Clinic-Pancreas Flashcards
pancreatic duct cell function
bicarb secretion neutralizes gastric acid and activates pancreatic enzymes
bicarb is secreted in response to?
secretin
pancreatic acinar cell function
production of pancreatic enzymes (“zymogens”)
zymogens are activated by?
brush border enzyme, enterokinase
what stimulates acinar cells to produce pancreatic enzymes?
CCK
etiologies of acute pancreatitis
GET SMASHED; but the major ones are Alcohol, Biliary (stone), and Medications (HUGE list)
this procedure can cause pancreatitis
ERCP
you should always get labs on these when a pt presents with acute pancreatitis
triglycerides, calcium (high levels cause pancreatitis)
hereditary pancreatitis is managed ____ , and has a ____ risk of developing pancreatic cancer
the same way; higher
mild acute pancreatitis causes ____, while more severe pancreatitis is ____
edema; necrotizing (sterile or infected)
clinical presentation of edematous pancreatitis
abdominal pain, N/V, tender abdomen, self-limiting
dx of edematous pancreatitis
very elevated amylase and/or lipase; LFTs to check for bile duct obstruction as cause; can do an US to look for gallstones
management of edematous pancreatitis
IV fluids, pain control, antiemetics, cholecystectomy if gallstones are the cause!
acute necrotizing pancreatitis is most commonly caused by _______ and is scored using the _____ score
gallstones; Ranson’s score
pancreatic tissue destruction leads to systemic inflammatory response that induces?
multisystem organ failure (pulm, renal, liver, GI)
presentation of acute necrotizing pancreatitis
severe abdominal pain (more diffuse), N/V, hypoTN, tachy, flank and periumbilical ecchymosis
dx of acute necrotizing pancreatitis
increased amylase/lipase + increased creatinine and BUN, high WBC, high platelets, increased LFTs, hypoxia, hypocalcemia
imaging for acute necrotizing pancreatitis
US for gallstones, CT with needle aspiration to determine if infected, ERCP to get problem out!
what are pancreatic pseudocysts?
non-infected cysts that are lined by fibrous material
causes of chronic pancreatitis
alcohol almost always (TIGARO)
presentation of chronic pancreatitis
chronic unremitting epigastric pain that radiates and requires narcotics, causes frequent hospitalization, N/V + pancreatic exocrine insufficiency (steatorrhea, malnutrition), diabetes
____ is practically pathognomonic for chronic pancreatitis
pancreatic calcification
lab signs of possible chronic pancreatitis
decreased albumin, decreased transthyretin, fat-soluble vitamin deficiences (DAKE)
complications of chronic pancreatitis
pseudocyst, mesenteric thrombosis, biliary obstruction from fibrosis, pancreatic ascites and pleural effusion, pancreatic cancer
management of chronic pancreatitis
medical = enzyme replacement, pain control, nutrition; ERCP; Puestow surgery (lateral drainage)
risk factors for pancreatic adenocarcinoma
chronic pancreatitis, hereditary pancreatitis, tobacco, fat/meat
signs of pancreatic adenocarcinoma
painless jaundice, pruritis, weight loss, malaise, palpable gallbladder, depression, diabetes
CT/MRI of pancreatic adenoCA shows?
hypodense mass within pancreas
this tumor marker can be followed to detect cancer recurrence
CA 19-9
management of pancreatic adenoCA
resection (Whipple procedure) or palliative with relief of obstruction (biliary stent)
prognosis of pancreatic adenoCA is?
POOR; lots of recurrence and mets
