Pancreas Flashcards
Pancreatic insufficiency is a decrease in _ due to obstruction/atrophy/inflammation
Pancreatic insufficiency is a decrease in pancreatic digestive enzymes (exocrine) due to obstruction/atrophy/inflammation
Causes of pancreatic insufficiency include:
Causes of pancreatic insufficiency include:
* Chronic pancreatitis
* Cystic fibrosis
* Cancer
Pancreatic insufficiency involves a (increase/decrease) in duodenal pH
Pancreatic insufficiency involves a decrease in duodenal pH
* Decrease in bicarbonate (duct cells responsible for making bicarbonate)
Pancreatic insufficiency is associated with a decrease in pancreatic enzymes; fecal _ is specifically used to monitor pancreatic function
Pancreatic insufficiency is associated with a decrease in pancreatic enzymes; fecal elastase is specifically used to monitor pancreatic function
Pancreatic insufficiency is associated with a decrease in the absorption of fat-solube vitamins and _
Pancreatic insufficiency is associated with a decrease in the absorption of fat-solube vitamins and vitamin B12
Pancreatic insufficiency will show a _ D-xylose test
Pancreatic insufficiency will show a normal D-xylose test
What kind of pain is associated with pancreatitis?
Epigastric pain that radiates to the back is typical for pancreatitis
* Worse postprandial
* Better leaning forward
How does pancreatic insufficiency present?
Pancreatic insufficiency presents with:
* Diarrhea (steatorrhea)
* Weight loss, fatigue
* Symptoms of vitamin deficiencies
* Symptoms of insulin resistance
Pancreatic insufficiency is caused by _
Pancreatic insufficiency is caused by enzyme supplementation or obstruction removal
Acute pancreatitis is caused by _
Acute pancreatitis is caused by intrapancreatic activation of enzymes that lead to the autodigestion of the pancreas
Acute pancreatitis occurs due to activation of _ inside the pancreas
Acute pancreatitis occurs due to activation of trypsin inside the pancreas
* Increases lipolysis, proteolysis, tissue destruction –> inflammation
Acute pancreatitis is associated with an increase in enzymes _ and _
Acute pancreatitis is associated with an increase in enzymes lipase and amylase
The most specific marker of acute pancreatitis is an increase in _
The most specific marker of acute pancreatitis is an increase in lipase
* Can be up to 3x normal limit
* More specific to pancreas than amylase level
Acute pancreatitis will appear _ on imaging
Acute pancreatitis will present with (on imaging):
* Effusion/ fluid collections
* Pseudocysts
* Fistulas
_ sign is bruising around the umbilicus associated with acute pancreatitis
Cullen’s sign is bruising around the umbilicus associated with acute pancreatitis
_ sign is flank bruising associated with acute pancreatitis
Grey Turner’s sign is flank bruising associated with acute pancreatitis
Explain the pathogenesis of shock in acute pancreatitis
Vasodilation and capillary leakage –> third space fluid loss –> shock (tachycardia, hypotension, oliguria)
Explain how acute pancreatitis can cause peripancreatic fat development
Shock –> decreased organ perfusion –> pancreatic necrosis –> pancreatic lipolysis –> peripancreatic fat
How does peripancreatic fat lead to tetany?
Peripancreatic fat –> calcium chelation of fat –> hypocalcemia and tetany
The mcc of chronic pancreatitis is _
The mcc of chronic pancreatitis is alcohol use
* Other causes: CF, autoimmune, obstructive, idiopathic
What do you expect to see on imaging for chronic pancreatitis?
- Calcification of pancreas
- Change in size (atrophy or enlargement)
- Fibrosis (hyperechoic)
- Pseudoaneurysms, pseudocyts
- Dilation of pancreatic duct
Chain of lakes sign is _
Chain of lakes sign is dilation of the pancreatic duct
Chronic inflammation of the pancreas activates _ cells which mediate the fibrosis in chronic pancreatitis
Chronic inflammation of the pancreas activates pancreatic stellate cells which mediate the fibrosis in chronic pancreatitis
Clinical presentation of chronic pancreatitis:
Clinical presentation of chronic pancreatitis:
* Epigastric pain
* Decreased biliary outflow (jaundice)
* Decreased exocrine function (malabsorption)
* Decreased endocrine function (new onset diabetes)
* Ascites
Pancreatic adenocarcinoma arises from the _ cells
Pancreatic adenocarcinoma arises from the pancreatic ducts
Pancreatic adenocarcinoma is most common in _ region of the pancreas
Pancreatic adenocarcinoma is most common in the pancreatic head
On histology, pancreatic adenocarcinoma appears _
On histology, pancreatic adenocarcinoma appears as disorganized glandular structure with cellular infiltration
Risk factors for pancreatic adenocarcinoma include:
Risk factors for pancreatic adenocarcinoma include:
* Chronic pancreatitis
* Smoking
* Diabetes
* Age > 50
Pancreatic adenocarcinoma is associated with tumor markers _ and _
Pancreatic adenocarcinoma is associated with tumor markers CA 19-9 and CEA (CEA is less specific)
Redness and tenderness on palpation of the extremities is a sign of _ ; which is associated with pancreatic adenocarcinoma
Redness and tenderness on palpation of the extremities is a sign of migratory thrombophlebitis ; which is associated with pancreatic adenocarcinoma
* Trousseau sign
* We can also get activation of clotting factors and DIC
Courvoisier sign is _
Courvoisier sign is obstructive jaundice with painless, palpable gallbladder
* Dark urine, pale stools
Acute pancreatitis can lead to severe critical illness including _
Acute pancreatitis can lead to severe critical illness including ARDS and death
The classic clinical presentation of acute pancreatitis will include:
The classic clinical presentation of acute pancreatitis will include:
* Acute abdominal pain radiating to back
* Nausea and vomiting
* Fever/ chills
* Tachycardia, hypotension, volume depletion
“Interstitial edematous pancreatitis” describes (chronic/acute) pancreatitis
“Interstitial edematous pancreatitis” describes acute pancreatitis
* Will most often be self-limiting
Severe acute pancreatitis occurs when we progress from interstitial edematous to _
Severe acute pancreatitis occurs when we progress from interstitial edematous to necrotizing –> necrotizing pancreatitis
* Extensive pancreatic tissue destruction
* Surrounding organ damage
* Can get systemic inflammatory response and multi-organ failure
Why does acute pancreatitis cause third spacing of fluid?
Activated enzymes damage the blood vessels –> leaky blood vessels –> third spacing of fluids –> hypotension
Explain how acute pancreatitis can cause multi-organ failure
Activated enzymes get into the blood stream –> travel to other organs –> cause damage/destruction –> AKI, ARDS, shock
Multiple recurrences of acute pancreatitis can lead to the development of _ and _
Multiple recurrences of acute pancreatitis can lead to the development of pancreatic insufficiency and chronic pancreatitis
Pancreatic pseudocyst
Necrotizing pancretitis
Grossly, acute pancreatitis will present with _
Grossly, acute pancreatitis will present with swollen, edematous pancreas with fat necrosis and hemorrhage
Explain the saponification of fat in acute pancreatitis
Inflammation mediated by neutrophils –> adipocytes get necrotic and release fatty acids –> fatty acids bind to calcium –> calcium soaps
The majority of acute pancreatic cases are caused by either _ or _
The majority of acute pancreatic cases are caused by either gallstones or alcohol
* Hypertriglyceridemia
* Medication
* Autoimmune
* Genetic (PRSS, SPINK1)
* Post-ERCP
* Trauma
* Infection
Diagnosis of acute pancreatitis requires 2/3 features:
1. Acute onset severe epigastric pain
2. Elevated amylase/lipase
3. CT imaging (or MRI)
Diagnosis of acute pancreatitis requires 2/3 features:
1. Acute onset severe epigastric pain
2. Elevated amylase/lipase
3. CT imaging (or MRI)
Besides elevated amylase and lipase and abdominal pain, what are other common features of acute pancreatitis?
- Hypocalcemia
- High BUN, Cr
- High WBC
- Hypoxia
- High LFTs (if gallstone)
- Elevated glucose
_ is the most important first intervention in acute pancreatitis
IV fluid resuscitation is the most important first intervention in acute pancreatitis
What is chronic pancreatitis?
Chronic pancreatitis is a progressive fibroinflammatory disorder that is associated with a loss of pancreatic parenchyma (structure and function)
Explain the structural damage associated with chronic pancreatitis
- Loss of parenchyma
- Atrophic pancreas
- Pancreatic duct dilation/obstruction
- Chronic pain
- Calcifications on imaging
- Pseudocysts
Once we lose about 80-90% of pancreatic function we can end up with _
Once we lose about 80-90% of pancreatic function we can end up with significant pancreatic insufficiency
* Loss of exocrine function
* Malabsorption
* Low ADEK, protein/albumin
* Steatorrhea
* Weight loss
Dilation of the main pancreatic duct is associated with (acute/chronic) pancreatitis
Dilation of the main pancreatic duct is associated with chronic pancreatitis
Chronic pancreatitis
Etiologies of chronic pancreatitis
Etiologies of chronic pancreatitis:
TIGAR-O
1. Toxin (alcohol)
2. Idiopathic
3. Genetic (SPINK1, PRSS)
4. Autoimmune
5. Recurrent
6. Obstructive
Fecal elastase will be (high/low) in chronic pancreatitis
Fecal elastase will be low in chronic pancreatitis
What labs do we expect with chronic pancreatitis?
- Low fecal elastase
- Fecal fat
- Fat soluble vitamins (ADEK)
- Low albumin
- Low duodenal pH
- Amylase and lipase are not helpful, often low or normal
Chronic pancreatitis
_ is a tumor maker for pancreatic adenocarcinoma
Ca19-9 is a tumor maker for pancreatic adenocarcinoma
