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F3 E3 Shea > Pancreas 2 > Flashcards

Pancreas 2 Flashcards

1
Q

Chronic pancreatitis is repeated episodes of acute inflammation leading to what 2 things?

A

permanent structural damage and ductal obstruction

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2
Q

Chronic pancreatitis:

Gradual loss of pancreatic function leads to what 2 things?

A
  1. Exocrine insufficiency (malabsorption, steatorrhea,etc)
  2. Endocrine insufficiency (No insulin, DM)
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3
Q

What is the MCC of chronic pancreatitis

A

Alcohol

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4
Q

Clinical presentation of what?

  • Epigastric pain (episodic or continuous)
  • Aggravated by alcohol and fatty meals
  • Steatorrhea
  • Weight loss
  • Diabetes sxs- polyuria, polydipsia, etc
  • Pancreatic calcifications
A

Chronic pancreatitis

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5
Q

Which two cells are effected in Diabetes caused by chronic pancreatitis

A

Brittle DM- alpha and beta cells affected

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6
Q

What is the classic triad of chronic pancreatitis?

A
  1. Diabetes (endocrine dysfunction)
  2. Steattorhea (exocrine dysfunction- not making insulin)

Pancreatic calcifications

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7
Q

What is often seen on labs for chronic pancreatitis? (normal, elevated or decreased)

Amylase and lipase: ____

Bilirubin and alk phos: ____

Glucose: _____

Fecal Fat testing: ____

A

Amylase and lipase: normal or slightly increased

Bilirubin and alk phos: +/- mild elevation

Glucose: Elevated

Fecal Fat testing: Elevated

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8
Q

What 3 things can an abdominal CT be helpful in looking for in Chronic pancreatitis

A
  1. calcifications
  2. Ductal Dilation
  3. Pseudocysts
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9
Q

What is the gold standard for chronic pancreatitis and what will it show?

A

ERCP

will show “chain-of-lakes”

(however, this is more invasive and is used less often)

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10
Q

What are the 6 complonents of chronic pancreatitis management?

A
  1. Abstinence from alcohol
  2. small, low fat meals
  3. Early identification of complications (change in symptom pattern)
  4. Insulin for diabetes

5. Pancreatic enzyme supplements

6. +/- pain relief: Amitryplyline or SSRI (careful with narcotics due to increased risk of substance abuse), etc

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11
Q

What are the options for pain relief in chronic pancreatitis (5)

A
  1. Start w/ panc enzyme supplements
  2. Consider Amitriptyline or SSRI
  3. Careful with narcotics (long acting MS contin vs Fentanyl patch)
  4. Endoscopic ductal dilation or stenting
  5. Nerve blocks
  6. Surgical resection if cancer or failed other treatments
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12
Q

What is the 4th leading cause of cancer death in the US?

A

Pancreatic cancer

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13
Q

Pancreatic carcinoma:

Majority of tumors are in the _____ of the pancreas

A

head

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14
Q

The majority of pancreatic carcinomas are what type of carcinoma?

A

adenocarcinoma

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15
Q

Pancreatic carcinoma:

_____% of cysts are neoplasms

A

15%

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16
Q

What should you do with all patients with pancreatic lesions?

A

refer to GI/surgery

17
Q

Risk factors of what?

  • male
  • african american
  • >45y/o
  • smoking
  • alcohol
A

Pancreatic Carcinoma

18
Q

Presentation of what?

  • bloating
  • _**gnawing, epigastric pain radiating to the back (MC presenting sx)_
  • weight loss
  • jaundice (pruritis, acholic stools, dark urine)
  • steatorrhea
A

Pancreatic carcinoma

19
Q

Painless jaundice is ______ until proven otherwise

A

pancreatic cancer

20
Q

Which condition has the following:

  • Virchow’s node (left supraclavicular)
  • Courvoisier’s sign (palpable non-tender GB)
A

Pancreatic carcinoma

21
Q

What is CA 19-9 for?

A

tumor marker for pancreatic carcinoma

22
Q

Which diagnostic study is the 1st step if you suspect pancreatic carcinoma

A

CT scan/helical CT

(test of choice for staging disease and to identify eligibility for resection)

23
Q

Which diagnostic study is considered primary diagnostic tool for pancreatic carcinoma?

What will you see?

A

ERCP

Look for “double duct sign” (stricture of both CBD and pancreatic ducts)

Obtain tissue sample

24
Q

Which diagnostic study for pancreatic carcinoma?

  • Evaluates local tumor involvement, vascular involvement, and best for tissue diagnosis
A

Endoscopic US

25
Q

What is the only potential cure for Pancreatic carcinoma?

A

Surgical resection via Whipple procedure (will need chemo +/- radiation)

(most patients present too late for Whipple)

26
Q

What is the overall prognosis of pancreatic cancer?

A

poor

5 year survival <5%

27
Q

Pancreatic Carcinoma: Median survival with an un-resectable lesion

___ - ____ months if locally invasive

____-____ months if metastatic

A

8-12 months if locally invasive

_3-6 months if metastatic

28
Q

In what condition do you see the “double duct sign” on ERCP?

A

Pancreatic carcinoma

F3 E3 Shea (24 decks)

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