GI

Question 1

Function of pancreas

Answer 1

Exocrine — digestion

• secrete bicarb
• trypsin (protein), amylase (carbs), lipase (fats)

Endocrine — regulate blood sugar

• alpha cells: secrete glucagon
• beta cells: secrete insulin
• delta cells: inhibit secretion

Question 2

Pancreatic juice flow

Answer 2

Pancreas
Pancreatic duct
Common bile duct
Sm intestine (duodenum)

Live and Gallbladder empty into CBD as well for mine bile

Question 3

Acute pancreatitis patho

Answer 3

Inflammation and auto-digestion due to premature activation of exocrine enzymes / build up of enzymes.

Activates inflammatory response
(cytokines, histamine, clotting factors)
And SIRS
(Vascular permeability, vasodilation, vascular stasis, microthrombus)

Question 4

Etiology of acute pancreatitis

Answer 4

• ETOH: poor prognosis
• obstruction, gallstones
• and surgery, trauma
• drugs: steroids, thiazides
• infection

Question 5

Acute pancreatitis S/S:

• physical
• labs
• imaging

Answer 5

Physical:
-Abd pain: boring, radiates all quadrants and lumbar
-low grade fever
- hypoactive bowel sounds
**pulmonary complications:
Left lobe atelectasis, left pleural effusions, ARDS(enzyme released kills alveolar cells, decreases surfactant)

Labs:
^WBC
^amylase 
^Lipase
^BG ( beta cell destruction eliminates insulin secretion)
Low Ca (used up during autodigestion)

Imaging:
CT- fluid around pancreas, acute vs chronic
MRI- bile ducts, pancreatic duct, perfusion

Question 6

Hemorrhagic pancreatitis signs

Answer 6

Grey Turners: blue flanks

Question 7

Treatment of pancreatitis

Answer 7

Fluids
Replacement of Ca, K, Mag
PPI \ H2 blockers 
Morphine
Post pyloric feeds, NG to decompress

Question 8

H2 Agonists

Answer 8

Famotidine
Ranitidine

Block histamine, decrease stomach acid production

Question 9

Proton pump Inhibitors

Answer 9

Omeprazole Prilosec
Pantoprazole Protonix

Block the enzyme in the stomach that produces acid

Question 10

Upper GI Bleed causes

Answer 10

• PUD — assoc with H.pylori
• esophageal varices
• ulcers
• Mallory Weiss tear

Question 11

GI Bleed treatment

Answer 11

Fluids
PRBCs, FFP, Plts
Fix the cause
Meds: Vasopressin, Sandostatin, Osmotic laxitives, Beta blockers

Question 12

Vasopressin for GI bleed

Answer 12

Constricts arteriolar bed of intestines, decreases portal venous pressure.

Question 13

Sandostatjn for variceal bleeds

Answer 13

Reduces blood flow to intestines
Reduces gastric acid
Reduces GI motility

Question 14

Meds that can cause GI bleed

Answer 14

NSAIDs
COX2 inhibitors
SSRI (tetracycline)
Corticosteroids
Anticoags
Propofol

Question 15

Esophageal varices pathophys

Answer 15

Due to liver disease
GI venous drainage flows through liver blood flow. Cirrhosis causes back up of blood into esophageal vein causing “hemorrhoids is the esophagus”

Question 16

Indirect bili?
Direct bili?
Total bili?

Answer 16

Liver dysfunction

Indirect - excessive RBC breakdown
Direct - cellular injury within liver
Total - biliary obstruction