Gallbladder & pancreas Flashcards
The pancreas is located in the ________ deep within the ________.
retroperitoneum
epigastrium
pancreas is a gland with both ___ and ___ function
exocrine and endocrine
exocrine function of the pancreas: 2 main parts
- secretion of bicarbonate to neutralize gastric acid entering the duodenum with ingested food. Ductal cells play a major role in HCO3 secretion
- Secretion of digestive enzymes for digestion and absorption of fats, carbs, and proteins. Acinar cells play a major role in pancreatic enzyme secretion
____ cells play a major role in HCO3 secretion while ___ cells play a major role in pancreatic enzyme secretion
ductal- HCO3
acinar- pancreatic enzyme
Protein digestive enzymes are secreted in an inactive form (______). They are converted to their active enzyme in the _______ (____).
trypsinogen
duodenum, trypsin
Inappropriate activation of trypsinogen to the active form of trypsin within the pancreas causes …
autodigestion of the pancreas (pancreatitis).
Duodenal hormones, _____ and _______ ,are responsible for pancreatic exocrine secretions (pancreatic enzymes).
what are responsible for these duodenal hormones being secreted? why is this clinically important?
secretin and cholecystokinin (CCK)
Acidic ingested food reaching the duodenum is responsible for their secretion. This is why a patient with acute pancreatitis is treated with IV fluids and NPO; this will decrease pancreatic enzyme secretions.
small intestine:
I cells secrete what? this goes on to do what?
S cells secrete what? this goes on to do what?
I cells- CCK –> activates acinar cells –> pancreatic digestive enzyme secretion
S cells- Secretin –>activates ductal cells –> secretion aqueous solution of Na+ and HCO3-
where is the endocrine function of the pancreas?
islet of langerhans
what is the endocrine function of the pancreas responsible for?
Responsible for secretion of insulin and glucagon.
Chronic pancreatitis with destruction and fibrosis of the pancreas can result in both…
both exocrine and endocrine (diabetes) pancreatic dysfunction.
Acinar cells are the main ________ ______ of pancreatic secretion and digestion
enzymatic component
Two most common conditions associated with acute pancreatitis are ____ and _____
alcohol abuse and biliary tract disease.
Amylase normal values?
27-130
lipase normal values?
130-60
lipase or amylase more specific for the pancreas and therefore used more?
LIPASE!
elevated amylase may be due to…
not super important to memorize
Acute pancreatitis Cancer of the pancreas, ovaries, or lungs Cholecystitis Gastroenteritis (severe) Intestinal blockage Pancreatic or bile duct blockage Perforated ulcer Ectopic pregnancy
decreased amylase may be due to …
not super important to memorize
Cancer of the pancreas
Damage to the pancreas
Kidney disease
Toxemia of pregnancy
elevated lipase may be due to…
Blockage of the bowel (bowel obstruction) Celiac disease Duodenal ulcer Pancreatic Cancer Pancreatitis
acute pancreatitis: Represents _______ and _______ of the pancreas and ________ tissues.
acute inflammation and destructive autodigestion peripancreatic
what is being inappropriately activated with acute pancreatitis?
inactive trypsinogen to active trypsin
in acute pancreatitis, tissue destruction can extend outside of the pancreas and lead to ______
sepsis (SIRS)
two biggest causes of acute pancreatitis?
gallstones & alcohol use
what is ERCP?
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.
what is the clinical presentation of acute pancreatitis?
acute upper abdominal pain that radiates to the back, nausea, vomiting and fever.
ranson criteria tells you what?
risk of mortality for acute pancreatitis
what is your best indicator of acute pancreatitis (lab value)?
Elevated lipase (responsible for digestion of fats). Lipase more specific for pancreas than amylase and remains elevated >4 days. (amylase elevated as well but only for 3-4 days)
dx and txt of acute pancreatitis
Dx: CT abdomen
Txt: pain control (no Morphine-remember the sphincter of Oddi; use Demerol instead), NPO and aggressive hydration with IV fluids
ranson criteria: initial presentation (not sure if exact # or general trends are more important to know)
initial: Age >55 years WBC > 16,000 Serum glucose >200 Serum lactate dehydrogenase (LDH) >350 AST >250
(overall: high in age, WBC, glucose, LDH and AST)
ranson criteria: within 48 hours of admission (not sure if exact # or general trends are more important to know)
Hematocrit drop >10% BUN rise >5 mg per dL after IV hydration Arterial PO2 <60 mmHg Serum calcium <8 mg per dL Base deficit >4 mmol/L Requires >6L of IVFs within 48 hrs
(overall: HcT drop, BUN rise, low pO2, Ca+, and base)
how does scoring go for ranson criteria (more important to know than actual criteria)
Each element gets 1 point; <2, : 1% chance of mortality 3-4, : 15% chance of mortality 5-6, : 40% chance of mortality 7< , : 100% chance of mortality
most common cause of death from acute pancreatitis?
HYPOVOLEMIC SHOCK!
how do you get hypovolemic shock from acute pancreatitis?
…from third spacing and sequestration of large amount of fluid in the abdomen, pulmonary edema, acute respiratory distress syndrome (ARDS), and/or myocardial dysfunction
what is a phlegmon?
solid mass of inflamed pancreas w/ necrosis
from acute pancreatitis- if untreated it can kill the pt in 1 week
what is a pancreatic pseudocyst?
collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue (1 in 10 get this)
____% of people with acute pancreatitis have severe dz; ____% of patients with acute pancreatitis die from it!
20%
10-30%
chronic pancreatitis:a relapsing disorder causing severe abdominal pain with _______ pancreatic ______ and _______ insufficiency.
permanent exocrine and possible endocrine
major cause of chronic pancreatitis in adults vs kids
adults: chronic alcoholism
kids: cystic fibrosis
Dx of chronic pancreatitis (5 parts)
- History of compatible abdominal pain with weight loss and steatorrhea; often see diabetes as well.
- Amylase elevation (in about 50% of patients with chronic pancreatitis, the amylase is within normal limits)
- Imaging studies of the abdomen (CT scan)
- Increase 72 hour fecal fats
- Decrease serum level of trypsinogen
txt of chronic pancreatitis (5 parts)
- Stop alcohol
- Pain control
- Pancreatic enzyme replacement
amylase, protease, and lipase - Blood sugar control. Insulin
- Surgery
stenting the pancreatic duct or partial resection
pancreatic carcinoma, usually from what?
infiltrating ductal adenocarcinoma
pancreatic cancer: its silent until? can cause jaundice how?
The malignancy is usually silent until it impinges on other structures. Local extension of the tumor entraps nerves causing debilitating pain
Obstructive jaundice: carcinoma of the head of the pancreas obstructing the common bile duct.
what two things will be possibly elevated with pancreatic cancer?
alk phos and direct bili
Pear shaped muscular sac on the ventral surface of the liver
gallbladder
gallbladder’s two major functions
stores and concentrates bile. then EJECTS it 30 min after eating
food –> gallbladder contracts. _______ is the main stimulus for gallbladder contraction and bile ejection
CCK
It does these actions through contraction of GB and relaxation of the sphincter of Oddi
what are the 4 Fs for? and what are they?
risk factors for cholelithiasis :
forty, female, fat, fertile
cholelithiasis: Caused by precipitation of substances in bile (cholesterol and bilirubin) usually d/t either ____, _____ or ________
abnormal composition of bile, stasis of bile (look left), or inflammation of the bladder
symptoms of cholelithiasis
can be asymptomatic or can have colicky RUQ pain worse after eating greasy food, may radiate into back and R shoulder, nausea, vomiting
If the stone travels out of the GB can cause _________
Choledocolithiasis (stone in the common bile duct, obstructs CBD, causes jaundice)
Dx of cholelithiasis ?
US (shows calcified gallstone)
what is cholecystitis?
Diffuse inflammation of the gallbladder, usually secondary to obstruction of the GB outlet likely from stones (but can also be d/t sepsis, infection of the GB, or trauma)
presentation of cholecystitis?
with acute onset of persistent RUQ or epigastric pain +/- radiation to back and R shoulder
also.. fever, N/V, anorexia, +/- abnormal VS
lab findings for cholecystitis?
leukocytosis with left shift and MILDY elevated AST, ALT, bilirubin, alk phos
imaging for cholecystitis?
RUQ Ultrasound looking for wall thickness (>3 mm is abnormal), stones, stranding, abscess, perforation
Txt for cholecystitis? (weeds?… possibly)
IVFs Analgesics Anti-emetics NPO Pre-op antibiotics Surgical consult for cholecystectomy
primary sclerosis cholangitis
inflammatory disease of the biliary system (often assoc with other inflamm diseases like UC)
Primary Sclerosing Cholangitis is what?
dz of the large bile ducts causing scars within the ducts
–> liver damage
labs for cholangitis?
consistent with obstructive labs = elevated direct bili
gallbladder cancer (cholangiocarcinoma): onset is _____, most people also have _____
insidious ( gradual, subtle)
gallstones
mean five year survival rate for gallbladder cancer?
1%
gallbladder cancer often associated with what 3 things?
probably weeds..
Associated with parasitic infections of the liver, primary sclerosing cholangitis, toxins
three anatomical parts of gallbladder
Fundus (rounded end), body, infundibulum (“neck”- leads into cystic duct)
what makes gallstones: percentage of bile salts go _____ or percentage of ____ go _____
bile salts really high OR other lipid components (cholesterol has limited solubility) really low
–> cholesterol precipitates into crystals
two types of gallstones
yellow- cholesterol
black/brown- pigment (bilirubin)
exocrine vs endocrine
Endocrine glands release chemical substances directly into the bloodstream or tissues of the body.The chemical substances released by the endocrine glands are known as hormones.
Exocrine glands release chemical substances through ducts to outside the body or onto another surface within the body.Jul
