GI Block 2: 13 14 17 Flashcards
Where is the pancreas located?
Retroperitoneal space posterior to greater curvature of stomach
What is the pancreatic duct made of and called?
Duct of Wirsung
Joins CBD from liver and gallbladder then enters hepatopancreatic ampulls (Vater)
Where does Ampulla of Vater open in the intestine?
What controls this opening?
4” inferior to pyloric sphincter
Controlled by Sphincter of Oddi
Acute pancreatitis is inflammation characterized by ?
Acute abdominal pain
Inc pancreatic enzymes most commonly from gallstones or chronic alcohol abuse
What risk factors contribute to development of acute pancreatitis?
Gallstones ETOH abuse Hypertriglyceridemia Smoking CF
What causes hyperlipidemia induced pancreatitis
Free FAs released from serum in toxic concentrations due to pancreatic lipase
What is the Atlanta Classificaiton of acute pancreatitis?
Interstitial edematous acute pancreatitis
Necrotizing acute pancreatitis
Mild/Mod/Severe criteria for Acute Pancreatitis
Mild= absence or organ failure Mod= transient organ failure that resolves in 48hrs Severe= persistent organ failure
What will PE of acute pancreatitis show?
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
What will lab results show in PTs with Acute pancreatitis
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
What pancreatic enzyme has a higher sensitivity for pancreatitis
Lipase
How is pancreatitis diagnosed with imaging?
CT is scan of choice
What are the DDx for acute pancreatitits?
Cholecystitis Choledocholithiasis Cholangitis PUD Perforated viscus Intestinal obstruction Mesenteric ischemia
What criteria and amount of points is used for predicting the severity of acute pancreatitis?
0-2= 1% 3-4= 16% 5-6= 40% 7-11= nearly 100%
What complications can arise from acute pancreatitis?
Acute peripancreatic fluid collection
Pancreatic pseudocyst
Acute necrotis collection
Walled off necrosis
What is the treatment method for acute pancreatitis?
General measures
ERCP for gallstone pancreatitis w/in 24hrs of admission
How is Acute Pancreatitis Mild Disease treated?
Admit NPO Bed rest IV fluids/E+ Pain- demerol causes less spasms of Oddi but morphine can be used
How is Acute Pancreatitis Severe Diseases treated?
Admit to ICU
Early surgical consult
IV fluid/E+
ABX
Characteristics of Chronic Pancreatitis
Fibro-inflammatory process resulting in permanent strcture changes and impairement of exo/endocrine function most often in chronic alcoholics
How does chornic pancreatitis present on PE?
LUQ/epigastric pain Anorexia/weight loss N/V Constipation Flatulence Steatorrhea
What is the diagnostic testing for chronic pancreatitis?
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
When/why is a Secretin pancreatic function test conducted?
Stimulation of pancreas to test duodenal fluids
Dx early chronic pancreatitis in PTs w/out characteristic radiographic findings
How is chronic pancreatitis treated?
Refferal to GI Low fat diet No ETOH Non-opiod pain control Pancreatic enzyme supplements
Define Exocrine Pancreatic Insufficiency
Deficiency of exocrine pancreatic enzymes resulting in inability to digest foods
How do PTs with Exocrine Pancreatic Insufficiency present and why is it difficult to Dx?
Dyspepsia
Abd pain w/ cramping/bloating w/ flatulence
Watery, bulky diarrhea
Weight loss
Vague Sx common w/ other GI issues
What odd Sx do PTs with Exocrine pancreatic insufficiency complain of?
Steatorrhea due to lack of lipase
What are the DDX for Exocrine Pancreatic Insufficicncy
Celiac Dz
Malabsorption Dz
IBS
IBD
What are the two most common etiologies of exocrine pancreatic insufficiency
Chronic pancreatitis
CF
What is the diagnostic approach for treating exocrine pancreatic insufficiency?
Suspect in all PTs w/ Abd pain, chronic diarrhea and steatorrhea
What is the mainstay of diagnosis for exocrine pancreatic insufficiency
Pancreatic enzyme replacement therapy
What are the risk factors for pancreatic cancer?
Tobacco use ETOH abuse Obesity Chronic pancreatitis FamHx
What is the clinical presentation of pancreatic cancer?
Abd Pain
Jaundice
Weight loss
Courvoisier sign- non-tender palpable gallbladder
What are lab results going to show for PTs with pancreatic cancer?
Amylase/lipase elevation
Billirubinemia
CA19-9- serum tumor marker
What images are orders and for what purpose in pancreatic CA?
US- jaundice
CT- pain/weight loss
ERCP- ducts
How is pancreatic cancer treated?
Surgical resection
