General Surgery Flashcards
Pancreas:
- secretes how many liters per day of fluid into the duodenum?
- this aqueous solution is hi in what ot neutralize the acidic solution from the stomach?
- what other 3 ions does this solution contain?
- the arrival of what from the stomach stimulates the pancreas to produce the aqueous solution? (C)
- arrival of what stimulates enzyme production? (F)
- 1 L
- HCO3
- Na, K, Cl
- chyme (acidic solution)
- food
what are the 3 endocrine hormones the pancreas secretes? (IGS)
insulin, glucagon, somatostatin
do pancreatic enzymes require an acidic or basic solution to function?
basic
what 2 pancreatic enzymes are active enzymes? (A, L)
amylase, lipases
what pancreatic enzyme is secreted in an inactive form? (P)
proteases
what cells in the pancreas are responsible for releasing the enzymatic component? (AC)
acinar cells
what cells in the pancreas are responsible for the release aqueous component? (DC)
ductal cells
what is the most important enzymatic component that acinar cells produce? (C)
cholecystokinin (CCK)
what is the most important enzymatic component the ductal cells secrete? (S)
secretin
what compound potentiates the release of CCK? (A)
Ach
what 2 compounds potentiates the release of secretin? (C,A)
CCK, Ach
atropine and glyco cause a decreased response to what component? (S)
secretin
fasting results in a decreased secretion of what 2 enzymes? (A, L)
lipase, amylase
protein malnutrition results in a decreased amount of what secretion? (P)
peptidase
ETOH and gallstones account for what % range of all acute pancreatitis cases?
60-80%
can an acute pancreatitis be restored to normal function if the primary cause is resolved?
yes
what 2 position moves help pts decrease pain with acute pancreatitis? (S, LF)
sitting, leaning forward
what lab increase is the hallmark of acute pancreatitis? (SA)
serum amylase
what diagnostic procedure is the most useful in the setting of traumatic causes or gallstone?
ERCP
other than an ERCP, what is another diagnostic procedure to identify an acute pancreatitis?
CT with contrast
what % mortality with these ranges of Ranson Criteria:
- 1-2
- 3-4
- 5-6
- 7-8
- 5%
- 20%
- 40%
- 100%
Ranson Criteria for acute pancreatitis mortality:
- metabolic acidosis with base deficit >?
- fluid deficit >?
- corrected Ca
- drop in HCT >?
- BUN >?
- age >?
- PO2
- AST >?
- lactate dehydrogenase
- WBC >?
- 4
- 6
- 8
- 10
- 16
- 55
- 60
- 250
- 350
- 16,000
why does fluid leave IV space in acute pancreatitis?
lack of IV protein
what is the #1 C/V concern with acute pancreatitis? (IVVD)
IV volume depletion
acute pancreatitis can receive up to how many liters of crystalloids?
10 L
are attempts to decrease pancreatic production with an NGT or H2 blockers beneficial?
no
what is the abx of choice for surgical debridement of an acute pancreatitis? (C)
cefoxitin
what are 2 common complications with surgical debridement of an acute pancreatitis? (FF, DGE)
fistula formation, delayed gastric emptying