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GI > Disorders of the Pancreas > Flashcards

Disorders of the Pancreas Flashcards

1
Q

Where is the pancreas?

A

Retroperitoneal behind the stomach

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2
Q

How and where does the pancreas enter the duodenum?

A

Forms the hepatopancreatic ampulla/ampulla of vater with the bile duct, which is separated from the duodenum by the sphincter of Oddi.

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3
Q

What are the exocrine enzymes released by the pancreas and the endocrine hormones?

A
  • Exocrine: protease, lipase, amylase
  • Endocrine: Glucagon and insulin
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4
Q

3 components of the Islets of Langerhans

A
  1. Alpha: glucagon
  2. Beta cells: insulin (MC cell type)
  3. Delta cells: somatostatin (inhibits insulin, increases glucagon secretion)
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5
Q

What do acinar cells secrete?

A
  1. Proteases = protein
  2. Lipases = triglycerides
  3. Amylase = carbs
  4. Epithelial cells: Bicarb = neutralize acid
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6
Q

MCC of GI-related hospitalization

A

Acute pancreatitis

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7
Q

MCC of acute pancreatitis

A
  1. Gallstone
  2. Heavy alcohol intake (more than just a binge)
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8
Q

Drinking what can reduce the risk of non-biliary pancreatitis?

A

Caffeine

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9
Q

3 components of the pathophysiology of acute pancreatitis

A
  1. Edema/obstruction at ampulla, causing bile reflux
  2. Premature/overactivation of enzymes
  3. Autodigestion (early activation of enzymes)
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10
Q

3 phases of acute pancreatitis

A
  1. Initial phase: activation of enzymes
  2. Second phase: activation of leukocytes and macrophages
  3. Third phase: Activated proteolytic enzymes and cytokines
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11
Q

What characterizes the beginning of gallstone induced acute pancreatitis?

A

Gallstone blocks the ampulla but you are still making enzymes

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12
Q

What happens as pancreatic enzymes buildup during gallstone blockage in acute pancreatitis?

A

Microvascular injury leading to inflammatory mediator release and damage.

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13
Q

Classic presentation of acute pancreatitis

A
  1. Epigastric abdominal pain radiating to the back that improves when leaning forward.
  2. N/V
  3. Weakness, sweating, anxiety
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14
Q

What would cause jaundice in acute pancreatitis?

A

If it is at the ampulla of Vater

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15
Q

What are the PE signs for acute pancreatitis?

A
  • Cullen’s sign: bruising of the periumbilical region
  • Grey Turner sign: bruising of the flanks

Grey Turner = 2 words = 2 flanks

Both suggest presence of retroperitoneal bleed

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16
Q

What are the two classifications of acute pancreatitis?

A
  • Acute interstitial edematous pancreatitis
  • Necrotizing acute pancreatitis
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17
Q

What is the most sensitive test for acute pancreatitis?

A

Serum Lipase (3x ULN)

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18
Q

Which serum lab rises sooner in acute pancreatitis?

A

Serum lipase

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19
Q

Elevation of what labs might suggest biliary pancreatitis?

A

ALT/AST/ALP

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20
Q

Is imaging needed for diagnosis of acute pancreatitis?

A

Nope if labs are abnormal

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21
Q

What XRAY signs might be seen in acute pancreatitis?

A
  • Sentinel Loop: Dilated air filled SI near pancreas
  • Colon cut-off sign: gas filled segment of transverse colon abruptly ends at pancreas.
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22
Q

What imaging modality is generally not that helpful in acute pancreatitis?

A

US unless looking for a gallstone specifically.

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23
Q

What are the essentials of diagnosing acute pancreatitis?

A
  • Abrupt onset of deep, epigastric pain that radiates to the back
  • Hx of previous episodes, often related to alcohol intake
  • N/V, sweating, and weakness
  • ABd tenderness, fever, and distention
  • Serum amylase/lipase and leukocytosis
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24
Q

If imaging is used to help diagnose acute pancreatitis, which scan will be diagnostic?

A

Abd CT w/o con

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25
Q

What is the primary criteria we use for acute pancreatitis?

A

Ranson’s criteria

26
Q

What are the 5 prognostic signs for Ransons on admission?

A
  • Age > 55
  • BG > 200
  • LDH > 350
  • AST > 250
  • WBC > 16k

3+ = severe course

27
Q

What are the 6 ranson’s signs we obtain within 48 hours of admission?

A
  • HCT decrease by 10%
  • BUN increases by 5+
  • Serum calcium < 8
  • PaO2 < 60
  • Base deficit > 4
  • Estimated fluid sequestration > 6L
28
Q

What is the BISAP scale?

A
  • BUN > 25
  • Impaired mental status
  • Systemic inflammatory response syndrome (SIRS)
  • Age > 60
  • Pleural effusion

3+ = high chance of mortality

29
Q

Tx of mild acute pancreatitis

A
  1. Admit
  2. Rest pancreas
  3. NPO + NG tube + fluids
  4. IV analgesia with meperidine (TOC)
  5. IV antiemetics
  6. Bed rest
  7. Cholecystectomy if gallstone induced

3 days to resolve generally

30
Q

Tx of severe acute pancreatitis

A
  1. ICU
  2. Massive fluid resus (6-8L)
  3. Enteral feeding if pt cant eat for 5 days or more
  4. ABX (imipenem) only if abscess present
31
Q

What is the role of CT in severe acute pancreatitis?

A

Looking for associated complications

32
Q

Complications of acute pancreatitis

A
  1. Pancreatic abscess
  2. Acute peripancreatic fluid secretion
  3. Pancreatic pseudocyst
33
Q

Presence of what two things on CT suggest increased mortality in acute pancreatitis?

A
  • Peripancreatic fluid = +10%
  • Necrotizing pancreatitis = +30%
34
Q

What is the MCC of chronic pancreatitis?

A

Alcohol

35
Q

In children, what is the MCC of chronic pancreatitis?

A

Cystic fibrosis

36
Q

What happens to the pancreas in chronic pancreatitis?

A

Persistent inflammation leading to permanent damage.

37
Q

MC clinical presentation of chronic pancreatitis?

A
  • LLQ pain after eating
  • malabsorption
  • Intermittent acute attacks
  • 65% of patients have osteopenia or osteoporosis
38
Q

MC reason to hospitalize chronic pancreatitis

A

Increase in pain

39
Q

MC scan used to diagnose chronic pancreatitis

A

CT

40
Q

What is the most sensitive imaging modality for imaging the pancreatic duct?

A

ERCP

41
Q

Non-pharm tx of chronic pancreatitis

A
  • Low fat
  • Avoid alcohol
  • Avoid opioids or aspirin
  • Enzymes
  • Insulin
  • Treatment of any primary malabsorptive condition
42
Q

What are the invasive therapies for chronic pancreatitis?

A
  • Puestow procedure: Fileted open pancreas
  • Whipple procedure
  • Stimulators
43
Q

Where are most carcinomas of the pancreas found and what are the main types?

A

In the head, made of adenocarcinomas

44
Q

An older patient develops new onset DM. What must always be in the DDx?

A

Pancreatic cancer

45
Q

What is the greatest risk factor for pancreatic cancer?

A

Smoking

46
Q

What is the clinical presentation of pancreatic cancer?

A
  • Vague epigastric pain with radiation to the back
  • Acute pancreatitis without an identifiable cause
47
Q

What is courvoisier’s sign?

A

Painless jaundice and enlarged palpable gallbladder from tumor blocking common bile duct.

48
Q

What is the hard periumbilical nodule called when it is palpable?

A

Sister Mary Joseph nodule

49
Q

What is the first-line study to look for pancreatic cancer?

A

CT

50
Q

What is the second-line imaging if CT is inconclusive for pancreatic cancer?

A

ERCP showing simultaneous dilation of pancreatic and common bile duct

51
Q

When is open surgical exploration indicated in pancreatic cancer?

A

Unable to get CT guided or ERCP guided biopsies.

52
Q

How is pancreatic cancer staged?

A

TNM

53
Q

How does surgery happen in pancreatic cancer treatment?

A
  1. Exploratory/staging laparoscopy
  2. Whipple procedure (radical pancreaticoduodenal resection)
54
Q

What does the whipple procedure remove?

A
  • Pancreatic head
  • Duodenum
  • 15cm of jejunum
  • Common bile duct
  • Gall bladder
  • Partial gastrectomy
55
Q

When can we do a distal pancreatomy?

A

If the tumor is only in the body and tail, but you gotta take out the spleen too.

56
Q

Why is a total pancreatomy bad?

A

We still need pancreatic enzymes to function properly.

57
Q

When is resection not indicated in pancreatic cancer?

A
  • Mets to liver, peritoneum, and omentum.
  • Encasement of superior mesenteric artery/vein
  • Extension into IVC
58
Q

How do we treat non-resectable pancreatic cancer?

A
  • Biliary stents
  • Chemo
  • Palliative
59
Q

Who should get screened for pancreatic cancer?

A

1st degree relative = get screened at 40-45 or 10 yrs before that person got cancer.

No normal screening for healthy adults.

60
Q

What are the 3 common S/S of pancreatic cancer patients should monitor for?

A
  • Jaundice
  • Unexplained weight loss
  • Pain (radiating to the back)
61
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

GI (17 decks)

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