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Clin Med I- GI > Pancreas > Flashcards

Pancreas Flashcards

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
Q

What is tx for pancreatic pseudocyst

A

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.

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26
Q

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

A

Abscess

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27
Q

Tx for abscess caused from acute pancreatitis

A

IR drainage, open surgical drainage, IV antibiotics

28
Q

What diseases may you see steatorrhea in?

A

Cystic Fibrosis, chronic pancreatitis

29
Q

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?

A

chronic pancreatitis- pancreatic calcification in half of patients shows in xray.

30
Q

Pancreatic insufficiency occurs in 30% of chronic pancreatitis patients, resulting in..

A

malabsorption- steatorrhea (unabsorbed fat in stools) from exocrine malfunction, and diabetes from endocrine malfunction

31
Q

ERCP mostly used for…

A

diagnosing and treating problems of biliary and pancreatic ductal systems

32
Q

Complications of chronic pancreatitis

A

Pancreatic pseudocyst, biliary or duodenal obstruction, malnutrition, diabetes

33
Q

Medical tx of chronic pancreatitis

A

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
Q

Surgical tx of chronic pancreatitis

A

Drainage via peustow (pancreaticojejunostomy), pancreatectomy (whipple procedure- pancreaticoduodenectomy), and celiac plexus block

35
Q

To determine causes of chronic pancreatits or rule it out…

A

secretin and CCK test, pancreolauryl test, PABA excretion test, fecal fat balance

36
Q

Malabsorption tx in chronic pancreatitis

A

Pancreatic enzyme- Pancrease, high calorie diet with fat restriction, and H2 blocker- can degrade the ingested enzymes

37
Q

Pancreatic neoplasms

A

pancreatic adenocarcioma, cystic neoplasm, adenoma and adenocarcinoma of the ampulla of Vater, pancreatic islet cell tumors

38
Q

Pancreatic islet cell tumors

A

non-functioning islet cell tumors, insulinoma, glucagonoma, somatostatinoma, pancreatic cholera

39
Q

2/3rds of adenocarcinoma cases involve which part of pancreas?

A

head of pancreas, which is good because jaundice occurs faster- detection faster

40
Q

Most common risk factor associated with pancreatic adenocarcinoma

A

Smoking. also obesity, tobacco, cirrhosis, chronic pancreatitis

41
Q

Courvoisier sign

A

Palpable non-tender gallbladder in jaundiced patient- can indicate pancreatic adenocarcinoma of head

42
Q

Labs in pancreatic adenocarcinoma

A

elevated alk phos, bilirubin, CA 19-9 which is a tumor marker

43
Q

Imaging of pancreatic adenocarcinoma

A

CT, ERCP + biopsy, aspiration biopsy

44
Q

Distal pancreatectomy removes…

A

tail

45
Q

Whipple procedure…

A

pancreaticoduodenectomy- tx for pancreatic head tumors and chronic pancreatitis

46
Q

Surgical resection done in pancreatic adenocarcinoma only if tumor does not involve…

A

hepatic artery, SMA, and liver, and regional lymph nodes

47
Q

another tx option in adenocarcinoma is diversion of the biliary stream via…

A

connecting jejunum to gallbladder (cholecystojejunostomy) or connecting jejunum to bile duct (choledochojejunostomy)

48
Q

Cystadenoma vs. cystadenocarcinoma

A

cystadenoma- benign, cystadenocarcinoma- malignant

49
Q

serous vs. mucinous cystadenoma

A

serous- benign, resect. Mucinous- benign but can undergo malignant degeneration, resect

50
Q

Cystic neoplasms

A

cystadenoma, cystadenocarcinoma, papillary-cystic neoplasm

51
Q

Adenomoas/adenocarcinomas of ampulla of vater benign or malignant

A

1/3 adenoma, 2/3 adenocarcinoma

52
Q

If adenoma/adenocarcinoma of ampulla of vater has become metastatic, do you still do resection?

A

No. Do sphincterotomy and stent placement

53
Q

symptoms in non-functioning islet cell tumors vs. funcitoning islet cell tumors

A

non-functioning don’t have symptoms because no hormones released. pancreatic islet cell tumors release hormones so many symptoms

54
Q

non-functioning islet cell tumor benign or malignant

A

malignant tumor of the head of the gland

55
Q

Insulinoma symptoms

A

bizarre behavior- unconsciousness, memory lapse due to cerebral glucose deprivation. Weight gain because eating helps symptoms

56
Q

To check for insulinoma

A

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
Q

Pancreatic cholera symptoms

A

non-Beta islet cell tumor that secretes VIP and peptide histidine isoleucine. Profuse watery diarrhea, low serum K.

58
Q

Which pancreatic tumor can present the same as chronic laxative use?

A

pancreatic cholera

59
Q

pancreatic cholera often located in…

A

body or tail of pancreas

60
Q

Glucoagonoma major sx

A

Prominent rash in a patient with diabetes (all over body)

61
Q

Somatostatinoma characterized by..

A

diabetes, malabsorption, diarrhea, dialtion of gallbladder

62
Q

somatostatinoma benign or malignant

A

half and half

63
Q

Annular pancreas

A

rare congenital condition- ring of pancreas surrounding second portion of duodenum- duodenal obstruction in infancy

64
Q

tx of annular pancreas

A

bypass obstruction with duodenojejunostomy

65
Q

postprandial vomitting seen in which pancreatic condition?

A

annular pancreas (throwing up after eating)

66
Q

pancreas divisum

A

failure of fusion of the dorsal and ventral duct structures

67
Q

Why might pancreas divisum predispose to pancreatitis?

A

d/t obstruction of the outflow of the minor duct

Clin Med I- GI (10 decks)

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