Pancreas Flashcards
Where is the pancreas located
behind the stomach, surrounded by the duodenum, liver, and spleen
What does the pancreas produce
produces insulin, glucagon, somatostatin and releases it into the vascular system
What does the pancreas secrete
digestive enzymes: lipase, amylase, trypsin and chymotrypsin, bicarbonate
What does lipase do
digest fats
What does amylase do
digest carbs
What does trypsin and chymotrypsin do
digest proteins
When are pancreatic enzymes triggered and released
with food
Pancreatitis
dysfunctional pancreas undergoes inflammation and cellular injury caused by the leakage of digestive enzymes into glandular tissue
Etiology of pancreatitis
biliary tract disease, alcohol abuse, abdominal trauma, hypoperfusion, prescription drugs
How do gallstones cause pancreatitis
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
What does autodigestion lead to
damaged pancreatic cells, edema, vascular insufficiency, and ischemia of the gland
How does alcohol, drugs, and infectious agents cause damage to the pancreas
the substances reach the pancreas and cause premature activation of pancreatic enzymes
What does ethanol do to the pancreas
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
Clinical presentation of pancreatitis
severe abdominal pain, nausea, vomiting, diarrhea, anorexia, fever, tachycardia, hypotension, diminished bowel sounds, jaundiced/pale, cullen sign, grey turner sign
Cullen sign
bluish discoloration around the umbilicus resulting from blood in the peritoneal cavity because of hemorrhagic pancreatitis
Grey turner sign
reddish-brown discoloration along the flanks resulting from retroperitoneal bleeding
Blood work for diagnosis
amylase, lipase, CBC, glucose, BUN, calcium, lactate dehydrogenase
Amylase
early to respond to an injury
Lipase
spikes 24 hours after the onset of symptoms
Lactate dehydrogenase (LDH)
tells us if there is a tissue injury
Noninvasive imaging
abdominal and endoscopic ultrasound, CT, MRCP
What does a MRCP show
the biliary and pancreatic ducts
Treatment of pancreatitis
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
Necrotic pancreatitis
death of pancreatic tissue
Complications of pancreatitis
necrotic pancreatitis, pancreatic pseudocytes, renal failure, respiratory failire, ARDs
Pancreatic pseudocytes
collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue
What causes renal failure
hypovolemia and decreased renal perfusion
What causes respiratory failure
splinting of respirations and atelectasis
What causes ARDs
injury to the alveolar membrane by circulating enzymes (poor prognosis)
Chronic pancreatitis
inflammation of the pancreas that does not heal and leads permanent damage
When does chronic pancreatitis occur
when digestive enzymes attack the pancreas and nearby tissues causing episodes of pain
What is the most common cause of chronic pancreatitis
heavy alcohol use
What is apparent in chronic pancreatitis
cellular injury and fibrotic changes of the pancreas
When does the pancreas stop functioning and develop scar tissue
in chronic pancreatitis
When does a patient require supplementation of digestive enzymes and insulin
in chronic pancreatitis
What happens to amylase and lipase in chronic pancreatitis
levels decrease
When does the pancreas no longer make digestive enzymes
chronic pancreatitis
What will x-rays show in chronic pancreatitis
pancreatic calcifications
Treatment for chronic pancreatitis
Hospitalization for pain management, IV hydration, nutritional support, synthetic pancreatic enzymes with every meal, low fat diet, frequent meals, eliminate smoking and alcohol, surgery
