Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Jackie - Summer 6901 > Hepatic, Pancreatic, Splenic & Carcinoid > Flashcards

Hepatic, Pancreatic, Splenic & Carcinoid Flashcards

1
Q

True or False: The pancreas only has endocrine, not exocrine, function.

A

False

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

What is the exocrine function of the pancreas? And how much fluid is made?

A

Secretion of pancreatic fluid.

1,500-3,000cc fluid per day

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

What is the endocrine hormone secreted from the alpha cells of the pancreas? And what is it’s function?

A

Glucagon. Opposes insulin secretion and causes the liver to convert stored glycogen into glucose (which is released into the bloodstream)

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

What is released from the beta cells of the pancreas? How much? And what is it’s function?

A

Insulin. ~ 50 units per day. Responsible for carbohydrate consumption and suppression of fat metabolism.

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

What is contained in the Islets of Langerhans?

A

Endocrine hormones of the pancreas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Secretin is released from where? In response of what? And what does it stimulate?

A

Duodenum/jejunum/ileum in the Crypts of Liberkuhn.
In response to low pH in the duodenum.
Stimulates the release of: 1.) alkaline pancreatic juice from the pancreas 2.) Bile from the liver. 3.) Bicarb from the duodenal Brunner’s glands

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

What is released from the delta cells of the pancreas? And what is it’s function?

A

Delta: Somatostatin. AKA: Growth hormone - releasing inhibitory factor - which is responsible for controlling the plasma levels of both insulin and glucagon, and gastrin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the function of G-coupled protein receptors? Why are they significant with Anesthesia

A

Receptors that sense molecules outside of the cell and activate signal transduction pathways and ultimately make an internal cellular response.
G-coupled proteins are involved in many diseases and are the targets of about 40% of all medicinal drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of hormone is insulin?

a. amino acid
b. peptide/protein
c. fatty acid
d. steroid

A

b. Peptide/protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: Does insulin cause the cells in the liver, skeletal muscle and fat tissue to release glucose?

A

False. It causes it to take up glucose.

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

Glucose is stored as what in the liver and muscle? How is it stored in fat?

A

glycogen

triglycerides

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

How does insulin inhibit the use of fat as an energy source?

A

By inhibition of glucagon release. Stores energy by decreasing blood glucose levels, increasing protein synthesis, decreasing glycogenolysis (glycogen breakdown), decreasing lipolysis (fat breakdown), and increasing glucose transport into cells.

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

What is the function of glucagon?

A

Opposite of insulin: increase blood glucose levels - stimulation of: 1. glycogenolysis, gluconeogenesis, and lipolysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What was the first hormone to be discovered? When

A

Secretin in 1902

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What was a recently discovered role of secretin (besides release of bile, pancreatic juice, and bicarb)?

A

Regulatory role in osmoregulation with the hypothalamus, pituitary, and kidneys.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Does alpha-adrenergic stimulation inhibit or stimulate insulin secretion?

A

Inhibit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Does beta-adrenergic and cholinergic blockade inhibit or stimulate insulin secretion?

A

Inhibit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Does vagal stimulation, B2-adrenergic stimulation and Cholinergic drugs inhibit or stimulate insulin secretion?

A

stimulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Will a patient on an epinepherine drip have high or low blood sugars? Why?

A

High. Because epi is constantly stimulating the alpha-adrenergic system which is consequently inhibiting insulin secretion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F are these common causes of acute pancreatitis?

a. ) Alcohol abuse
b. ) Trauma to or near pancreas - example: cholecystectomy
c. ) Ulcerative penetration from adjacent structures (example duodenum)
d. ) Infection
e. ) Biliary tract disease
f. ) Metabolic disorders (hyperlipidemia, hypercalcemia)
g. ) Drugs (corticosteroids, furosemide, estrogens, thiazide diuretics)
h. ) surgery (example: post-op pancreatitis)

A

All true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F: Hypocalcemia causes pancreatitis.

A

False: hypercalcemia (including from cardiopulmonary bypass) is a cause of acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of injury is caused by acute pancreatitis? What type of symptoms/syndrome does it cause?

A

“severe chemical burn of the peritoneal cavity”

produces syndrome that results in hemorrhage, edema, and necrosis of the pancreas - induced auto-digestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the first symptom of acute pancreatitis?

A

Pain

24
Q

What are the characteristics of acute pancreatitis pain? Where is the pain located? What position makes the pain worse?

A

Localized, radiating, dull or severe.
Mid-epigastric to periumbilical
May be worse when supine

25
Q

Besides pain, what are other symptoms of acute pancreatitis?

A

N/V, abdominal distention, fever, hypotension, acute renal failure, hypocalcemia (with EKG changes - prolonged QT)

26
Q

What are causes of acute pancreatitis or pancreatic pain?

A
  1. Obstruction/distention of pancreatic ducts
  2. Edema, with stretching of the pancreatic capsule
  3. Duodenal obstruction (edematous)
  4. Biliary tract obstruction - dilation of the pancreatic ducts
  5. Inflammatory exudates - blood/enzymes in the retroperitoneum
  6. Chemical peritonitis.
27
Q

What are common causes of chronic pancreatitis?

A
  1. Chronic alcoholism
  2. Pancreatic trauma at an early age
  3. Chronic biliary tract disease
28
Q

What is the diagnosis triad of chronic pancreatitis?

A

Steatorrhea (fat in stool - undigested), pancreatic calcification, diabetes mellitus

29
Q

What is the most common clinical problem that results from abdominal pain of chronic pancreatitis?

A

Loss of appetite causing weight loss (emaciated) and malnutrition.

30
Q

Is the incidence of chronic pancreatitis higher in males or females?

A

Males

31
Q

Chronic pancreatitis: Pancreatic abscesses (3-5%) and formations of pseudocysts (8%) develop from infected peripancreatic collections of fluid. What is the mortality rate if it ruptures? What is the treatment?

A

90% mortality rate.

Surgical drainage to prevent spread of the infectious contents to the subphrenic and pericolic spaces.

32
Q

Chronic pancreatitis: What are the clinical signs and symptoms seen in these systems: liver, heart/lungs and pancreas?

A
  1. Liver: jaundice, ascites, esophageal varices, derangements in coag factors, serum albumin, and transferase enzymes
  2. pericardial/pleural effusions
  3. Pancreatic abscesses (severe intraabdominal hemorrhage)
33
Q

When is surgical drainage of a pancreatic pseudocyst done?

A

After the cyst matures (6 weeks)

34
Q

T/F: Internal drainage of a pancreatic pseudocyst can done with a cystogastrostomy, cystojejunostomy, cystoduodenostomy or a distal pancreatectomy. Which type of procedure is usually chosen for a pseudocyst?

A

True.
The location and size of the pseudocyst dictates the extent and type of procedure used for providing drainage of cystic contents into the gastrointestinal tract.

35
Q

Can a pseudocyst be drained under CT guidance?

A

Yes. When the pseudocyst is particularly friable.

36
Q

T/F: spontaneous resolution of pseudocysts may be expected in 20% or more of patients who have undergone surgical drainage.

A

True

37
Q

Pancreatic tumors: What percent of pancreatic tumors are adenocarcinoma?

A

90%

38
Q

Pancreatic tumors: What happens if there is biliary obstruction?

A

Jaundice

39
Q

Pancreatic tumors: How is the diagnosis made for a biliary obstruction?

A

Percutaneous transhebatic cholangiography or endoscopic retrograde cholangiopancreatography (ERCP)

40
Q

What is an ERCP?

A

Endoscopic retrograde cholangiopancreatography is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts.

41
Q

Pancreatic tumors: What is the cancer of the beta cells of the pancreas? And what is the consequence of this tumor?

A

Insulinoma.

Hypersecretion of insulin –> profound hypoglycemia

42
Q

What is the treatment for an insulinoma?

A

Distal, subtotal or total pancreatectomy (child’s procedure)

43
Q

What is the Whipple procedure used for? And what does the procedure entail?

A 
Used to treat pancreatic cancer and some benign pancreatic lesions and cysts and cancers in the bile duct and beginning part of the small intestine (duodenum).
It entails excision of the: 
1. antrum/distal stomach 
2. 1st/2nd portions of the duodenum
3. Head of the pancreas
4. Common bile duct
5. Gallbladder
Reconstruction with:
1. choledochostomy
2. pancreaticogastrojejunostomy
44
Q

What is the Zollinger-Ellison Syndrome (gastrinoma)?

A

neoplasm primarily arising from the duodenum:
hypersecretion of gastrin from the pancreas –> resulting in the secretion of massive quantities of hydrochloric acid from the parietal cells in the stomach –> severe peptic ulcer disease –> potential for perforation, erosion and hemorrhage.

45
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

Surgical excision of the lesion

46
Q

Why do all of the organs (stomach, pancreas, gallbladder, duodenum) have to be removed in a Whipple procedure?

A

Share the same blood supply, so the organs have to be removed if the single blood supply is severed.

47
Q

What autosomal dominant syndrome does zollinger-ellison syndrome occur with? What percent?

A

MEN 1 (multiple endocrine neoplasm type 1) - about 25% have multiple tumors with the MEN syndrome.

48
Q

What is the treatment for a gastronoma? What is removed? How is flow of gastric contents re-established?

A

Complete pancreatectomy.
Pancreas, pancreatic duct, Gallbladder, common bile duct, duodenum, and antrum of the stomach.
Hepaticojejunostomy (re-establishes bile flow); duodenojejunostomy (re-establishes food stream)

49
Q

What type of anesthesia is used for an ERCP? What is most common?

A

Conscious sedation, MAC, or GA (most common)

50
Q

What position in the patient in for an ERCP?

A

semi-lateral or prone

51
Q

What do you give for an ERCP to relax the sphincter of Oddi? What is the dose?

A

Glucagon (0.4-1mg)

52
Q

How long do ERCPs last?

A

Usually 1-4 hours - or about 30min for a stent change

53
Q

Pancreatic disease patients - anesthesia considerations:

  1. GI issues
  2. Electrolyte/glucose
  3. Coagulation
  4. Pulmonary
  5. Renal
  6. Anesthetic plan
A
  1. Ileus (aspiration precaution)
  2. Lyte disorders (hypocalcemia, hypomagnesemia, hypocalcemia, hypochloremic metabolic acidosis)
  3. Coagulation disorders - frequent draws
  4. Pleural effusions
  5. Maintain renal function/perfusion (UO 0.5-1ml/kg/hr)
  6. Most are GA - other monitoring depending on patient comorbidities
54
Q

Pancreatic transplant: Who is it a treatment option for? What is the survival rate?

A

Insulin-dependent diabetics who fail medical management.

1 yr graft 70%; Patient survival 90%

55
Q

What other transplant is common simultaneously with a pancreas transplant?

A

Kidney (Renal failure secondary to DM I)

56
Q

Preop considerations for pancreatic transplant

A
  1. Evaluate labs - metabolic/electrolytes (high incidence of renal insufficiency - dialysis? when? K?
  2. Evaluate decree of diabetic complications - ischemic cardiac, renal insufficiency
  3. Airway - difficulty intubation in diabetic pts -> joint stiffness
  4. Neuropathies - autonomic/systemic -> hemodynamic lability; vagal neuropathy ->gastroparesis.
  5. Hyperkalemia (renal disease) caution with succinylcholine
57
Q

Pancreatic transplant operative considerations:

  1. monitoring
  2. glucose
  3. ABG
  4. transplant considerations
  5. type of fluid administered
A
  1. art line, CVP, or PA
  2. Frequent BG monitoring (q30min)
  3. Blood gas monitoring
  4. immunosuppressives
  5. preference to use colloid to prevent graft edema - decrease crystalloid (less than 1.5L)

Jackie - Summer 6901 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions