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TERM 4 N2261 KNLG 3 > GI 2 > Flashcards

GI 2 Flashcards

1
Q

Where is the pancreas located?

A

Behind the stomach at L1/2 epigastric level

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2
Q

What 4 hormones are secreted by the pancreas?

A
  1. Insulin
  2. Glucagon
  3. Somatostatin
  4. Pancreatic polypeptide
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3
Q

Along which path do pancreatic enzymes flow?

A

Pancreas > CBD > duodenum

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4
Q

What 2 organs make up the biliary tract?

A

Gallbladder, CBD

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5
Q

Where is the gallbladder located?

A

RUQ below the liver

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6
Q

About how much bile does the gallbladder store?

A

45ml

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7
Q

Along which path does bile flow?

A

Liver > hepatic ducts > CBD > gallbladder

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8
Q

What are the 4 pancreatic enzymes, and what do they digest?

A

Trypsinogen, chymotrypsin: proteins

Amylase: starches

Lipase: fats

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9
Q

What are 3 components of bile?

A
  1. Bile salts (for fat emulsification & digestion)
  2. Bilirubin
  3. Cholesterol
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10
Q

What is the term for a test involving an endoscope with an ultrasound transducer?

A

Endoscopic ultrasonography (EUS)

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11
Q

What are the purposes of EUS?

A

Closer to organs for better images

Used to detect/stage tumours/disease, biopsy

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12
Q

What is the term for a test using an endoscope to directly visualize the duodenum, CBD, and/or pancreatic duct?

A

Enteroretrograde cholangiopancreatography (ERCP)

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13
Q

What is the purpose of ERCP?

A

Image, dilate, stent, remove stones, biopsy

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14
Q

What is the term for a test using MRI to obtain detailed images of the biliary and pancreatic ducts?

A

Magnetic resonance cholangiopancreatography (MRCP)

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15
Q

What is the term for a radionuclide study used to identify obstructions of bile ducts, disease of gallbladder, or bile leaks?

A

HIDA (Hepatobiliary iminodiacetic acid) scan

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16
Q

How is a HIDA scan performed?

A

Tracer given to patient

Camera follows distribution of tracer through liver, biliary tree, gallbladder, and proximal small bowel

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17
Q

What is the term for a fluoroscopic radiographic study to determine the filling of the hepatic and biliary ducts?

A

PTC (percutaneous transhepatic cholangiography)

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18
Q

How is a PTC performed?

A

Anesthesia administered, liver entered by long needle via abdo wall

Needle passed into CBD, bile removed, contrast injected

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19
Q

What is a common cause of cholecystitis?

A

Related to bile stasis caused by obstruction (due to stones or biliary sludge)

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20
Q

What is the mechanism behind formation of gallstones (cholelithiasis)?

A

Idiopathic cause leads to precipitation of cholesterol, bile salts, and calcium

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21
Q

What may exacerbate pain due to cholecystitis/cholelithiasis?

A

High fat meal

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22
Q

What kind of cancer is common to the gallbladder?

A

Adenocarcinoma

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23
Q

Why is gallbladder cancer difficult to identify?

A

Symptoms similar to cholecystitis/cholelithiasis

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24
Q

What is the mechanism behind the development of acute pancreatitis?

A

Trigger (e.g. gallbladder disease, EtOH, trauma) causes autodigestion of pancreas by pancreatic enzymes

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25
Q

What may exacerbate pain due to acute pancreatitis?

A

Eating, lying down

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26
Q

What is the term for a symptom of severe acute pancreatitis that involves ecchymoses of the flanks?

A

Turner’s sign

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27
Q

What is the term for a symptom of severe acute pancreatitis that involves ecchymoses of the periumbilical area?

A

Cullen’s sign

28
Q

What are 3 life threatening complications related to severe acute pancreatitis?

A
  1. Shock due to hemorrhage
  2. Toxemia from pancreatic enzymes
  3. Hypovolemia due to fluid shifting into retroperitoneum
29
Q

Why may acute pancreatitis cause respiratory symptoms?

A

Pancreas is in close proximity to lungs/diaphragm

30
Q

Why may acute pancreatitis increase the risk for intravascular thrombus?

A

Enzymes can activate prothrombin/plasminogen

31
Q

What lab values are expected to increase in acute pancreatitis?

A

Amylase, lipase
LFTs, trig, gluc, bili

32
Q

What lab value is expected to decrease with acute pancreatitis?

A

Calcium

33
Q

Why would a patient with acute pancreatitis be placed on NPO status?

A

Minimize stimulation of pancreas

34
Q

How does chronic pancreatitis differ from acute pancreatitis?

A

Inflammation of the pancreas leading to fibrosis, strictures, calcifications

35
Q

What is the most common etiology of chronic pancreatitis in Canada?

A

EtOH

36
Q

What are 2 examples of causes of chronic obstructive pancreatitis?

A

Associated with biliary disease (e.g. cholelithiasis, cancer)

37
Q

What is the mechanism behind chronic nonobstructive pancreatitis?

A

Inflammation and sclerosis in the head of the pancreas and pancreatic duct that often leads to abscesses and pseudocysts

38
Q

What is the most significant symptom of chronic pancreatitis?

A

Sharp abdo pain that may radiate to back that is worse after eating and when lying down

39
Q

What is the common theme behind other common symptoms of chronic pancreatitis, e.g. malabsorption, weight loss, steatorrhea?

A

Pancreatic insufficiency

40
Q

What are 3 examples of complications of chronic pancreatitis?

A
  1. Bile duct/duodenal obstruction
  2. Diabetes mellitus
  3. Ascites
41
Q

What dietary changes are needed in patients with chronic pancreatitis?

A
  1. Pancreatic enzyme replacements
  2. Bland/low fat diet
  3. Alcohol elimination
  4. Glycemic control
42
Q

What would be the purpose of surgery to treat chronic pancreatitis?

A

Divert bile flow or relieve obstruction

43
Q

What is the 5-year survival rate of pancreatic cancer?

A

6%

44
Q

Why is pancreatic cancer hard to detect?

A

Symptoms are nonspecific unless the tumour obstructs the CBD

45
Q

What are 3 surgeries that may be used to treat pancreatic cancer?

A
  1. Whipple
  2. Pancreatectomy
  3. Biliary stent insertion
46
Q

What drains should nurses NOT remove?

A
  1. Pigtail
  2. Placed by IR
47
Q

What is the full name of a PTC drain?

A

Percutaneous transhepatic cholangiogram drain

48
Q

What path does a PTC drain follow?

A

Through the abdominal wall, through the CBD, ending in the duodenum

49
Q

What is the purpose of the PTC drain?

A

Allow free flow of bile

50
Q

Where is a PTC drain inserted?

A

Interventional radiology

51
Q

If a PTC drain has no output, what should this mean?

A

The bile is flowing along the normal/expected route

52
Q

What is the purpose of a T-tube?

A

Holds open CBD and drains bile to external collection bag

53
Q

Where is a T-tube inserted?

A

In the OR

54
Q

What are examples of contraindications for laparoscopic cholecystectomy?

A
  1. Peritonitis/chonlangitis
  2. Gangrene
  3. Perforation
  4. Portal hypertension
  5. Bleeding risk
55
Q

What kind of pain is very common after a lap chole, and what is it caused by?

A

Right shoulder pain, due to CO2 irritating phrenic nerve

56
Q

What dietary adjustment is needed in the early recovery period after lap chole?

A

Low fat diet

57
Q

What other organs may require excision with pancreatectomy?

A

Spleen, gallbladder, duodenum, stomach

58
Q

What is the difference between distal and total pancreatectomy?

A

Distal: Excision of either body or tail
Total: Entire organ removed

59
Q

Why are CBGs necessary after pancreatectomy?

A

Impaired pancreatic function during recovery; in total pancreatectomy the patient will become type 1 diabetic

60
Q

What is the formal name of the Whipple procedure?

A

Pancreaticoduodenectomy

61
Q

What 5 organs are removed in the Whipple procedure?

A
  1. Antrum (lower part) of stomach
  2. Proximal duodenum
  3. Gallbladder
  4. Distal CBD
  5. Head of pancreas
62
Q

What is the prognosis after Whipple?

A

Average 18 months, but chance of 5 years

63
Q

After Whipple, which anastomoses are formed?

A
  1. Choledochojejunostomy
  2. Gastrojejunostomy
  3. Pancreaticojejunostomy
63
Q

What is important to remember regarding patients who have undergone Whipple who have an NG tube?

A

Nurses cannot reposition NG tubes that are located near an anastomosis

64
Q

What are 3 complications unique to the Whipple procedure?

A
  1. Delayed gastric emptying - Nausea
  2. Dumping syndrome
  3. Bile/pancreatic leak

TERM 4 N2261 KNLG 3 (9 decks)

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