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Emma GI > Exocrine Pancreas, Acute/Chronic Pancreatitis > Flashcards

Exocrine Pancreas, Acute/Chronic Pancreatitis Flashcards

1
Q

most comm cause of acute pancreatitis

A

gallstones

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2
Q

pancreatic juice

A

digestive enzymes

bicarbonate

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3
Q

pancreatic acinar cells

A

secrete enzymes

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4
Q

pancreatic epithelial ductal cells

A

secrete bicarb

modify fluid

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5
Q

+ regulators of inc fluid/HCO3-from ductal cells

A

secretin

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6
Q

+ regulators of enzyme release

A

vagal ACh

CCK

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7
Q

CCK

A

secreted by enteric I cells of duodenum

strongly stim by presence of partially digested proteins/fats in SI

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8
Q

As chyme floods into SI, ___ is released into blood and binds to receptors on pancreatic acinar cells –> digestive enz release

A

As chyme floods into SI, CCK is released into blood and binds to receptors on pancreatic acinar cells –> digestive enz release

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9
Q

pancreatic protease activation

A

takes place in SI

trypsinogen comes in contact w/ enteropeptidase –> TRYPSIN

trypsin cleaves all inactive proteases to their active forms

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10
Q

proteins are cleaved by proteases into

A

peptides

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11
Q

pancreatic lipase

A

digests triglycerides into 2-monoglyceride + 2 FFAs

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12
Q

alpha-amylase

A

hydrolyses starch to simple sugars

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13
Q

cellulose

A

NOT metabolized by vertebrates

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14
Q

secretin is secreted from

A

S-cells in response to acid-laden chyme coming from stomach–> duodenum

effect: stim pancreas ductal cells to secrete copious amounts of water and HCO3

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15
Q

vasovagal reflex

A

vagus nerve increases enzyme release from acinar cells

stim by peptides/amino acids, fats, H+

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16
Q

pancreas divisum

A

dorsal and ventral ducts do not fuse

2 separate ducts

  • accessory –> drains majority of pancreas
  • second ventral duct persists

may cause pancreatitis

*can be a normal variant

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17
Q

acute pancreatitis

A

AUTODIGESTION via activated pancreatic enzymes

inflammation, necrosis, cytokines (SIRS)

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18
Q

causes of acute pancreatitis must

A

-stimulate pancreatic enzyme synthesis
AND
-block secretion from acinar cells
-EtOH

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19
Q

complications of severe acute hemorrhagic pancreatitis

A
  • peripancreatic fat necrosis
  • abd/systemic fat necrosis
  • hemorrhage into parenchyma
  • hypOcalcemia
  • shock
  • ARDS/DAD
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20
Q

T/F

gallstones cause both acute and chronic pancreatitis

A

F

gallstone pancreatitis is acute only (either recover or die)

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21
Q

T/F

alcohol causes both acute and chronic pancreatitis

A

T

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22
Q

AI or Sclerosing Pancreatitis

A
  • subacute sx
  • acute pancreatitis
  • irregular, narrowed (beaded) pancreatic duct
  • periductal inflammation and fibrosis
  • elevated IgG4
  • steroid responsive
  • type I and II
  • may mimic pancreatic cancer
23
Q

hypertriglyceridemic pancreatitis

A
  • rare cause of acute pancreatitis
  • serum triglycerides usu >1000 mg/dL
  • may cause chronic disease
  • can be drug-induced
24
Q

drugs that may induce hypertriglyceridemic pancreatitis

A

alcohol
estrogens
isotretinoin
HIV-protease inhibitors

25
which enzyme is most sensitive for acute pancreatitis dx?
lipase
26
circulatory complications of acute pancreatitis
circulatory shock - hypOtension - hemoconcentration as plasma fluids leak into tissues
27
acute pancreatitis prognosis scoring systems
Ranson's index APACHE-!! -BISHAP
28
Ranson's Criteria sx present on admission
-age >55 -WBC >16000/ul -blood glucose >200 -serum LDH >350 SGOT (AST) >250
29
developing during first 48 hr
- HCt fall >10% - BUN increase >8mg/dl - serum Ca less than 8 mg/dl - arterial O2 sat <60 mmHg - base deficit - fluid sequestration
30
BISHAP
``` BUN >25 mg/dl - impaired mental status (disorientation etc) -SIRS > 60 y/o pleural effusions ```
31
early (<1 week) causes of acute pancreatitis
SIRS multiorgan failure
32
late (>1 week) causes of acute pancreatitis
multiorgan failute pancreatic infections/sepsis
33
Cullen's sign
periumbilical hemorrhage seen in acute pancreatitis
34
Grey Turner's sign
flank hemorrhage seen in acute pancreatitis
35
late complications of acute pancreatitis
pancreatic necrosis abscess pancreatic pseudocyst
36
pseudocysts
NO epithelial lining suspect if serum amylase does not return to normal or with persistent pain may occur after acute pancreatitis ("late" problem) complications: pain, hemorrhage, infection, peritonitis
37
acute pancreatitis tx
-aggressive fluid/electrolyte replacement -monitoring analgesia, antiemetics - gastric acid suppression, abx, NG tube, nutrition, urgent ERCP if biliary stone obstruction - surgical debridement
38
chronic pancreatitis
- fibrosis and destruction of exocrine and endocrine cells - irregular pancreatic ducts, narrowed and/or dilated in segments - Ca stones
39
chronic pancreatitis pathogenesis
-ductal obstruction - not after 1-2 attacks of acute pancreatitis - injuries may be silent - toxic-metabolic - necrosis-fibrosis - genetic mutations (CFTR, SPINK1)
40
increased pancreatic secretion with increased protein and proteinaceous plugs
alcohol induced chronic pancreatitis
41
increased pancreatic secretion and proteinaceous plugs
alcohol induced chronic pancreatitis
42
hereditary chronic pancreatitis
calcification of pancreatic ducts similar to EtOH path
43
cystic fibrosis --> chronic pancreatitis path
similar to alcohol w/ proteinaceous plugs and atrophy
44
chronic pancreatitis pathology
- gradual progressive destruction - gross: firm, calcified - irregular fibrosis - dec size and # of acini - chronic inflammation - sparing of islets - duct destruction - pseudocysts
45
3 key histo features of chronic pancreatitis
1. destruction of normal tissue 2. fibrosis 3. inflammatory cells
46
features of chronic pancreatitis
- pain - calcification - pancreatic insufficiency (malabsorption, diabetes)
47
steatorrhea
- dec concentration of lipase and colipase | - dec duodenal pH (inactivation of pancreatic lipase, precipitation of bile salts)
48
sudan III stain
steatorrhea
49
dx of chronic pancreatitis
Tests of function - direct tests (tube tests for enzyme output in pancreatic juice) - indirect tests (serum trypsinogen, stool elastase, stool fat, fat sol vit) -imaging (CT, ERCP, US, XR)
50
chronic pancreatitis tx
- stop alcohol and smoking - chronic pain control - malabsorption (pancreatic enz, low fat diet) - diabetes control
51
tx for neuropathic pain in chronic pancreatitis
nerve block neurolysis thoracoscopic splanchicectomy transient relief
52
chronic pancreatitis etiology
90% alcohol 10% idiopathic CF
53
acute pancreatitis etiology
50% alcohol 25% gallstones 20% idiopathic

Emma GI (18 decks)

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