Exam 2 PANCREATIC DZ

Question 1

Pancreas vascular supply?

Answer 1

Celiac axis

SMA

Question 2

Pancreas innervation?

Answer 2

Autonomic

Question 3

Pancreas fxn: Exocrine?

Other contents of juice? (2)

Juice release stim by? (3)

Answer 3

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

Bicarb, e-

Gastric acid
Cholecystokinin
Vagal stim

Question 4

Pancreas fxn: Endocrine?

Answer 4

Insulin release (response to high glucose)

Glucagon release (response to low glucose)

Question 5

Acute Pancreatitis is?

Answer 5

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

Question 6

Acute Pancreatitis caused by? (6)

Answer 6

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

Question 7

Acute Pancreatitis presentation: OLDCARS

Answer 7

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

Question 8

Acute Pancreatitis presentation: exam findings

Vitals?

Skin?

Abd:

Other? (2)

Answer 8

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

Question 9

Acute Pancreatitis labs? (9)

Answer 9

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

Question 10

Acute Pancreatitis imaging? (5)

Answer 10

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

Question 11

Acute Pancreatitis tx? (6)

Answer 11

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

Question 12

Acute Pancreatitis: signs of complications?

Answer 12

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

Question 13

Acute Pancreatitis: Complications

Pseudocyst?

Abscess?

Ascites?

Answer 13

fluid/debris collection w/ fibrotic wall

infected pseudocyst or necrotic area

leaking duct or pseudocyst

Question 14

Acute Pancreatitis: Systemic Complications

Pulmon?

Renal?

Card?

GI?

Metabolic?

Answer 14

Pulmonary fail, edema, effusion, atelectasis

Renal fail

hypoTN/shock

ileus

hypergly/hypoCa2+

Question 15

Chronic Pancreatitis is?

Answer 15

Repeat episodes of acute inflamm ->

permanent structural damage/obstruction

Question 16

Chronic Pancreatitis caused by? (4)

Answer 16

EtOH (80%)
Repeat acute pancr
Cystic fibrosis
Hereditary

Question 17

Chronic Pancreatitis presentation?

Triad?

Answer 17

Epigastric pain aggravated by EtOH, fat

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

Question 18

Chronic Pancreatitis induced Exocrine Insuff causes?

Endocrine Insuff causes?

Answer 18

Malabsorp -> steatorrhea, wgt loss

Diabetes (damages α, β cells)

Question 19

Chronic Pancreatitis labs? (4)

Answer 19

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

Question 20

Chronic Pancreatitis imaging? (4)

Answer 20

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

Question 21

Chronic Pancreatitis tx? (3)

Answer 21

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

Question 22

Chronic Pancreatitis Pain tx? (6)

Answer 22

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

Question 23

Pancreatic CA U located?

U what type?

Answer 23

head of pancr

adenocarc
∴ 15% of cysts are CA

Question 24

Pancreatic CA risk factors? (8)

Answer 24

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

Question 25

Pancreatic CA presentation? (6)

Answer 25

U Abd pain: Gnawing epigast w/ radiation to back ``` Bloating Early satiety/anorexia Wgt loss Jaundice Steatorr ```

Question 26

Pancreatic CA exam findings? (5)

Answer 26

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

Question 27

Pancreatic CA labs? (5)

Answer 27

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

Question 28

Pancreatic CA imaging? (3)

Answer 28

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

Question 29

Pancreatic CA tx? Prognosis?

Answer 29

Resection is only cure Poor