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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
What may exacerbate pain due to acute pancreatitis?
Eating, lying down
26
What is the term for a symptom of severe acute pancreatitis that involves ecchymoses of the flanks?
Turner's sign
27
What is the term for a symptom of severe acute pancreatitis that involves ecchymoses of the periumbilical area?
Cullen's sign
28
What are 3 life threatening complications related to severe acute pancreatitis?
1. Shock due to hemorrhage 2. Toxemia from pancreatic enzymes 3. Hypovolemia due to fluid shifting into retroperitoneum
29
Why may acute pancreatitis cause respiratory symptoms?
Pancreas is in close proximity to lungs/diaphragm
30
Why may acute pancreatitis increase the risk for intravascular thrombus?
Enzymes can activate prothrombin/plasminogen
31
What lab values are expected to increase in acute pancreatitis?
Amylase, lipase LFTs, trig, gluc, bili
32
What lab value is expected to decrease with acute pancreatitis?
Calcium
33
Why would a patient with acute pancreatitis be placed on NPO status?
Minimize stimulation of pancreas
34
How does chronic pancreatitis differ from acute pancreatitis?
Inflammation of the pancreas leading to fibrosis, strictures, calcifications
35
What is the most common etiology of chronic pancreatitis in Canada?
EtOH
36
What are 2 examples of causes of chronic obstructive pancreatitis?
Associated with biliary disease (e.g. cholelithiasis, cancer)
37
What is the mechanism behind chronic nonobstructive pancreatitis?
Inflammation and sclerosis in the head of the pancreas and pancreatic duct that often leads to abscesses and pseudocysts
38
What is the most significant symptom of chronic pancreatitis?
Sharp abdo pain that may radiate to back that is worse after eating and when lying down
39
What is the common theme behind other common symptoms of chronic pancreatitis, e.g. malabsorption, weight loss, steatorrhea?
Pancreatic insufficiency
40
What are 3 examples of complications of chronic pancreatitis?
1. Bile duct/duodenal obstruction 2. Diabetes mellitus 3. Ascites
41
What dietary changes are needed in patients with chronic pancreatitis?
1. Pancreatic enzyme replacements 2. Bland/low fat diet 3. Alcohol elimination 4. Glycemic control
42
What would be the purpose of surgery to treat chronic pancreatitis?
Divert bile flow or relieve obstruction
43
What is the 5-year survival rate of pancreatic cancer?
6%
44
Why is pancreatic cancer hard to detect?
Symptoms are nonspecific unless the tumour obstructs the CBD
45
What are 3 surgeries that may be used to treat pancreatic cancer?
1. Whipple 2. Pancreatectomy 3. Biliary stent insertion
46
What drains should nurses NOT remove?
1. Pigtail 2. Placed by IR
47
What is the full name of a PTC drain?
Percutaneous transhepatic cholangiogram drain
48
What path does a PTC drain follow?
Through the abdominal wall, through the CBD, ending in the duodenum
49
What is the purpose of the PTC drain?
Allow free flow of bile
50
Where is a PTC drain inserted?
Interventional radiology
51
If a PTC drain has no output, what should this mean?
The bile is flowing along the normal/expected route
52
What is the purpose of a T-tube?
Holds open CBD and drains bile to external collection bag
53
Where is a T-tube inserted?
In the OR
54
What are examples of contraindications for laparoscopic cholecystectomy?
1. Peritonitis/chonlangitis 2. Gangrene 3. Perforation 4. Portal hypertension 5. Bleeding risk
55
What kind of pain is very common after a lap chole, and what is it caused by?
Right shoulder pain, due to CO2 irritating phrenic nerve
56
What dietary adjustment is needed in the early recovery period after lap chole?
Low fat diet
57
What other organs may require excision with pancreatectomy?
Spleen, gallbladder, duodenum, stomach
58
What is the difference between distal and total pancreatectomy?
Distal: Excision of either body or tail Total: Entire organ removed
59
Why are CBGs necessary after pancreatectomy?
Impaired pancreatic function during recovery; in total pancreatectomy the patient will become type 1 diabetic
60
What is the formal name of the Whipple procedure?
Pancreaticoduodenectomy
61
What 5 organs are removed in the Whipple procedure?
1. Antrum (lower part) of stomach 2. Proximal duodenum 3. Gallbladder 4. Distal CBD 5. Head of pancreas
62
What is the prognosis after Whipple?
Average 18 months, but chance of 5 years
63
After Whipple, which anastomoses are formed?
1. Choledochojejunostomy 2. Gastrojejunostomy 3. Pancreaticojejunostomy
63
What is important to remember regarding patients who have undergone Whipple who have an NG tube?
Nurses cannot reposition NG tubes that are located near an anastomosis
64
What are 3 complications unique to the Whipple procedure?
1. Delayed gastric emptying - Nausea 2. Dumping syndrome 3. Bile/pancreatic leak

TERM 4 N2261 KNLG 3 (9 decks)

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