11. Acute Pancreatitis Flashcards
What are the exocrine functions of the pancreas?
- secretes 1.5 - 3 L of fluid per day
- acinar cells secrete pancreatic enzymes
- alkaline secretion to neutralize gastric acid
What are the pancreatic enzymes and what cells produce them?
- proteoltic: trypsinogen
- amylolytic: amylase
- lipolytic: lipase
- secreted by the acinar cells
What are the endocrine functions of the pancreas?
- α cells: glucagon
- β cells: insulin
- δ cells: somatostatin
What is the path of secretion of the pancreas?
pancreatic duct → common bile duct → duodenum → enzymes activated
What are the 3 clinical findings that indicated pancreatitis?
- upper abdominal pain
- serum amylase or lipase > 3x the upper limit of normal
- visualized on imaging
What is Cullen’s sign?
Ecchymoses in the periumbilical region
What is Turner’s sign?
Ecchymoses on the flanks
Which enzyme remains elevated longest in pancreatitis and is a better indicator of pancreatitis?
lipase
Why does biliary disease or gallstone cause pancreatitis?
the obstruction leads to a reflux of bile/enzymes
Why does alcoholism cause pancreatitis?
- spasms of the sphincter of Oddi
- alcohol is toxic to the Acinar cells and disrupts enzyme synthesis
What are the pancreatitis treatment measures?
- supportive
- nutrition
- prevention of infection
- surgery
What is the agent of choice for fluid therapy?
crystalloids at 5-10 mL/kg/hr until resuscitated
- Ringer’s Lactate is preferred
How can the pancreas be “rested”?
NPO
nasogastric suction
When should oral nutrition be provided?
- when pain is decreased
- patient feels hungry
What are the preferences for enteral feeding in pancreatitis?
- elemental or polymeric nutrition
- nasojejunal or nasogastric route
When is parenteral nutrition indicated in pancreatitis?
- only if enteral is not tolerated and nutrition is needed
- very high risk
What is the drug of choice for pancreatitis pain?
parenteral narcotics
- morphine
- hydromorphone
- fentanyl
- meperidine is least preferred
What is the cause and result of spasms in the Sphincter of Oddi?
- cause: increase in biliary-tract pressure
- result: worsening pain/disease
What are local complications of pancreatitis?
- collection of pancreatic fluid
- pseudocysts
- necrosis
What is fluid collection and how is it resolved?
- a collection of pancreatic secretions
- usually resolves on its own
- persistant cysts need drainage
What are complications of necrosis?
- after 1 week of disease: risk of infection
- inflammation
- hypovolemia
- hypotension
- shunting of blood
What are the empiric agents of choice is pancreatic necrosis?
- carbapenems
- beta-lactams
- fluoroquinolones (+ metronidazole)
What organisms should be considered for pancreatic necrosis?
- enteric gram negative rods
- anaerobes
- enterococcus
What beta-lactams should be used empirically for pancreatic necrosis?
- Zosyn
- 3rd gen cephalosporins + metronidazole
The sphincter of Oddi regulates outflow of fluids and enzymes between which two anatomical structures? a. Gallbladder into the Pancreas b. Duodenum into the Pancreas c. Pancreas into the Duodenum d. Liver into Pancreas
c. Pancreas into the Duodenum
Which of the follow is NOT a main function of the pancreas?
a. Secrete digestive enzymes to help break down proteins
b. Store bile acids, which aid in digestion of fatty acids when released.
c. Contribute to glucose regulation
d. Neutralize gastric secretions
b. Store bile acids, which aid in digestion of fatty acids when released.
Diagnosis of acute pancreatitis is made using 3 criteria, which of the following is NOT one of the 3 criteria? a. Clinical presentation b. Laboratory data c. Family history d. Imaging
c. Family history
Medications are the most common cause of acute pancreatitis. (T/F)
False
What is the most common cause of acute pancreatitis?
a. Hypertriglyceridemia
b. Choledocholithiasis
c. Alcohol
d. Medications
b. Choledocholithiasis
