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MJ- F3E3: GI > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Exocrine function of pancreas:

What are the 3 pancreatic enzymes and what is their function?

A
  1. Amylase: breakdown starch
  2. Lipase: Breakdown fat
  3. Proteases: Breakdown proteins
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2
Q

Endocrine function of pancreas:

What is the role of insulin and glucagon?

A
  • Insulin: increases permeability of cell membranes (lowers BS)
  • Glucagon: Stimulates liver to convert glycogen–>glucose (increases BS)
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3
Q

Which pancreatic cells secrete amylase into the duodenum for the digestion of starch?

A

acinar cells

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4
Q

In pancreatitis, do you see elevation in amylase or lipase first?

A

Amylase

(A comes before L)

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5
Q

Is Amylase or Lipase more specific to pancreatic disease?

A

Lipase

(amylase is also found in saliva, ovaries, skeletal mm and GB)

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6
Q

T/F: pts w/ chronic pancreatitis might NOT have increase in amylase. Why?

A

TRUE.

Acinar cells destroyed–> no amylase

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7
Q

Although Lipase is more specific to pancreatic dz than amylase, what 2 othe rconditions is it seen in?

A
  1. renal failure
  2. intestinal infarction/obstruction
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8
Q

What is the definition of acute pancreatitis?

A

Inflammatory disease characterized by autodigestion of panc by proteolytic enzymes prematurely activated w/in the pancrease]

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9
Q

What are the 2 main etiologies of acute pancreatitis?

A
  1. Alcohol
  2. Gallstones
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10
Q

What is the MC mechanical cause of pancreatitis

A

gallstones

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11
Q

What is the MC metabolic cause of acute pancreatitis

A

alcohol

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12
Q

Other than alcohol, what is another metabolic etiology of pancreatitis

A

hypertriglyceridemia

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13
Q

Pt presents with constant, “boring” midepigastric pain radiating to the back—> what dx are you thinking

A

acute pancreatitis

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14
Q

what makes acute pancreatitis worse? better?

A

worse: lying supine
better: sitting and leaning forward

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15
Q

What is the tx for acute pancreatitis?

A
  1. Admit

2. keep NPO

  1. IV fluids​
  2. Strong pain meds
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16
Q

If a patient has signs of acute pancreatitis in addition to jaundice, what are you thinking is the cause?

A

biliary obstruction

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17
Q

What is heard on auscultation of the abdomen in acute pancreatitis

A

bowel sounds hypoactive or absent

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18
Q

What is Cullens sign and Grey Turners sign? what are they indicative of?

A

Cullens: Periumbilical ecchymosis (Cullens= around the Core)

Grey-Turner’s: Flank ecchymosis

****signs of hemorrhagic pancreatitis***

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19
Q

Amylase and lipase are >____x abnormal in acute pancreatitis

A

3x

20
Q

What 2 lab findings suggest gallstone pancreatitis

A

LFTs: transient elevations

  • ALT> 150
  • Increased bilirubin
21
Q

Will WBC be elevated in acute pancreatitis>

A

yes- 15-20k

22
Q

Although abdominal x-ray has limited role in dx of acute pancreatitis, what might it show?

A

sentinel loop of dilated bowel

+/- calcified gallstones in RUQ

23
Q

Why would you order a CXR if you are concerned for acute pancreatitis?

A

r/o pulmonary infiltrates or pleural effusions

24
Q

What will be on CT in acute pancreatitis?

A

enlargement of pancreas

blurring of fat planes/fat stranding

25
Q

What are the 4 complicatiosn of acute pancreatitis

A
  1. necrosis
  2. Pseudocysts
  3. Abscess
  4. Hemorrhage

(“He NAPs”)

26
Q

What are the 3 reasons to order a CT to eval for acute pancreatitis?

A
  1. For diagnosis (but not always necessary)
  2. Identify severity of disease
  3. Identify complications (necrosis, pseudocysts, abscess, hemorrhage)
27
Q

Which imaging has the following advantages over CT:

  • lower risk of hepatotoxicity
  • Better view of biliary and pancreatic ducts
A

MRI/MRCP

28
Q

Which diagnostic study is newer, has increased sensitivity and can be diagnostic and therapeutic

A

ERCP

(able to visualize biliary and pancreatic ductal anatomy, obtain cytology/biopsy and can be therapeutic- stone removal, stent insertion, sphincterotony)

29
Q

What 3 things is extrahepatic biliary obstruction caused by

A
  1. Gallstones
  2. pancreatitis
  3. pancreatic cancer
30
Q
A
31
Q

When are abx indicated in a patient w/ acute pancreatitis

A

when infected necrosis is a concern

(Imipenem)

32
Q

What are 3 early identification signs of complications of acute pancreatitis?

A
  1. decreased UOP/ rising SrCr
  2. resp failure
  3. Inc. pain, F, leukocytosis
33
Q

What are 5 local complications of acute pancreatitis?

A
  1. pseudocyst
  2. Pancreatic abscess
  3. pancreatic necrosis
  4. Hemorrhage (signs= cullens and grey turners)
  5. Ascites

(“He NAPs because of his Ascites”)

34
Q

When would you suspect a pancreatic abscess? (3_

A

suspect w/ fever, increased WBC, clinical deterioraion

35
Q

Which condition?

  • Abd pain
  • Early satiety
  • N/V
A

Pancreatic pseudocyst

36
Q

T/F: pancreatic pseudocysts can spontaneously resolve or continue to enlarge

A

true

(so only intervene if signs of infection)

37
Q

What are the 3 complications of pancreatic pseudocyst

A
  1. Rupture
  2. Hemorrhage
  3. Infection
38
Q

When is surgery or drainage indicated in pancreatic pseudocyst?

A

if symptomatic or infected

39
Q

Complication of acute pancreatitis:

What is a pancreatic pseudocyst?

A

collection of fluid and debri; no epithelial lining; fibrotic wall

40
Q

Complications of acute pancreatitis:

What is a pancreatic abscess? You would suspect this when you see what 3 things?

A
  • infected pseudocyst or necrotic area
  • Suspect w/ F, increased WBC, clinical deterioration
41
Q

What are the 5 systemic complications of Acute pancreatitis?

A
  1. Pulmonary- resp failure/ARDS, pulm edema, pleural effusions, atelectasis
  2. Renal failure
  3. Hypotension/shock
  4. Ileus
  5. Hyperglycemia/hypocalcemia
42
Q

What are 2 metabolic complications of acute pancreatitis?

A

hyperglycemia

hypocalcemia

43
Q

The following are all components of what criteria used to determine prognosis of Acute pancreatits? (see attached pic)

A

Ranson’s criteria

45
Q

Age > _____ is part of Ransons criteria (used for prognosis of acute pancreatitis)

A

55

46
Q

Mortality of Acute pancreatitis realted to number of Ranson’s signs:

0-2= ___%

3-4= ___%

5-6= ___%

7-8= ____%

A

0-2= <1%

3-4= 15%

5-6= 40%

7-8= 100%

47
Q

How do you prevent recurrence of biliary pancreatitis?

A

ERCP if CBD stone

Elective CCY

MJ- F3E3: GI (9 decks)

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