WBR0805
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| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Embryology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[Prompt::A 36-year-old man presents to the emergency department for right upper quadrant abdominal pain and jaundice. His temperature is 38.5 °C (101.3 °F), heart rate is 96/min, and a blood pressure is 118/78 mmHg. Following initial work-up, the diagnosis of acute cholangitis is made. During endoscopic retrograde cholangiopancreatography (ERCP), the patient is found to have 2 distinct pancreatic duct openings. Which of the following embryologic processes likely failed to occur in this patient?]] |
| Answer A | AnswerA::Fusion |
| Answer A Explanation | AnswerAExp::Pancreatic divisum is caused by failure of fusion of the dorsal and ventral ducts. |
| Answer B | AnswerB::Apoptosis |
| Answer B Explanation | AnswerBExp::Pancreatic divisum is not due to failed apoptosis. |
| Answer C | AnswerC::Differentiation |
| Answer C Explanation | AnswerCExp::Pancreatic divisum is not due to failed differentiation. |
| Answer D | AnswerD::Proliferation |
| Answer D Explanation | AnswerDExp::Pancreatic divisum is not due to failed proliferation. |
| Answer E | AnswerE::Recanalization |
| Answer E Explanation | AnswerEExp::Pancreatic divisum is not due to failed recanalization. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Pancreatic divisum is considered the most common variant of pancreatic ductal configuration that occurs in approximately 10% of the population. It is caused by failure of fusion of the dorsal and the ventral pancreatic ducts. Most patients with pancreatic divisum are asymptomatic and the diagnosis is based on incidental findings during ERCP. Only the minority of patients with pancreatic divisum are symptomatic and generally complain of non-specific recurrent abdominal pain and episodes of pancreatitis. Although no definitive cause for the symptoms has been confirmed, it is believed that the partial obstruction of pancreatic fluid at the level of the minor papilla causes an elevated pressure within the ducts and leads to pancreatitis. Symptomatic treatment for such patients is endoscopic sphincterotomy. Educational Objective: Pancreatic divisum is the most common congenital variant of pancreatic ductal configuration. It is caused by the failure of fusion of the distal and ventral pancreatic ducts leading to 2 distinct ducts. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Pancreatic divisum, WBRKeyword::Pancreas divisum, WBRKeyword::Pancreas, WBRKeyword::Differentiation, WBRKeyword::Failure, WBRKeyword::Cholangitis, WBRKeyword::Jaundice, WBRKeyword::Abdominal pain |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |