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Clin Med I- GI > Pancreas > Flashcards

Pancreas Flashcards

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1
Q

If superior mesenteric a severed, how would pancreas be affected?

A

Inferior portion of pancreas (and duodenum) would receive decreased blood and oxygen

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2
Q

If celiac trunk severed, how would pancreas be affected?

A

Superior portion of pancreas (and duodenum) would receive decreased blood and oxygen

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3
Q

Lymph drainage of pancreas

A

to the peripancreatic nodes

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4
Q

Nerve supply of pancreas

A

vagus and splanchnic nerves

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5
Q

How does pancreas receive its blood?

A

From superior and inferior pancreaticoduodenal arteries

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6
Q

Major pancreatic duct aka

A

Wirsung duct

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7
Q

Minor pancreatic duct aka

A

Santorini duct

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8
Q

Most common causes of pancreatitis

A

Alcohol and gallstones. Alcohol most common cause of chronic, while gallstones most common cause of acute.

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9
Q

Process of trypsinogen being activated within pancreas and destroying cells in pancreas called?

A

Autodigestion of the pancreas caused by gallstones that obstruct common duct

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10
Q

Effect of alcohol in causing pancreatitis

A

alcohol has direct toxic effect in parenchymal cells, increases secretion and causes spasm at the sphincter of Oddi, increases duct permeability

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11
Q

Results of alcohol cessation in pancreatitis

A

decreases acute attacks. Ongoing parenchymal damage occurs due to obstruction and fibrosis of the duct

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12
Q

If suspicious of hyperlipidemia causing pancreatitis, check..

A

serum triglyceride levels - over 400 mg/dl

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13
Q

Drug induced pancreatitis causes

A

TEA- tetracyclines, thiazide diuretics, estrongen containing contraceptives, and azathrioprine. (and steroids)

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14
Q

Patient presents with severe upper abdominal pain radiating to the back, nausea, vomiting, retching, dehydration, tachycardia. Decreased or absent BS, tenderness across upper abdomen. Labs show elevated lipase, amylase, and mild leukocytosis. Xray shows non specific sign of sentinel loop. Dx?

A

Acute pancreatitis

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15
Q

Labs to order in acute pancreatitis to figure out cause

A

LFT, LDH, triglycerides, BUN/Cr, electrolytes, Ca, glucose

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16
Q

What are 2 signs that may predict severe acute pancreatitis?

A

Cullen sign and Grey turner sign

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17
Q

Describe cullen sign

A

hemorrhagic discoloration or bruising of umbilicus - around belly button

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18
Q

Describe grey turner sign

A

hemorrhagic discoloration/bruising of flanks

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19
Q

what criteria used for acute pancreatitis

A

Ranson’s criteria- assesses risk of death

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20
Q

Potential complications of acute pancreatitis

A

pseudocyst, necrosis, abscess- can be seen from CT

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21
Q

Medical Tx of acute pancreatitis

A

NPO allows pancreas to rest, IV fluids, NG decompression, parenteral nutrition or J tube, electrolyte replacement, oxygen, antibiotics in severe cases (Imipenem)

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22
Q

Surgical tx of acute pancreatits

A

If gallstones cause, treat pancreatitis then cholecystectomy. Do cholangiogram and if stones are present in duct- sphincterotomy.

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23
Q

Pancreatic pseudocyst complications

A

infection, rupture, hemorrhage

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24
Q

Patient with resolved acute pancreatitis, but there is still ongoing pain. There is fluid collection around the pancreas. What complication do you suspect

A

Pancreatic pseudocyst

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25
What is tx for pancreatic pseudocyst
Wait for pseudocyst to mature 2-3 months then connect to GI tract for easier drainage via cystgastrostomy or cystjejunostomy. Interventional radiology used when fluid has become infected.
26
Patient with resolved acute pancreatitis, but there is still ongoing pain. There is fluid collection around the pancreas. Labs also show High wbC count, and fever in patient. What complication do you suspect
Abscess
27
Tx for abscess caused from acute pancreatitis
IR drainage, open surgical drainage, IV antibiotics
28
What diseases may you see steatorrhea in?
Cystic Fibrosis, chronic pancreatitis
29
Patient presents with abdominal pain radiating to back, malabsorption, fatty stools, diabetes. Acute pancreatitis episodes and addiction to narcotics. What do you suspect and what would xray show?
chronic pancreatitis- pancreatic calcification in half of patients shows in xray.
30
Pancreatic insufficiency occurs in 30% of chronic pancreatitis patients, resulting in..
malabsorption- steatorrhea (unabsorbed fat in stools) from exocrine malfunction, and diabetes from endocrine malfunction
31
ERCP mostly used for...
diagnosing and treating problems of biliary and pancreatic ductal systems
32
Complications of chronic pancreatitis
Pancreatic pseudocyst, biliary or duodenal obstruction, malnutrition, diabetes
33
Medical tx of chronic pancreatitis
think abt causes (alcohol)- alcohol cessation. think about what this disease results in and fix those problems- malabsorption and steatorrhea d/t exocrine dysfunction- give pancreatic enzymes. also diabets d/t endocrine dysfunction- give insulin. psychiatric tx because often addicted to narcotics. PAIN MANAGEMENT! - oral narcotics, patches, celiac plexus blackade
34
Surgical tx of chronic pancreatitis
Drainage via peustow (pancreaticojejunostomy), pancreatectomy (whipple procedure- pancreaticoduodenectomy), and celiac plexus block
35
To determine causes of chronic pancreatits or rule it out...
secretin and CCK test, pancreolauryl test, PABA excretion test, fecal fat balance
36
Malabsorption tx in chronic pancreatitis
Pancreatic enzyme- Pancrease, high calorie diet with fat restriction, and H2 blocker- can degrade the ingested enzymes
37
Pancreatic neoplasms
pancreatic adenocarcioma, cystic neoplasm, adenoma and adenocarcinoma of the ampulla of Vater, pancreatic islet cell tumors
38
Pancreatic islet cell tumors
non-functioning islet cell tumors, insulinoma, glucagonoma, somatostatinoma, pancreatic cholera
39
2/3rds of adenocarcinoma cases involve which part of pancreas?
head of pancreas, which is good because jaundice occurs faster- detection faster
40
Most common risk factor associated with pancreatic adenocarcinoma
Smoking. also obesity, tobacco, cirrhosis, chronic pancreatitis
41
Courvoisier sign
Palpable non-tender gallbladder in jaundiced patient- can indicate pancreatic adenocarcinoma of head
42
Labs in pancreatic adenocarcinoma
elevated alk phos, bilirubin, CA 19-9 which is a tumor marker
43
Imaging of pancreatic adenocarcinoma
CT, ERCP + biopsy, aspiration biopsy
44
Distal pancreatectomy removes...
tail
45
Whipple procedure...
pancreaticoduodenectomy- tx for pancreatic head tumors and chronic pancreatitis
46
Surgical resection done in pancreatic adenocarcinoma only if tumor does not involve...
hepatic artery, SMA, and liver, and regional lymph nodes
47
another tx option in adenocarcinoma is diversion of the biliary stream via...
connecting jejunum to gallbladder (cholecystojejunostomy) or connecting jejunum to bile duct (choledochojejunostomy)
48
Cystadenoma vs. cystadenocarcinoma
cystadenoma- benign, cystadenocarcinoma- malignant
49
serous vs. mucinous cystadenoma
serous- benign, resect. Mucinous- benign but can undergo malignant degeneration, resect
50
Cystic neoplasms
cystadenoma, cystadenocarcinoma, papillary-cystic neoplasm
51
Adenomoas/adenocarcinomas of ampulla of vater benign or malignant
1/3 adenoma, 2/3 adenocarcinoma
52
If adenoma/adenocarcinoma of ampulla of vater has become metastatic, do you still do resection?
No. Do sphincterotomy and stent placement
53
symptoms in non-functioning islet cell tumors vs. funcitoning islet cell tumors
non-functioning don't have symptoms because no hormones released. pancreatic islet cell tumors release hormones so many symptoms
54
non-functioning islet cell tumor benign or malignant
malignant tumor of the head of the gland
55
Insulinoma symptoms
bizarre behavior- unconsciousness, memory lapse due to cerebral glucose deprivation. Weight gain because eating helps symptoms
56
To check for insulinoma
Fasting hypoglycemia- glucose and insulin levels checked every 6 hours until hypoglycemia results over 72 hours. Ratio of plasma insulin to glucose greater than 0.3 is diagnostic.
57
Pancreatic cholera symptoms
non-Beta islet cell tumor that secretes VIP and peptide histidine isoleucine. Profuse watery diarrhea, low serum K.
58
Which pancreatic tumor can present the same as chronic laxative use?
pancreatic cholera
59
pancreatic cholera often located in...
body or tail of pancreas
60
Glucoagonoma major sx
Prominent rash in a patient with diabetes (all over body)
61
Somatostatinoma characterized by..
diabetes, malabsorption, diarrhea, dialtion of gallbladder
62
somatostatinoma benign or malignant
half and half
63
Annular pancreas
rare congenital condition- ring of pancreas surrounding second portion of duodenum- duodenal obstruction in infancy
64
tx of annular pancreas
bypass obstruction with duodenojejunostomy
65
postprandial vomitting seen in which pancreatic condition?
annular pancreas (throwing up after eating)
66
pancreas divisum
failure of fusion of the dorsal and ventral duct structures
67
Why might pancreas divisum predispose to pancreatitis?
d/t obstruction of the outflow of the minor duct

Clin Med I- GI (10 decks)

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