Acute Pancreatitis + Pancreatic Cancer

Question 1

What is Acute Pancreatitis?

Answer 1

In the most simplistic terms, it is inflammation of the pancreas. It can be a life-threatening condition in which the structural components of the pancreas are being auto digested.

Question 2

What are the causes of pancreatitis?

Answer 2

Alcohol abuse (70%), Gall Stones, Idiopathic (10%), Others

Question 3

What are some of the other causes of pancreatitis? (Other than EOH, gallstones, and idopathic reasons).

Answer 3

Pancreatic trauma, Drugs

Question 4

What are the two main ducts of the pancreas?

Answer 4

The main pancreatic duct and the accessory pancreatic duct.

Question 5

What is the name of the spincter which “empties” into the duodenum?

Answer 5

Spincter of Oddi.

Question 6

Why do pancreatic enzymes not normally harm the ducts/pacncreas?

Answer 6

Enzymes are released in an inactive form. They are only activated in the duodenum by bile.

Question 7

What is the Patho of Pancreatitis?

Answer 7

Nomally pancreatic enzymes are activated in the duodenum in the presence of bile. However, in acute pancreatitis, bile flow is obstructed which leads to premature activation of enzymes. The activated enzymes damage the pancreas through auto digestion, hemorrhage, and necrosis.

Question 8

What is the role of alcohol in actue pancreatitis?

Answer 8

Alcohol has two effects. It increases pancreatic secretions and it constricts the spincter in the pancreatic duct (spincter of Oddi)

Question 9

What are the manifestations of Acute Pancreatitis?

Answer 9

Acute onset (often a large meal or alcohol binge), Severe epigastric abdominal pain which radiates to the back and chest, 3rd spacing, Vascular collapse and possible shock, Increased blood amylase and lipase.

Question 10

Where is lipase primarily produced?

Answer 10

The pancreas

Question 11

Where is amylase primarily produced?

Answer 11

Salvilary glands

Question 12

When measuring blood amylase and lipase, which is the more important measurement?

Answer 12

Lipase

Question 13

Why is blood amylase and lipase an effective diagnostic in acute pancreatitis?

Answer 13

When cells die they release their contents. Because the pancreatic enzymes are causing damage and death to the pancreas the cells release their contents. (Lipase shows up because of damage, hense why we measure it in diagnosis).

Question 14

What is the treatment for acute pancreatitis?

Answer 14

Treatment is based on severity.
Mild: 1 wk severity, NPO, pain, fluid/electrolytes, correct any metabolic abnormalities (insulin deficiency).
Severe: ICU, renal, circulatory, hepatobiliary support, IV opioids, Surgery for stones.

Question 15

What are hepatobilary supports?

Answer 15

Hepatobilary supports are the pancreas, gallbladder, and the related ducts assoicated.

Question 16

Why is NPO an important aspect of acute pancreatitis treatment?

Answer 16

Eating causes the body to release enzymes to help breakdown and metabolize nutrients from the food consumed. However, enzymes release is the mechanism of damage. We do no want enzyme release, so nothing shall be taken orally during treatment.

Question 17

What form of Cancer is the leading cause of death?

Answer 17

Pancreatic cancer. It has a 90% mortality rate in the 1st year.

Question 18

What is the etiology of pancreatic cancer?

Answer 18

Unclear. However there links to smoking (major risk), alcohol, diabetes melious, chonic pancreatitis, age (>50yrs), poor diet.

Question 19

What is the most common from of Pancreatic Cancer?

Answer 19

Adrenocarcinomas (The ducts epithelium is where the cancer resides).

Question 20

What are the manifestation of Pancreatic Caner? Are the manifestation due to tumor mass or decreased function of organ?

Answer 20

Triade of manifestation: Jaundice, Weight Loss, Abdomenal pain. Manifestations are due to tumor mass, and not decreased function and enzyme secretion.