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Gastrointestinal and Liver > Lecture 13: Pancreas > Flashcards

Lecture 13: Pancreas Flashcards

1
Q

Pancreas is ______peritoneal

A

Retro

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2
Q

Arterial supply to pancreas

A

Gastroduodenal, SMA, splenic

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3
Q

Venous drainage of pancreas

A

Portal vein, splenic vein

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4
Q

Nerves to pancreas (stimulatory, inhibitory)

A

Vagal = stimulatory; sympathetic = inhibitory

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5
Q

Three stages of pancreas embryology and time scale

A

Formation, rotation, fusion; 5-8 weeks

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6
Q

2 ducts in pancreas, and they drain into…

A

Accessory and main, they drain into the Ampula of Vater (major papilla, note: minor duct also drains into minor papilla)

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7
Q

What else drains into the Ampulla of Vater? Sphincter?

A

Bile duct; sphincter of Oddi

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8
Q

Pancreas is 90%…

A

Exocrine

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9
Q

What does secretin cause in the pancreas?

A

Bicarbonate secretion (secretin stimulated by detection of H+)

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10
Q

What does CCK cause in the pancreas?

A

Pancreatic enzymes (CCK stimulated by detection of aa and fatty acids)

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11
Q

Majority of pancreatic enzymes are…

A

Proteases (but also lipases, glycosidases, and nucleases)

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12
Q

Describe the process of trypsinogen secretion

A

Trypsinogen –> trypsin via enterokinase; trypsin –> other zymogens into active enzymes

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13
Q

Four protective mechanisms in the pancreas (4)

A

Zymogens, trypsin inhibitor in zymogen granules, enzymes bound in membranes enterokinase restricted to small intestine

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14
Q

Acute pancreatitis: pathological activation casade

A

Failed regulation of trypsin (autoactivation)

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15
Q

Types of pancreatitis (mild –> worse)

A

Interstitial with inflammation/edema (acute edematous pancreatitis) –> hemorrhagic –> necrotizing pancreatitis

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16
Q

Causes of acute pancreatitis: 2 most common and gender associations

A

Gallstones (F) and alcohol (M)

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17
Q

Causes of acute pancreatitis: some other classes (7)

A

Drugs, trauma, metabolic (hypertriglyceridemia), obstruction (stones/sludge/tumors), toxin (scorpion), infection, pregnancy

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18
Q

How do stones cause pancreatitis?

A

Stone arising from gallbladder obstructs either the common channel or pancreatic duct

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19
Q

Vast majority of gallstones pass…

A

On their own

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20
Q

How does alcohol cause acute pancreatitis (4)

A

Intracellular accumulation of pancreatic enzymes, Sphincter Oddi spasm (obstruction), toxic metabolite accumulation, abnormal blood flow

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21
Q

What is Divisum? What can it cause?

A

Embryologically, lack of fusion of ductal system –> main pancreatic duct draining through minor papilla –> pancreatitis

22
Q

ERCP

A

Endoscopic procedure that allows one to visualize the common bile duct and pancreatic duct and remove stone = therapeutic procedure

23
Q

Pancreatitis: clinical featurs

A

PAIN (can radiate to back), N/V, fever, hypocalcemia, ileus (bowel paralysis due to abdomen inflammation) and other other “-itis” of the abdomen

24
Q

Pancreatitis: signs, lab values

A

Ab tenderness, fever, tachycardia; leukocytosis, hyperamylasemia/hyperlipasemia

25
Q

Pancreatitis: diff dx

A

Choledocholithiasis, perforated ulcer, mesenteric ischemia, intestinal obstruction, salpingitis/ectopic pregnancy

26
Q

% organ failure in necrotizing pancreatitis

A

~50%

27
Q

Pancreatitis: dx

A

Clinical picture + lab values (increased amylase and lipase, especially with injury) +imaging

28
Q

Are increased pancreatic enzymes specific to pancreatitis?

A

Nope: can be related to renal failure, medications, and female GU problems

29
Q

Who do we worry about with pancreatitis?

A

Older, high WBC, high glucose, hematocrit fall

30
Q

Pancreatitis: imaging tools

A

CT scan with contrast, ultrasound for stones, MRCP (MRI of pancreas), ERCP

31
Q

What might we see around the pancreas during pancreatitis?

A

Surrounding fluid/edema

32
Q

Describe stones: what other test will be elevated and how can we test bile? How do we view and treat stones?

A

Elevation in liver chemistries, bile aspiration analysis, ultrasound or MRCP (imaging) and ERCP (therapeutic)

33
Q

Interstitial pancreatitis: tx

A

Give fluid, NPO (rest pancreas), pain control, maintain nutrition if they are very sick (tube), address underlying cause (stones –> surgery/alcohol)

34
Q

If a pancreatitis patient doesn’t improve, what do you suspect? What should you do (2)?

A

Necrotizing pancreatitis: CT scan to evaluate perfusion (w/ contrast AND perfusion the pancreas will be “enhancing”) and if you suspect infection, do a fine needle asiration

35
Q

Late complications of pancreatitis: 3

A

Pseudocyst (not true due to lack of epithelium, assymptomatic unless large), abscess, hemorrhage (hemosuccus pancreaticus = rare form of GI bleed)

36
Q

T/F: Pancreatitis can cause systemic complications

A

True! ARDS, DIC, renal failure

37
Q

Chronic pancreatitis: define

A

Chronic inflammation with irreversible morphologic changes and loss of exocrine AND endocrine function

38
Q

Most common cause of chronic pancreatitis. What are some other causes?

A

ALCOHOL; tropical, pancreas divisum, autoimmune, neoplastic

39
Q

Two mechanisms of alcohol pancreatitis

A

Abnormal secretion theory leading: protein plugs –> obstruction; necrosis-fibrosis: repeated episodes of acute pancreatitis –> fibrosis –> necrosis and obstruction

40
Q

Chronic pancreatitis: presentation

A

Daily pain with exacerbations, steatorrhea, weight loss

41
Q

What is the best test to look for chronic pancreatitis?

A

Flat plate (abdominal X-ray) with CALCIFICATIONS

42
Q

Chronic pancreatitis: tx

A

Quit drinking, give analgesics, give pancreatic enzymes, invasive procedures (celiac plexus block, endoscopic decompression, surgical drainage)

43
Q

Chronic pancreatitis: complications

A

Pseudocyst, diabetes, steatorrhea, obstruction (bile duct), pancreatic ascities

44
Q

Pancreatic neoplasms: type, who, risk factors

A

Mostly adenocarcinoma, men in 60s, risk: smoking, alcohol, hereditary factors

45
Q

Where do pancreatic neoplasms typically land?

A

2/3 in head; 1/2 in body or tail

46
Q

Pancreatic neoplasm: clinical features

A

Painless jaundice, nonspecific (N/V, depression, new onset diabetes)

47
Q

Pancreatic neoplasm: exam

A

Jaundice, Courvosier’s sign (palpable gallbladder)

48
Q

What is one way to palliate jaundice-related pruritus?

A

ERCP to drain bile

49
Q

What are two other kinds of pancreatic tumors?

A

Neuroendocrine tumors (gastrinoma with peptic ulcer disease, inulinoma, glucagonoma, VIPoma with secretory diarrhea); lymphoma

50
Q

Neuroendocrine tumors: better or worse prognosis?

A

Better

Gastrointestinal and Liver (19 decks)

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