Pancreas Flashcards

1
Q

Where is the pancreas located

A

behind the stomach, surrounded by the duodenum, liver, and spleen

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2
Q

What does the pancreas produce

A

produces insulin, glucagon, somatostatin and releases it into the vascular system

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3
Q

What does the pancreas secrete

A

digestive enzymes: lipase, amylase, trypsin and chymotrypsin, bicarbonate

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4
Q

What does lipase do

A

digest fats

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5
Q

What does amylase do

A

digest carbs

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6
Q

What does trypsin and chymotrypsin do

A

digest proteins

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7
Q

When are pancreatic enzymes triggered and released

A

with food

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8
Q

Pancreatitis

A

dysfunctional pancreas undergoes inflammation and cellular injury caused by the leakage of digestive enzymes into glandular tissue

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9
Q

Etiology of pancreatitis

A

biliary tract disease, alcohol abuse, abdominal trauma, hypoperfusion, prescription drugs

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10
Q

How do gallstones cause pancreatitis

A

they lodge in the common bile duct and obstruct the flow of enzymes from the pancreas –> back-up and perform autodigestion on the gland tissue –> destroy pancreatic cells

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11
Q

What does autodigestion lead to

A

damaged pancreatic cells, edema, vascular insufficiency, and ischemia of the gland

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12
Q

How does alcohol, drugs, and infectious agents cause damage to the pancreas

A

the substances reach the pancreas and cause premature activation of pancreatic enzymes

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13
Q

What does ethanol do to the pancreas

A

increases the permeability of ductules –> enzymes reach the tissue and cause pancreatic damage, increases the protein content of pancreatic juice, decreases bicarbonate levels, and hinder trypsin inhibitor –> acids to injure the gland and protein plugs to block pancreatic outflow

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14
Q

Clinical presentation of pancreatitis

A

severe abdominal pain, nausea, vomiting, diarrhea, anorexia, fever, tachycardia, hypotension, diminished bowel sounds, jaundiced/pale, cullen sign, grey turner sign

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15
Q

Cullen sign

A

bluish discoloration around the umbilicus resulting from blood in the peritoneal cavity because of hemorrhagic pancreatitis

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16
Q

Grey turner sign

A

reddish-brown discoloration along the flanks resulting from retroperitoneal bleeding

17
Q

Blood work for diagnosis

A

amylase, lipase, CBC, glucose, BUN, calcium, lactate dehydrogenase

18
Q

Amylase

A

early to respond to an injury

19
Q

Lipase

A

spikes 24 hours after the onset of symptoms

20
Q

Lactate dehydrogenase (LDH)

A

tells us if there is a tissue injury

21
Q

Noninvasive imaging

A

abdominal and endoscopic ultrasound, CT, MRCP

22
Q

What does a MRCP show

A

the biliary and pancreatic ducts

23
Q

Treatment of pancreatitis

A

supportive care, minimize pancreatic stimulation, maintain optimal fluid balance, close monitoring of complications, NPO until abdominal pain and tenderness have subsided and bowel sounds return, NG suctioning for bile or ileus, central line placement for fluid and electrolyte management

24
Q

Necrotic pancreatitis

A

death of pancreatic tissue

25
Q

Complications of pancreatitis

A

necrotic pancreatitis, pancreatic pseudocytes, renal failure, respiratory failire, ARDs

26
Q

Pancreatic pseudocytes

A

collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue

27
Q

What causes renal failure

A

hypovolemia and decreased renal perfusion

28
Q

What causes respiratory failure

A

splinting of respirations and atelectasis

29
Q

What causes ARDs

A

injury to the alveolar membrane by circulating enzymes (poor prognosis)

30
Q

Chronic pancreatitis

A

inflammation of the pancreas that does not heal and leads permanent damage

31
Q

When does chronic pancreatitis occur

A

when digestive enzymes attack the pancreas and nearby tissues causing episodes of pain

32
Q

What is the most common cause of chronic pancreatitis

A

heavy alcohol use

33
Q

What is apparent in chronic pancreatitis

A

cellular injury and fibrotic changes of the pancreas

34
Q

When does the pancreas stop functioning and develop scar tissue

A

in chronic pancreatitis

35
Q

When does a patient require supplementation of digestive enzymes and insulin

A

in chronic pancreatitis

36
Q

What happens to amylase and lipase in chronic pancreatitis

A

levels decrease

37
Q

When does the pancreas no longer make digestive enzymes

A

chronic pancreatitis

38
Q

What will x-rays show in chronic pancreatitis

A

pancreatic calcifications

39
Q

Treatment for chronic pancreatitis

A

Hospitalization for pain management, IV hydration, nutritional support, synthetic pancreatic enzymes with every meal, low fat diet, frequent meals, eliminate smoking and alcohol, surgery