Pancreas

Question 1

endocrine issues

Answer 1

DM
this time we discuss exocrine function issues in pancreas

Question 2

acute pancreatitis

Answer 2

usually mild and resolves spontaneously -> severe acute can lead to hospitalization
cause: obstruction of outflow of pancreatic enzymes usually r/t pancreatic and bile duct obstruction (usually gallstone); also caused by OH, drugs, viral infection
backup of enzymes: autodigestion of pancreatic cells -> inflam (vascular damage, coagulopathy, necrosis, fat necrosis in pancreas)

Question 3

pancreatic enzymes: trypsin

Answer 3

edema, necrosis, hemorrhage

Question 4

pancreatic enzymes: elastase

Answer 4

hemorrhage

Question 5

pancreatic enzymes: phospholipase A

Answer 5

fat necrosis

Question 6

pancreatic enzymes: kallikrein

Answer 6

edema
vascular permeability -> fluid seeps into space, abd enlarged -> ascites
SM contraction -> pain
shock -> r/t vascular perm

Question 7

pancreatic enzymes: lipase

Answer 7

fat necrosis

Question 8

pancreatitis: cm - epigastric pain

Answer 8

in mid abd region
severe
sudden onset, may radiate to back, tenderness and guarding
d/t edema = distention of pancreatic ducts and capsule, and chm irritation and inflammation within perineum, and irritation of biliary tract obstruction or nerves in area

Question 9

pancreatitis: cm

Answer 9

n/v, abd distention, hypoBS, fever, hypoT + tachy d/t fluid loss, jaundice
lab changes: increase amylase, lipase, and wbc (inflam), glucose and increase or decrease depending on what cells are damaged
cyanosis or green-yellow/brown discoloration of abd
ecchymoses (severe cm) -> r/t hemorrhagic pancreatitis, bleed bc leaking vessels and pools in certain abd areas: flanks (grey turners) and periumbilical (cullens)

Question 10

pancreatitis: complications

Answer 10

pulm: pain, pleural effusion bc edema and permeability increase
hypoT -> shock
tetany from hypoCa -> lose Ca bc lipase generates free FA that binds Ca

Question 11

pancreatitis: complications - pseudocyst

Answer 11

fluid filled cavity that surrounds outside of pancreas, can see on CT -> necrotic product and secretions
results in inflam and scaring (longer term issues) of areas near pancreas
cm similar to pancreatitis and palpable epigastric mass
perforate -> peritonitis (sx intervention to prevent)

Question 12

pancreatitis: complications - abscess

Answer 12

fluid filled cavity inside the pancreas, d/t extensive pancreatic necrosis
can result in further infection and peritonitis (infected or perforate)
cm similar to pancreatitis and abd mass, elevated fever and leukocytosis

Question 13

chronic pancreatitis

Answer 13

progressive, fibrotic disease of pancreas
OH abuse: toxic metabolites release inflam cytokines and cause destruction of acinar cells and islet of langerhans -> manage glucose and insulin
other rf: genetics, gallstones, obstruction, smoking
pancreatic cysts: walled off areas of pancreatic juice necrotic debris, blood

Question 14

chronic pancreatitis: cm

Answer 14

attacks of acute pancreatitis with progressive s of dysF after attack subsides
2 major s: abd pain (v hard to treat) and weight loss
can lead to DM r/t loss of langerhans
have issues with nutritional abs -> particularly fats (no enzymes for digestion)

Question 15

Pancrelipase

Answer 15

Pancreatic enzyme replacement Replace pancreatic enzymes Reduce secretion of pancreatic enzymes
SE rare
Take with every meal and snack