pancreas

Question 1

what is the pancreas exocrine function?

Answer 1

pancreatic juices: tyrpsin, elastase, phospholipase A, lipase, kallikrein

Question 2

what is the pancreas endocrine function?

Answer 2

islets of langerhans: alpha cells, beta cells, delta cells

Question 3

what is acute pancreatitis?

Answer 3

acute is reversible

Question 4

what is chronic pancreatitis?

Answer 4

progressive-fibrosis

Question 5

what are some risk factors for pancreatitis?

Answer 5

1. genetic (ie. cystic fibrosis)
2. trauma
3. alcohol abuse
4. biliary tract dysfunction
5. men and women equal risk

Question 6

what is the pancreatitis inflammatory process?

Answer 6

1. acute inflammation response

2. multi-organ failure

Question 7

what can happen if there is obstruction of the pancreatic ducts?

Answer 7

1. pancreatic ischemia
2. gallstones
3. auto digestive effects
   - -pancreas enzymes in the wrong are cause destruction

Question 8

what does chronic alcohol do to the pancreas?

Answer 8

chronic alcohol intake- 5-10% of alcoholics increases digestive enzymes

Question 9

acute pancreatitis clinical manifestations

Answer 9

1. severe pain– epigastric; may radiate to back
2. n/v
3. abd distention, hypoactive sounds, changes in stool from fat malabsorption
4. diaphoresis
5. dyspnea, shallow respirations
6. low grade fever
7. tachycardia
8. hypotension
9. jaundice
10. leukocytosis
11. grey turner- may be hemorrhagic pancreas, looks like bruising
12. cullen’s sign- discoloration around the umbilicus (bruising) may be hemorrhagic pancreas

Question 10

chronic pancreatitis clinical manifestations

Answer 10

it is progressive or recurring

sxs:
1. persistent or recurrent mid-epigastic pain like “heavy” or “cramp like”

2. wt loss
3. malnutrition
4. hyper- or hypoglycemia
5. steatorrhea: foul, fatty, frothy stools

Question 11

pancreatitis diagnostic tests: labs

Answer 11

1. amylase
2. lipase
3. glucose
4. calcium
5. WBCs
6. triglycerides
7. AST/ALT
8. ranson criteria

Question 12

pancreatitis diagnostic tests: radiology

Answer 12

1. CT scan
2. ultrasound
3. HIDA scan
4. MRI
5. ERCP -endoscopic retrograde choangiopancreatography
6. MRCP- magnetic resonance choangiopancreatography

Question 13

pancreatitis treatment

Answer 13

1. pain management
2. iv fluids- usually 200-250 ml/hr
3. NPO
   - -introduce low-fat small meals, slowly after pain improves
4. NGT- possible if vomiting or ileum, or to reduce pancreatic secretions
5. pt education

Question 14

pancreatitis treatment medications

Answer 14

1. TPN (possibly for sustained or recurrent)
2. pancreatic enzymes (when taking po, if needed)
3. other meds for symptoms

Question 15

what complications should be prevented?

Answer 15

1. ARDS
2. pneumonia
3. hypo/ hyperglycemia
4. pseudo cyst
5. shock
6. necrotic pancreas