Acute Pancreatitis

Question 1

Acute pancreatitis?

Answer 1

Reversible inflammation fo the pancreas

Question 2

Is acute pancreatitis local or systemic?

Answer 2

It can be systemic in which it would cause hypovolemia [life-threatening; severe]

Question 3

Islets of langerhan?

Answer 3

Endocrine cells that release hormones (glucagon and insulin) to control blood sugar.

Question 4

Duct cells?

Answer 4

Exocrine cells that release NaHCO3 to neutralize acid in the duodenum

Question 5

Acinar cells?

Answer 5

Exocrine cells that release digestive enzymes

Question 6

What is acute pancreatitis a result of?

Answer 6

Auto-digestion (pancreas digests/damages itself)

Question 7

Etiology of acute pancreatitis?

Answer 7

• Alcohol abuse (~70%)
• Gallstones
• Idiopathic
• Others -> injury to the pancreas, drugs that are toxic to pancreas, infection

Question 8

Explain the pathology of how gallstones cause acute pancreatitis.

Answer 8

Pancreatic enzymes are usually activated in the duodenum in the presence of bile, but if the bile activates the enzymes and then the enzymes meet the pancreas again, the tissue will be damaged. If a gallstone is obstructing the common bile duct, then bile will move along the path of least resistance and can back up into the pancreatic duct, bringing prematurely activated digestive enzymes to the pancreas -> auto-digestion. BV’s can be damaged and lead to hemorrhage. If destruction continues, necrosis will occur

Question 9

How does Alcohol contribute to acute pancreatitis?

Answer 9

Alcohol results in excess pancreatic secretion and also constricts the sphincter of oddi (excess of bile)

Question 10

Manifestations of acute pancreatitis.

Answer 10

• Severe abdominal pain in the epigastric or periumbilic region that can radiate to the back, chest, flank
• Massive 3rd spacing

Question 11

What does pain often follow?

Answer 11

An alcohol binge or heavy meal because you increase pancreatic secretion / constrict the sphincter of Oddi

Question 12

What can removing fluid from the vasculature lead to?

Answer 12

Hypovolemia, vascular collapse, and hypovolemic shock

Question 13

What kind of shock occurs?

Answer 13

Distributive shock d/t inability to transport blood with decreased TPR from decreased volume

Question 14

Diagnostics for acute pancreatitis?

Answer 14

• Labs : amylase, lipase
• Biomarkers: Tumor necrosis factor, trypsinogen
• US, CT

Question 15

What is the limitation to diagnosing based off the labs (amylase, lipase)?

Answer 15

Amylase and lipase are also secreted by the mouth

Question 16

Mild treatment for acute pancreatitis?

Answer 16

Even though it is self-limiting, it must be treated to prevent complications. Mild NPO because the pancreas increases secretion when eating which is the problem here.
- Manage pain and fluid + electrolytes

Question 17

Severe treatment for acute pancreatitis?

Answer 17

Pt will be in the ICU.

• IV opiates for pain
• renal -> hypovolemia affects perfusion of the kidneys resulting in decreased function and fluid imbalance
• some instances require surgery