August 27, 2015 - Pancreatitis Flashcards

1
Q

Endocrine or Exocrine

A

Both! The pancreas is the only organ that is both. It secretes products through ducts, and also secretes insulin.

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2
Q

Major Functional Units

A

Acinus and Duct.

Acinus secretes proenzymes and enzymes. Proenzymes are zymogens which are an inactive enzyme precursor.

Duct secretes water, electrolytes, and other secretory products.

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3
Q

Pancreatic Protection Mechanisms

A

Synthesis of enzymes as inactive zymogens

Trypsin inhibitor packaged in zymogen granule

Segregation of enzymes in membrane-bound compartments

When these mechanisms break down, bad things happen. Enzymes may attack the pancreas and digest it, causing big inflammation.

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4
Q

Acute Pancreatitis

A

Alcohol and stones are the main causes. Zymogen activation causes autodigestion which results in massive inflammation of the pancreas as well as a systemic inflammatory response.

Ethanol may cause this by creating toxic metabolites, and gallstones may cause this by potentially causing a bile reflux. Small stones are more likely to cause pancreatitis than large stones.

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5
Q

Acute Pancreatitis and Drugs

A

Some drugs may cause pancreatitis and there is good evidence for about 20 of them. Drugs account for approximately 1.5% of the cases of pancreatitis.

Azathioprine is a bad culprit.

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6
Q

Azathioprine

A

Azathioprine is an immunosuppressive drug that is often used in organ transplantation and autoimmune diseases.

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7
Q

Iatrogenic

A

We did it.

For pancreatitis, this can be induced by performing an ERCP which is the fancy endoscope to look into the bile duct. Unfortunately, this has approximately a 1-10% chance of causing acute pancreatitis.

Surgery can also cause this when done in the upper abdomen. If pancreatitis develops post-surgery, the morality rate can be up to 35%.

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8
Q

Traumatic Pancreatitis

A

May be caused by handle-bar injuries. Under the microscope, you can observe leakage.

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9
Q

Immune Pancreatitis

A

Autoantibodies (ANA, ASMA) that target the pancreas. Fortunately, this condition responds well to steroids and is the only case where you want to put the patient on anti-inflammatory drugs.

Always be aware, that autoimmune pancreatitis is a good mimicker of malignancy. You must be aware that it may not be cancer, but may instead be autoimmune pancreatitis.

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10
Q

Acute Pancreatitis Presenting Features

A

Abdominal pain

Nausea / vomiting

Tachycardia

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11
Q

Grey Turner’s Sign

A

Bruises that appear on the flanks of an individual. This indicates a retroperitoneal hemorrhage. This is bad and is a huge indication for acute pancreatitis or a pancreatic hemorrhage.

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12
Q

Acute Pancreatitis Diagnosis

A

Patient must have two out of the following

  • Typical upper abdominal pain
  • Serum levels of amylase or lipase >3x ULN
  • Confirmatory findings from cross-sectional imaging

Every patient with potential pancreatitis needs an abominal ultrasound to rule out gallstones as a cause.

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13
Q

Treatment for Acute Pancreatitis

A

Supportive care

  • Aggressive fluid and electrolyte replacement
  • Monitoring
  • Analgesia, anti-emetics
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14
Q

Nutrition for Pancreatitis

A

Nasogastric (NG) or Nasojujunal (NJ) is far superior to Total Parenteral Nutrition (TPN)

NG/NJ >> TPN

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15
Q

Antibiotics and Pancreatitis

A

Routine antibiotics are not recommended unless for specific indications such as infected necrosis or cholangitis.

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16
Q

Pseudocyst

A

A complication with pancreatitis. May occur longer than 4 weeks after the onset of the disease.

17
Q

Chronic Pancreatitis

A

The number one cause is alcohol.

Characterised by pain, calcification, and pancreatic insufficiency.

18
Q

Treatment of Chronic Pancreatitis

A
  1. Treat the complications
  2. Medical treatment of the pain
  3. Cessation of EtOH
  4. Antioxidants to reduce damage by O2 radicals
19
Q
A