Chronic Pancreatitis Flashcards
What are the 3 types of chronic pancreatitis?
- Chronic Calcifying
- Chronic Obstructing
- Chronic Autoimmune
3 most common causes of chronic calcifying pancreatitis.
- EtOH
- Hereditary
- Tropical
Name the 6 known gene mutations associated with the hereditary cause of chronic calcifying pancreatitis.
- Cationic Trypsinogen Gene
- Anionic Trypsinogen Gene
- SPINK-1 gene
- CFTR gene
- Chymotrypsin C gene
- Calcium Sensing Receptor Gene
What are the 4 main causes of chronic obstructive pancreatitis?
- Adenocarcinoma
- Intrapapillary Mucosal Neoplasm (IPMN)
- Post-pancreatitis stricture
- Post-traumatic stricture
Antibody that is elevated in autoimmune pancreatitis.
IgG4
Biopsy characteristic of autoimmune pacreatitis.
Lymphoplasmocytic Infiltrate around veins and medium ducts
EtOH can cause pancreatitis by what 3 mechanisms?
- EtOH increases viscosity of pancreatic secretions causing protein “plugs” (lithostathine)
- Causes sphincter of Oddi spasm
- Loss of R protein which keeps pancreatic juices in solution
At what level does pancreatic lipase activity have to diminish before steatorrhea becomes a symptom?
Only 10% of the original level of lipase must remain
How does the Secretin Test asses for chronic pancreatitis?
- Measure bicarb and volume of pancreatic juices in duodenum for a standard.
- Administer Secretin
- Re-check bicarb and volume levels
- if levels go up: (-) for pancreatitis
- if levels do not change: (+) for pancreatitis
What is the bentiromide test?
Bentiromide is a protein given to the patient PO.
1. In a normal person pancreatic enzymes break down bentriomide, and one component of the protein is PABA.
- PABA is reabsorbed and sent to the liver where it is conjugated into PABA-glucuronide
- PABA-g is the sent into the blood and excreted thru the kidneys.
If there is pancreatic insufficiency due to pancreatitis, the PABA-g levels will be low when the urine is analyzed.
What is the Sudan Fat Stain Test?
Test to find the cause of steatorrhea. It looks for whole fat or split fat metabolites.
- if whole fats are found in the feces, pancreatic lipases are not being secreted and pancreatitis is suspected.
- if split fats are found, it usually indicates an intestinal absorption problem (sprue etc.)
Name and describe the two types of Pancreatic Enzyme Therapies.
- Non-enteric coated pancreatic enzymes: high in peptidases, given with antacids so it can be available in the duodenum to relieve pancreatitis PAIN by preventing pancreatic secretions.
- Enteric coated pancreatic enzymes: high in lipases to prevent STEATORRHEA.
What is the Peustow Procedure?
Lateral Pancreaticojejunostomy: a surgical technique used in the treatment of chronic pancreatitis. It involves a side-to-side anastomosis of the pancreatic duct and the jejunum.
Used when there is a pancreatic duct obstruction.
What is the Whipple Procedure?
Pancreaticoduodenectomy: removal of the distal half of the stomach (antrectomy), the gall bladder and its cystic duct (cholecystectomy), the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Then the rest of the stomach and rest of the pancreas are attached to the jejunum.
