Pancreas Flashcards
Acute pancreatitis
inflammation of the pancreas that is mild and often spontaneously resolves
What percentage of acute pancreatitis ends patients in the hospital?
20%
Acute pancreatitis patho
obstruction of outflow of pancreatic enzymes often related to pancreatic and common bile duct obstruction (often gallstones)
Causes of acute pancreatitis
Alcohol, drugs, viral infection
What does build up of enzymes cause?
Autodigestion of pancreatic cells which causes inflammation
Complications of autodigestion of the pancreatic cells
Necrosis, fat necrosis, coagulopathy, vascular damage
What does elevated trypsin cause
edema, hemorrhage, necrosis
What does elevated elastase cause
hemorrhage
What does elevated phospholipase A cause
Fat necrosis
What does elevated kallikrein cause
edema, vascular permeability, shock, smooth muscle contractions
What does vascular permeability cause
Fluid seeps into the pancreas which can cause ascites
What does smooth muscle contractions cause
pain
What is the cause of shock with acute pancreatitis
vascular permeability
What does elevated lipase cause
fat necrosis
Necrosis
Death and breakdown of tissues
s/s acute pancreatitis
severe epigastric pain, N/V, hypoactive bowel sounds, ab distension, fever, hypotension, tachycardia, jaundice, ecchymosis
Characteristics of acute pancreatitis pain
- sudden onset
- tender abdomen
- guarding
- may radiate to back
What causes acute pancreatitis pain
edema - distention of pancreatic ducts and capsules and irritation of peritoneum and biliary tract
Elevated labs with acute pancreatitis
amylase, lipase, WBCs
How does acute pancreatitis affect glucose
Glucose can be high or low (depends which cells are autodigested)
Ecchymosis
Cyanosis or green-yellow/brown color on abdomen
Grey Turners
ecchymosis on the flanks
Cullen sign
ecchymosis in the periumbilical area
What kind of pancreatitis causes ecchymosis
Hemorrhagic pancreatitis
Complications of acute pancreatitis
abscess, pseudocyst, pulmonary compromise, tetany, hypotension (shock)
Pseudocyst
- Fluid filled cavity SURROUNDING the outside pancreas that are made of necrotic products and secretions, cause more inflam and scarring
- visible on a CT
- may be palpable epigastric mass that can cause peritonitis if it perforates - may need surgery to prevent
Abscess
- Large fluid filled cavity in pancreas that can cause infection or perforation
- Abdominal mass, inc fever, inc leukocytosis
- cause is often necrotic pancreatic hemorrhage
Why does tetany happen with acute pancreatitis?
Lipase causes fat necrosis which releases FFA that binds to calcium deposits in the peritoneum and causes dec calcium
Chronic pancreatitis
Progressive fibrotic disease of the pancreas
Most often cause of chronic pancreatitis
Alcohol
Patho of alc chronic hepatitis
Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of langerhans
Risk factors for chronic pancreatitis
Genetics, SMOKE, gallstone obstruction, Alcohol
CM for chronic pancreatitis
- attacks of acute pancreatitis with progressive signs of dysfunction after attacks subside
- abdominal pain and weight loss
- diabetes r/t loss of islet of Langerhans
- issues with nutrition, especially fat abs–wt loss
- pancreatic psuedocysts
Pharm for pancreatitis
Opioids, Antispasmodics, antacids, H2 receptor antagonists, pancrelipase, insulin or glucagon
Dicyclamine
Antispasmodic (anti-ACh agent) that decreases spasming bile ducts
Antacids
Neutralize Hcl secretion in stomach which dec secretion of pancreatic enzymes
H2 receptor antagonists
basically antacids
Pancrelipase
Replaces panc enzymes (chronic only)
