correct

This patient has chronic pancreatitis. Alcohol promotes intracellular proenzyme activation that leads to acinar cell
injury. Chronic alcoholism also causes secretion of protein-rich pancreatic fluid, which is inspissated and deposited in
small pancreatic ducts. Ductal obstruction predisposes to acinar injury. Ongoing or repeated injury leads to chronic
pancreatitis. A dilated cardiomyopathy also can occur in chronic alcoholism, as in this case. A deficiency of α 1-antitrypsin
can produce liver disease with chronic hepatitis or cirrhosis, or both. Hypercholesterolemia can cause acute pancreatitis,
as can cholelithiasis. Blunt abdominal trauma can produce hemorrhage, sometimes with a component of acute
pancreatitis.
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