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Q4 Clin Med III (GI) > Exam 2 PANCREATIC DZ > Flashcards

Exam 2 PANCREATIC DZ Flashcards

1
Q

Pancreas vascular supply?

A

Celiac axis

SMA

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2
Q

Pancreas innervation?

A

Autonomic

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3
Q

Pancreas fxn: Exocrine?

Other contents of juice? (2)

Juice release stim by? (3)

A

Breakdown of:
Starch (Amylase)
Fat (Lipase)
Protein (Protease)

Bicarb, e-

Gastric acid
Cholecystokinin
Vagal stim

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4
Q

Pancreas fxn: Endocrine?

A

Insulin release (response to high glucose)

Glucagon release (response to low glucose)

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5
Q

Acute Pancreatitis is?

A

Inflamm dz -> premature activation of protealytic enz -> autodigestion of pancreas

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6
Q

Acute Pancreatitis caused by? (6)

A 
EtOH (Toxins)
Gallstones (Mechanical)
Hypertrigly (Metabolic)
Ischemia (Vascular)
Viral
Genetic
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7
Q

Acute Pancreatitis presentation: OLDCARS

A 
Acute, P post meal
Midepigast -> back radiation
Constant
Steady, boring
Supine
Tripod
Anorexia, N/V, distention
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8
Q

Acute Pancreatitis presentation: exam findings

Vitals?

Skin?

Abd:

Other? (2)

A

Fever, tachy/tachy, +/- hypoTN

Jaundice if obstruction

hypoactive or no BS
tender w/ or w/o guarding/rebound

Cullen’s Sign: periumbil ecchy
Grey-Turner’s Sign: flank ecchy

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9
Q

Acute Pancreatitis labs? (9)

A 
Amylase = ↑
Lipase = ↑
WBC = ↑
HCT = ↑
Cr = ↑
Glu = mild ↑
LFT = transient ↑
Ca2+ = ↓
ABG =  P ↓
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10
Q

Acute Pancreatitis imaging? (5)

A 
XRay = r/o obstruction/perf
US = stones
CT = edema, inflamm, calcif, necrosis, abscess
MRCP
EUS = newest/best
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11
Q

Acute Pancreatitis tx? (6)

A 
Admit
Tx underlying dz
NPO
IV fluids!
Pain (Demerol)
P abx (Imipenem)
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12
Q

Acute Pancreatitis: signs of complications?

A

↓ urine/↑ Cr
Resp fail
↑pain, fever, leukocytosis

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13
Q

Acute Pancreatitis: Complications

Pseudocyst?

Abscess?

Ascites?

A

fluid/debris collection w/ fibrotic wall

infected pseudocyst or necrotic area

leaking duct or pseudocyst

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14
Q

Acute Pancreatitis: Systemic Complications

Pulmon?

Renal?

Card?

GI?

Metabolic?

A

Pulmonary fail, edema, effusion, atelectasis

Renal fail

hypoTN/shock

ileus

hypergly/hypoCa2+

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15
Q

Chronic Pancreatitis is?

A

Repeat episodes of acute inflamm ->

permanent structural damage/obstruction

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16
Q

Chronic Pancreatitis caused by? (4)

A

EtOH (80%)
Repeat acute pancr
Cystic fibrosis
Hereditary

17
Q

Chronic Pancreatitis presentation?

Triad?

A

Epigastric pain aggravated by EtOH, fat

DM (endo dysf)
Steatorrhea (exo dysf)
Pancreatic calcification

18
Q

Chronic Pancreatitis induced Exocrine Insuff causes?

Endocrine Insuff causes?

A

Malabsorp -> steatorrhea, wgt loss

Diabetes (damages α, β cells)

19
Q

Chronic Pancreatitis labs? (4)

A

Amylase/Lipase = N or slight ↑
Bilirubin/Alk Phos = mild ↑
Glu = ↑
72hr Fecal Fat Test = ↑

20
Q

Chronic Pancreatitis imaging? (4)

A 
XRay = P scattered calcification
CT = calcif, ductal dilation, pseudocysts
MRCP = good view pancr/bili ducts
ERCP = chain-of-lakes DIAGNOSTIC
21
Q

Chronic Pancreatitis tx? (3)

A

Behavior (EtOH, tobacco, fat)
Pancr enz supplements (Creon)
DM tx w/ insulin
Pain

22
Q

Chronic Pancreatitis Pain tx? (6)

A 
Pancreatic supplements 1st
Amitriptyline or SSRI
Long-act narcotics (MS Contin)
Endoscopic ductal dilation, stenting
Nerve block (celiac plexus)
Resection
23
Q

Pancreatic CA U located?

U what type?

A

head of pancr

adenocarc
∴ 15% of cysts are CA

24
Q

Pancreatic CA risk factors? (8)

A 
M > F
Blacks
> 45yo
Smoke/EtOH
Chronic pancr
DM
Obese
FHX
25
Q

Pancreatic CA presentation? (6)

A

U Abd pain: Gnawing epigast w/ radiation to back

Bloating
Early satiety/anorexia
Wgt loss
Jaundice
Steatorr
26
Q

Pancreatic CA exam findings? (5)

A 
Cachexia (wasting)
Jaundice/Icterus
L supraclavicular LN (Virchow's)
Ascites
Palp GB (Courvoisier's Sign)
27
Q

Pancreatic CA labs? (5)

A 
Amylase/Lipase = mild ↑
Bilirubin/Alk Phos = ↑
Glucose intolerance
Mild anemia
CA 19-9 (carbohydrate antigen) = 90% sen/spec for pancr CA
28
Q

Pancreatic CA imaging? (3)

A 
US = dilated CBD, head mass
ERCP = DIAGNOSTIC, Double-Duct Sign
CT = Dx and staging
29
Q

Pancreatic CA tx?

Prognosis?

A

Resection is only cure

Poor

Q4 Clin Med III (GI) (32 decks)

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