Cell injury: fat necrosis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Cell injury: fat necrosis

Sample item

A 45-year-old man with severe epigastric pain and raised serum lipase undergoes laparotomy and has chalky white foci scattered over the omentum. What is the mechanism behind these foci?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Lipase-mediated triglyceride breakdown, with fatty acids combining with calcium to form soaps

Acute pancreatitis releases pancreatic lipases that digest the triglycerides of fat cells. The liberated fatty acids bind calcium in a process called saponification, producing the chalky white deposits of enzymatic fat necrosis. The calcium binding can contribute to hypocalcaemia in severe pancreatitis.

Option by option

  • A. Lipase-mediated triglyceride breakdown, with fatty acids combining with calcium to form soaps (correct)

    Correct. Lipase digestion followed by calcium soap formation produces enzymatic fat necrosis.

  • B. Ischaemic coagulation of omental fat from thrombosis of its vessels

    Vascular thrombosis would cause an infarct of omentum rather than chalky foci with raised lipase.

  • C. Deposition of immune complexes in omental vessel walls

    Immune complex vasculitis does not produce chalky saponified fat.

  • D. Granuloma formation with central caseation by mycobacteria

    Caseating granulomas appear grey-white and cheesy in tuberculosis, with no raised lipase.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Lipase-mediated triglyceride breakdown, with fatty acids combining with calcium to form soaps. Acute pancreatitis releases pancreatic lipases that digest the triglycerides of fat cells.

Why is "Ischaemic coagulation of omental fat from thrombosis of its vessels" not the answer?

Vascular thrombosis would cause an infarct of omentum rather than chalky foci with raised lipase.

Why is "Deposition of immune complexes in omental vessel walls" not the answer?

Immune complex vasculitis does not produce chalky saponified fat.

Why is "Granuloma formation with central caseation by mycobacteria" not the answer?

Caseating granulomas appear grey-white and cheesy in tuberculosis, with no raised lipase.

What concept does this question test?

It tests Cell injury: fat necrosis in Pathology. The liberated fatty acids bind calcium in a process called saponification, producing the chalky white deposits of enzymatic fat necrosis. The calcium binding can contribute to hypocalcaemia in severe pancreatitis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cell injury: fat necrosis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.