Pancreas Flashcards
Pancreas Exocrine Function
- synthesis of enzymes needed for digestion of fats, proteins, and carbs
- neutralizes gastric acid and chyme
Pancreas Endocrine Function
-synthesizes and secretes hormones (insulin, glucagon) that regulate glucose and lipid metabolism
Acute Pancreatitis
- acute inflammation
- acute abd pain
- elevated pancreatic enzymes in serum
- self limited
- cause: gall stone obstruction, EtOH
- pro-enzymes are prematurely activated within pancreas
- autodigestion of gland
- tx: admit to hospital, NPO then slow advancement of diet, IV narc for pain, surgery if gall stones are present, ERCP for bile duct stone removal
Chronic Pancreatitis
- chronic inflammtion
- ductal obstruction
- chronic pain or malabsorption
- permanent loss of pancreatic function
- features: stones, pseudocysts, acinar destruction
- causes: alcoholic, idiopathic, diabetes, CF, hereditary
- sx: abd pain, steatorrhea, hypo or hyperglycemia
- dx: history/physical, X ray, CT
- tx: EtOH avoidance, enzymes replacement, dilation/stent placement of duct, stone removal, celiac nerve block for pain, pancreatectomy
Pancreatic Pseudocyst
- collection of pancreatic fluid, debris surrounded by wall of granulation tissue- lacks epithelial lining
- results from ductal disruption, necrosis, or both
- develop in 10-30% of acute pancreatitis
- majority resolve with time
- tx: may place stent
Adult Respiratory Distress Syndrome (ARDS)
- delayed onset
- associated with pancreatic necrosis
- commonly leads to resp. failure
- fully reversible
- tx= support
Steatorrhea
- dec. lipase and colipase in duodenum
- dec. duodenal pH
B12 and Pancreas
-inc. pancreatic enzymes-> dec. breakdown of B12-> dec. binding to IF-> dec. B12 absorption
Endoscopic Retrograde Cholangiopancreatography (ERCP_
-can use to remove stones in bile duct?
Secretin Test
-evaluates pancreatic function
-secretin is given IV
-secretin-> inc. HCO3 + H2O secreted from pancreas
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Pancreatic Cancer
- adenocarcinoma most common
- diagnosed late
- presentation: jaundice, dark urine, pruritus, late abd/back pain, weight loss, N/V late, hormonal excess (neuroendocrine)
- dx: CT/MRI, biopsy
- tx: surgical resection, ERCP with stent, celiac block
Neuroendocrine Tumor
- slow growing
- prognosis favorable
- islet cell origin
- may present with sx of hormone excess
Autoimmune Pancreatitis (AIP)
-diffuse or focal enlargement of pancreatic parenchyma (plasma cells/lymphocytes)
-infiltration by IgG-4+ plasma cells with lymphocytes
-male 40-70
association with other autoimmune disease
-may masquerade as pancreatic cancer
-sx: abd pain, jaundice, weight loss
-imaging: diffuse or focal enlargement of pancreas (sausage pancreas)
-dx: CT/MRI, serum IgG-4, ERCP
-tx: PO corticosteroids x 6 weeks, biliary stenting for sx relief
Zollinger Ellison Syndrome
- tumors called gastrinomas form in pancreas or duodenum
- secrete large amounts of gastrin -> inc. acid -> ulcers
Acinar Cell
- secrete enzymes
- located in pancreas
