Pancreas Flashcards
What structure is the tail of the pancreas said to “tickle”?
Spleen
What are the 2 pancreatic ducts?
- Wirsung duct
2. Santorini duct
Which duct is the main duct?
Wirsung duct (Mnemonic: Santorini = Small)
How is the blood supplied to the head of the pancreas?
- Celiac –> gastroduodenal –> anterior and posterior superior pancreaticoduodenal
- SMA –> anterior and posterior inferior pancreaticoduodenal
- Splenic –> dorsal pancreatic
Why must the duodenum be removed if the head of the pancreas is removed?
They share the same blood supply (gastroduodenal)
What is the endocrine portion of the pancreas?
Islets of Langerhans
What is the exocrine function of the pancreas?
Digestive enzymes: amylase, lipase, trypsin, chymotrypsin, carboxypeptidase
What maneuver is used to mobilize the duodenum and pancreas and evaluate the entire pancreas?
Kocher maneuver: Incise the lateral attachments of the duodenum and then lift the pancreas to examine the posterior surface
What is acute pancreatitis?
Inflammation of the pancreas
What are the most common etiologies of acute pancreatitis in the US?
- Alcohol abuse
- Gallstones
- Idiopathic
What is the acronym to remember all the causes of pancreatitis?
I GET SMASHED:
Idiopathic, Gallstones, Ethanol, Trauma, Scorpion bite, Mumps (viruses), Autoimmune, Steroids, Hyperlipidemia, ERCP, Drugs
What are the symptoms of acute pancreatitis?
Epigastric pain (frequently radiating to the back), N/V
What are the signs of pancreatitis?
Epigastric tenderness, diffuse abdominal tenderness, decreased bowel sounds (adynamic ileus), fever, dehydration, shock
What is the differential diagnosis of acute pancreatitis?
Gastritis, PUD, perforated viscus, acute cholecystitis, SBO, mesenteric ischemia, ruptured AAA, biliary colic, inferior MI, pneumonia
What lab tests should be ordered for acute pancreatitis?
CBC, LFT, amylase/lipase, T&C, ABG, Ca, coags, serum lipids
What are the associated diagnostic findings for acute pancreatitis?
Lab: high amylase, lipase, WBC
AXR: sentinel loop, colon cutoff, possibly gallstones
U/S: phlegmon, cholelithiasis
CT: phlegmon, pancreatic necrosis
What is the most common sign of pancreatitis on AXR?
Sentinel loops
What is the treatment for acute pancreatitis?
NPO, IVF, NGT if vomiting, +/- TPN vs. post-pyloric tube feeds, H2 blocker, PPI, analgesia (Demerol), correction of coags/electrolytes, +/- alcohol withdrawal prophylaxis
What are the possible complications of acute pancreatitis?
Pseudocyst, abscess/infection, pancreatic necrosis, splenic/mesenteric/portal vessel rupture or thrombosis, pancreatic ascites/pleural effusion, diabetes, ARDS, sepsis, MOF, coagulopathy, DIC, encephalopathy, severe hypocalcemia
What is the prognosis of acute pancreatitis?
Based on Ranson’s criteria
Are post-pyloric tube feeds safe in acute pancreatitis?
Yes
What are Ranson’s criteria at presentation for acute pancreatitis?
- Age > 55
- WBC > 16,000
- Glucose > 200
- AST > 250
- LDH > 350
What are Ranson’s criteria during the initial 48 hours of acute pancreatitis?
- Base deficit > 4
- BUN increase > 5 mg/dL
- Fluid sequestration > 6 L
- Serum Ca < 8
- Hct decrease > 10%
- PO2 < 60 mmHg
How can the admission Ranson criteria be remembered?
GA LAW: Glucose > 200 Age > 55 LDH > 350 AST > 250 WBC > 16,000