GI Block 2: 13 14 17 Flashcards

1
Q

Where is the pancreas located?

A

Retroperitoneal space posterior to greater curvature of stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute pancreatitis is inflammation characterized by ?

A

Acute abdominal pain

Inc pancreatic enzymes most commonly from gallstones or chronic alcohol abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What risk factors contribute to development of acute pancreatitis?

A
Gallstones
ETOH abuse
Hypertriglyceridemia
Smoking
CF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes hyperlipidemia induced pancreatitis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Atlanta Classificaiton of acute pancreatitis?

A

Interstitial edematous acute pancreatitis

Necrotizing acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What pancreatic enzyme has a higher sensitivity for pancreatitis

A

Lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is pancreatitis diagnosed with imaging?

A

CT is scan of choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the DDx for acute pancreatitits?

A
Cholecystitis
Choledocholithiasis
Cholangitis
PUD
Perforated viscus
Intestinal obstruction
Mesenteric ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What complications can arise from acute pancreatitis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
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
26
What odd Sx do PTs with Exocrine pancreatic insufficiency complain of?
Steatorrhea due to lack of lipase
27
What are the DDX for Exocrine Pancreatic Insufficicncy
Celiac Dz Malabsorption Dz IBS IBD
28
What are the two most common etiologies of exocrine pancreatic insufficiency
Chronic pancreatitis | CF
29
What is the diagnostic approach for treating exocrine pancreatic insufficiency?
Suspect in all PTs w/ Abd pain, chronic diarrhea and steatorrhea
30
What is the mainstay of diagnosis for exocrine pancreatic insufficiency
Pancreatic enzyme replacement therapy
31
What are the risk factors for pancreatic cancer?
``` Tobacco use ETOH abuse Obesity Chronic pancreatitis FamHx ```
32
What is the clinical presentation of pancreatic cancer?
Abd Pain Jaundice Weight loss Courvoisier sign- non-tender palpable gallbladder
33
What are lab results going to show for PTs with pancreatic cancer?
Amylase/lipase elevation Billirubinemia CA19-9- serum tumor marker
34
What images are orders and for what purpose in pancreatic CA?
US- jaundice CT- pain/weight loss ERCP- ducts
35
How is pancreatic cancer treated?
Surgical resection