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GI block 2 > Lecture 8 Pancreas > Flashcards

Lecture 8 Pancreas Flashcards

1
Q

An acute inflammatory process of the pancreas characterized by acute abd pain and elevated pancreatic enzymes

Most commonly caused by what?

A

Acute pancreatitis… most commonly caused by gallstones or alcohol abuse

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2
Q

RIsk factors for pancreatitis?

A 
Gallstone (-> ampullary obstruction)
Alcohol abuse
Hypertriglyceridemia
Smoking
Cystic fibrosis
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3
Q

Characterized by acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but w/o RECOGNIZABLE TISSUE NECROSIS

A

Interstitial edematous acute pancreatitis

Atlanta classification

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4
Q

Characterized by inflammation associated WITH pancreatic parenchymal necrosis and/or peripancretic necrosis

A

Necrotizing acute pancreatitis

Atlanta classification

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5
Q

Characterized by the absence of organ failure and local or systemic complications

A

Mild acute pancreatitis

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6
Q

Characterized by transient organ failure (resolves w/in 48 hours) and/or local or systemic complications w/o persistent organ failure

A

moderate acute pancreatitis

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7
Q

Characterized by persistent organ failure that may involve one of multiple organs

A

severe acute pancreatitis

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8
Q

Bilateral upper quadrant/epigastric abd pain
(severe, steady, boring AND radiation to the back is common)

Nausea vomiting

A

Acute pancreatitis ssx

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9
Q

ACUTE onset of bilateral upper quadrant pain…

Steady, boring, severe w/ radiation to the back

What ya thinking?

A

Acute onset in gallstone pancreatitis

more gradual if due to other causes

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10
Q

PE findings for acute pancreatitis?

A

Pain INCREASED w/ lying supine (better leaning forward)

Epigastric/abd TTP

Fever, tachy, HOTN

(may have hypoactive bowel sounds)

(may have obstructive jaundice)

Cullen’s or Grey-Turner sign (associated w/ more severe disease)

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11
Q

With acute pancreatitis, what position makes it better? What makes it worse?

A

Pain is increased when lying supine.

Pain is better with leaning forward

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12
Q

Lab findings for acute pancreatitis?

What’s most sensitive?

A

Serum amylase and lipase

(lipase is better! It increases earlier, remains elevated longer, and has higher sensitivity)

CBC = leukocytosis
CMP = elevated BUN
LFT = elevated ALK PHOS and bilirubin

(elevated CRP, of course)

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13
Q

Radiograph of choice for acute pancreatitis?

A

CT scan!

Reveals diffuse pancreatic enlargement

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14
Q

Some ddx for acute pancreatitis?

A

cholecystitis, choledocholithiasis, cholangitis

PUD
perforated viscus
intestinal obstruction
mesenteric ischemia

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15
Q

Ranson criteria? What are the 5 you “see upon initial presentation?”

A 
Blood glucose (>200)
Age (>55)
Leukocytosis (>16,000)
LDH (>350)
AST (>250)
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16
Q

Ranson criteria… what are the 6 that you assess at 48 hours?

A 
HCT (fall by more than 10%)
BUN (increase by more than 5 mg/dL despite fluids)
SrCr (<8 mg/dL)
pO2 (<60 mm Hg)
Base deficit (>4 mEg/L)
Fluid sequestration (>6000)
17
Q

Acute peripancreatic fluid collection

Pancreatic pseudocyst

acute necrotic colleciton

Walled off necrosis

A

Complications of pancreatitis

you might see the initially, or on a subsequent CT scan…

18
Q

General tx measures for acute pancreatitis?

A

ERCP for gallstone pancreatitis

(w/ 24 hours of admission)

(not for alcoholic pancreatitis)

19
Q

Admission

Pancreatic rest (NPO)

Bed rest

IV fluid/electrolyte replacement

Pain control (MORPHINE, maybe meperidine, but probably MORPHINE)

A

Tx for acute MILD acute pancreatitis

20
Q

What’s the tx for SEVERE acute pancreatitis?

A
  • Admission to ICU
  • Early surgical consultation

IV fluid/electrolyte replacement (monitor hemodynamics)

Abx

21
Q

A progressive fibro-inflammatory process of the pancreas that results in permanent structural damage and impairment of exocrine/endocrine function

What is it and who’s it common in?

A

Chronic pancreatitis, most common in chronic alcoholics

22
Q

How does chronic pancreatitis present clinically?

A

Recurrent episodes of LUQ/epigastric pain (attacks may last **hours, days)

Anorexia/wt loss

nausea/vomiting

constipation

Flatulence

**Steatorrhea

23
Q

Diagnostic testing for chronic pancreatitis is different from acute pancreatitis…

What does diagnostic testing for chronic pancreatitis look like?

A

Plain film/CT film showing pancreatic calcification is diagnostic (must r/o pancreatic cancer)

Amylase, lipase may be normal in chronic (so not very useful)

Can quantitatively evaluate fecal fat

24
Q

What is a test typically performed by specialists that can help detect chronic pancreatitis that is w/o characteristic radiographic findings?

A

Secretin pancreatic function test

Main role is diagnosis of early chronic pancreatitis in patients w/ compatible clinical features but no radiographic features

stimulation of the pancreas followed by evaluation of the duodenal fluid.

25
Q

Tx for chronic pancreatitis?

A

referral to GI/pancreatology

low fat diet
NO ETOH
*Non-opioid pain control

pancreatic enzyme supplementation

26
Q

Due to deficiency of exocrine pancreatic
enzymes (-> inability to digest food)

Clinical diagnosis is difficult becuase of vague ssx that are common in other GI conditions

Patients complain of dyspepsia, abd cramping/bloating w/ flatulence, watery diarrhea

PATIENTS MAY ALSO COMPLAIN OF STEATORRHEA (lack of pancreatic lipase)

A

exocrine pancreatic insufficiency

ddx =

  • Celiac/malabsorption syndromes
  • IBS
  • IBD
27
Q

Most common etiologies for exocrine pancreatic insufficiency?

A

CHronic pancreatitis

Cystic fibrosis

28
Q

Watery, bulky, foul-smelling diarrhea w/ steatorrhea

Wt loss

Abd pain

Bloating

Flatulence

A

exocrine pancreatic insufficiency

clinical presentation

29
Q

Diagnostic approach…

Suspect in all patients w/ abd pain, chronic diarrhea/steatorrha

Routine labs to observe for anemia, nutrient deficiences

Labs to evaluate pancreatic function (fecal elastase)

  • R/o other malabsorption causes
  • refer to GI

What’s the mainstay of tx?

A

exocrine pancreatic insufficiency

Mainstay = pancreatic enzyme replacement therapy

30
Q

Highly lethal due to late presentation

Risk factors include…

tobacco use
ETOH abuse
obesity
chronic pancreatitis
Fam Hx
A

Pancreatic CA

31
Q

Abd pain, jaundice, WT LOSS

(vague, diffuse epigastric/LUQ pain)

Pos Courvoisier sign

A

Pancreatic CA

32
Q

What’s the Courvoisier sign?

A

NON-TENDER, palpable gallbladder

seen in Pancreatic CA, biliary carcinoma

33
Q

Lab findings for pancreatic cancer?

A

**CA 19-9 = serum tumor marker

Non specific (w/w/o amylase/lipase)

34
Q

Pancreatic cancer might not be directly “image-able” but what imaging modalities might you use to r/o other etiologies?

A

US (to evaluate jaundice)

Abd CT (to eval pain/wt loss)

ERCP (evaluate ducts)

35
Q

Tx for pancreatic CA?

A

msotly surgical resection… prognosis is poor

GI block 2 (10 decks)

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