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IPAP > GI Block 2: 13 14 17 > Flashcards

GI Block 2: 13 14 17 Flashcards

1
Q

Where is the pancreas located?

A

Retroperitoneal space posterior to greater curvature of stomach

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2
Q

What is the pancreatic duct made of and called?

A

Duct of Wirsung

Joins CBD from liver and gallbladder then enters hepatopancreatic ampulls (Vater)

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3
Q

Where does Ampulla of Vater open in the intestine?

What controls this opening?

A

4” inferior to pyloric sphincter

Controlled by Sphincter of Oddi

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4
Q

Acute pancreatitis is inflammation characterized by ?

A

Acute abdominal pain

Inc pancreatic enzymes most commonly from gallstones or chronic alcohol abuse

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5
Q

What risk factors contribute to development of acute pancreatitis?

A 
Gallstones
ETOH abuse
Hypertriglyceridemia
Smoking
CF
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6
Q

What causes hyperlipidemia induced pancreatitis

A

Free FAs released from serum in toxic concentrations due to pancreatic lipase

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7
Q

What is the Atlanta Classificaiton of acute pancreatitis?

A

Interstitial edematous acute pancreatitis

Necrotizing acute pancreatitis

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8
Q

Mild/Mod/Severe criteria for Acute Pancreatitis

A 
Mild= absence or organ failure
Mod= transient organ failure that resolves in 48hrs
Severe= persistent organ failure
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9
Q

What will PE of acute pancreatitis show?

A 
Pain w/ laying supine, better w/ leaning forward
Abd TTP
Hypoactive bowel sounds
Fever/tachy/HOTN if severe
Obstructive jaundice +/-
Cullen Sign
Grey-Turner Sign
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10
Q

What will lab results show in PTs with Acute pancreatitis

A 
3x inc serum amylase and lipase- lipase inc earlier and remains inc longer
CBC- leukocytosis
CMP- inc BUN
Hepatic panel- inc AlkPhos and bilirubin
Inc CRP
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11
Q

What pancreatic enzyme has a higher sensitivity for pancreatitis

A

Lipase

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12
Q

How is pancreatitis diagnosed with imaging?

A

CT is scan of choice

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13
Q

What are the DDx for acute pancreatitits?

A 
Cholecystitis
Choledocholithiasis
Cholangitis
PUD
Perforated viscus
Intestinal obstruction
Mesenteric ischemia
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14
Q

What criteria and amount of points is used for predicting the severity of acute pancreatitis?

A 
0-2= 1%
3-4= 16%
5-6= 40%
7-11= nearly 100%
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15
Q

What complications can arise from acute pancreatitis?

A

Acute peripancreatic fluid collection
Pancreatic pseudocyst
Acute necrotis collection
Walled off necrosis

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16
Q

What is the treatment method for acute pancreatitis?

A

General measures

ERCP for gallstone pancreatitis w/in 24hrs of admission

17
Q

How is Acute Pancreatitis Mild Disease treated?

A 
Admit
NPO
Bed rest
IV fluids/E+
Pain- demerol causes less spasms of Oddi but morphine can be used
18
Q

How is Acute Pancreatitis Severe Diseases treated?

A

Admit to ICU
Early surgical consult
IV fluid/E+
ABX

19
Q

Characteristics of Chronic Pancreatitis

A

Fibro-inflammatory process resulting in permanent strcture changes and impairement of exo/endocrine function most often in chronic alcoholics

20
Q

How does chornic pancreatitis present on PE?

A 
LUQ/epigastric pain
Anorexia/weight loss
N/V
Constipation
Flatulence
Steatorrhea
21
Q

What is the diagnostic testing for chronic pancreatitis?

A

Amylase and lipase normal so not useful for Dx
Quantitative eval of fecal fat
Plain film/CT scan showing pancreatic calcifications= Dx BUT r/o pancreatic CA

22
Q

When/why is a Secretin pancreatic function test conducted?

A

Stimulation of pancreas to test duodenal fluids

Dx early chronic pancreatitis in PTs w/out characteristic radiographic findings

23
Q

How is chronic pancreatitis treated?

A 
Refferal to GI
Low fat diet
No ETOH
Non-opiod pain control
Pancreatic enzyme supplements
24
Q

Define Exocrine Pancreatic Insufficiency

A

Deficiency of exocrine pancreatic enzymes resulting in inability to digest foods

25
Q

How do PTs with Exocrine Pancreatic Insufficiency present and why is it difficult to Dx?

A

Dyspepsia
Abd pain w/ cramping/bloating w/ flatulence
Watery, bulky diarrhea
Weight loss

Vague Sx common w/ other GI issues

26
Q

What odd Sx do PTs with Exocrine pancreatic insufficiency complain of?

A

Steatorrhea due to lack of lipase

27
Q

What are the DDX for Exocrine Pancreatic Insufficicncy

A

Celiac Dz
Malabsorption Dz
IBS
IBD

28
Q

What are the two most common etiologies of exocrine pancreatic insufficiency

A

Chronic pancreatitis

CF

29
Q

What is the diagnostic approach for treating exocrine pancreatic insufficiency?

A

Suspect in all PTs w/ Abd pain, chronic diarrhea and steatorrhea

30
Q

What is the mainstay of diagnosis for exocrine pancreatic insufficiency

A

Pancreatic enzyme replacement therapy

31
Q

What are the risk factors for pancreatic cancer?

A 
Tobacco use
ETOH abuse 
Obesity
Chronic pancreatitis
FamHx
32
Q

What is the clinical presentation of pancreatic cancer?

A

Abd Pain
Jaundice
Weight loss
Courvoisier sign- non-tender palpable gallbladder

33
Q

What are lab results going to show for PTs with pancreatic cancer?

A

Amylase/lipase elevation
Billirubinemia
CA19-9- serum tumor marker

34
Q

What images are orders and for what purpose in pancreatic CA?

A

US- jaundice
CT- pain/weight loss
ERCP- ducts

35
Q

How is pancreatic cancer treated?

A

Surgical resection

IPAP (212 decks)

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