Clinic-Pancreas

Question 1

pancreatic duct cell function

Answer 1

bicarb secretion neutralizes gastric acid and activates pancreatic enzymes

Question 2

bicarb is secreted in response to?

Answer 2

secretin

Question 3

pancreatic acinar cell function

Answer 3

production of pancreatic enzymes (“zymogens”)

Question 4

zymogens are activated by?

Answer 4

brush border enzyme, enterokinase

Question 5

what stimulates acinar cells to produce pancreatic enzymes?

Answer 5

CCK

Question 6

etiologies of acute pancreatitis

Answer 6

GET SMASHED; but the major ones are Alcohol, Biliary (stone), and Medications (HUGE list)

Question 7

this procedure can cause pancreatitis

Answer 7

ERCP

Question 8

you should always get labs on these when a pt presents with acute pancreatitis

Answer 8

triglycerides, calcium (high levels cause pancreatitis)

Question 9

hereditary pancreatitis is managed ____ , and has a ____ risk of developing pancreatic cancer

Answer 9

the same way; higher

Question 10

mild acute pancreatitis causes ____, while more severe pancreatitis is ____

Answer 10

edema; necrotizing (sterile or infected)

Question 11

clinical presentation of edematous pancreatitis

Answer 11

abdominal pain, N/V, tender abdomen, self-limiting

Question 12

dx of edematous pancreatitis

Answer 12

very elevated amylase and/or lipase; LFTs to check for bile duct obstruction as cause; can do an US to look for gallstones

Question 13

management of edematous pancreatitis

Answer 13

IV fluids, pain control, antiemetics, cholecystectomy if gallstones are the cause!

Question 14

acute necrotizing pancreatitis is most commonly caused by _______ and is scored using the _____ score

Answer 14

gallstones; Ranson’s score

Question 15

pancreatic tissue destruction leads to systemic inflammatory response that induces?

Answer 15

multisystem organ failure (pulm, renal, liver, GI)

Question 16

presentation of acute necrotizing pancreatitis

Answer 16

severe abdominal pain (more diffuse), N/V, hypoTN, tachy, flank and periumbilical ecchymosis

Question 17

dx of acute necrotizing pancreatitis

Answer 17

increased amylase/lipase + increased creatinine and BUN, high WBC, high platelets, increased LFTs, hypoxia, hypocalcemia

Question 18

imaging for acute necrotizing pancreatitis

Answer 18

US for gallstones, CT with needle aspiration to determine if infected, ERCP to get problem out!

Question 19

what are pancreatic pseudocysts?

Answer 19

non-infected cysts that are lined by fibrous material

Question 20

causes of chronic pancreatitis

Answer 20

alcohol almost always (TIGARO)

Question 21

presentation of chronic pancreatitis

Answer 21

chronic unremitting epigastric pain that radiates and requires narcotics, causes frequent hospitalization, N/V + pancreatic exocrine insufficiency (steatorrhea, malnutrition), diabetes

Question 22

____ is practically pathognomonic for chronic pancreatitis

Answer 22

pancreatic calcification

Question 23

lab signs of possible chronic pancreatitis

Answer 23

decreased albumin, decreased transthyretin, fat-soluble vitamin deficiences (DAKE)

Question 24

complications of chronic pancreatitis

Answer 24

pseudocyst, mesenteric thrombosis, biliary obstruction from fibrosis, pancreatic ascites and pleural effusion, pancreatic cancer

Question 25

management of chronic pancreatitis

Answer 25

medical = enzyme replacement, pain control, nutrition; ERCP; Puestow surgery (lateral drainage)

Question 26

risk factors for pancreatic adenocarcinoma

Answer 26

chronic pancreatitis, hereditary pancreatitis, tobacco, fat/meat

Question 27

signs of pancreatic adenocarcinoma

Answer 27

painless jaundice, pruritis, weight loss, malaise, palpable gallbladder, depression, diabetes

Question 28

CT/MRI of pancreatic adenoCA shows?

Answer 28

hypodense mass within pancreas

Question 29

this tumor marker can be followed to detect cancer recurrence

Answer 29

CA 19-9

Question 30

management of pancreatic adenoCA

Answer 30

resection (Whipple procedure) or palliative with relief of obstruction (biliary stent)

Question 31

prognosis of pancreatic adenoCA is?

Answer 31

POOR; lots of recurrence and mets