Pancreas Flashcards
Exocrine function of pancreas:
What are the 3 pancreatic enzymes and what is their function?
- Amylase: breakdown starch
- Lipase: Breakdown fat
- Proteases: Breakdown proteins
Endocrine function of pancreas:
What is the role of insulin and glucagon?
- Insulin: increases permeability of cell membranes (lowers BS)
- Glucagon: Stimulates liver to convert glycogen–>glucose (increases BS)
Which pancreatic cells secrete amylase into the duodenum for the digestion of starch?
acinar cells
In pancreatitis, do you see elevation in amylase or lipase first?
Amylase
(A comes before L)
Is Amylase or Lipase more specific to pancreatic disease?
Lipase
(amylase is also found in saliva, ovaries, skeletal mm and GB)
T/F: pts w/ chronic pancreatitis might NOT have increase in amylase. Why?
TRUE.
Acinar cells destroyed–> no amylase
Although Lipase is more specific to pancreatic dz than amylase, what 2 othe rconditions is it seen in?
- renal failure
- intestinal infarction/obstruction
What is the definition of acute pancreatitis?
Inflammatory disease characterized by autodigestion of panc by proteolytic enzymes prematurely activated w/in the pancrease]
What are the 2 main etiologies of acute pancreatitis?
- Alcohol
- Gallstones
What is the MC mechanical cause of pancreatitis
gallstones
What is the MC metabolic cause of acute pancreatitis
alcohol
Other than alcohol, what is another metabolic etiology of pancreatitis
hypertriglyceridemia
Pt presents with constant, “boring” midepigastric pain radiating to the back—> what dx are you thinking
acute pancreatitis
what makes acute pancreatitis worse? better?
worse: lying supine
better: sitting and leaning forward
What is the tx for acute pancreatitis?
- Admit
2. keep NPO
- IV fluids
- Strong pain meds
If a patient has signs of acute pancreatitis in addition to jaundice, what are you thinking is the cause?
biliary obstruction
What is heard on auscultation of the abdomen in acute pancreatitis
bowel sounds hypoactive or absent
What is Cullens sign and Grey Turners sign? what are they indicative of?
Cullens: Periumbilical ecchymosis (Cullens= around the Core)
Grey-Turner’s: Flank ecchymosis
****signs of hemorrhagic pancreatitis***
Amylase and lipase are >____x abnormal in acute pancreatitis
3x
What 2 lab findings suggest gallstone pancreatitis
LFTs: transient elevations
- ALT> 150
- Increased bilirubin
Will WBC be elevated in acute pancreatitis>
yes- 15-20k
Although abdominal x-ray has limited role in dx of acute pancreatitis, what might it show?
sentinel loop of dilated bowel
+/- calcified gallstones in RUQ
Why would you order a CXR if you are concerned for acute pancreatitis?
r/o pulmonary infiltrates or pleural effusions
What will be on CT in acute pancreatitis?
enlargement of pancreas
blurring of fat planes/fat stranding
What are the 4 complicatiosn of acute pancreatitis
- necrosis
- Pseudocysts
- Abscess
- Hemorrhage
(“He NAPs”)
What are the 3 reasons to order a CT to eval for acute pancreatitis?
- For diagnosis (but not always necessary)
- Identify severity of disease
- Identify complications (necrosis, pseudocysts, abscess, hemorrhage)
Which imaging has the following advantages over CT:
- lower risk of hepatotoxicity
- Better view of biliary and pancreatic ducts
MRI/MRCP
Which diagnostic study is newer, has increased sensitivity and can be diagnostic and therapeutic
ERCP
(able to visualize biliary and pancreatic ductal anatomy, obtain cytology/biopsy and can be therapeutic- stone removal, stent insertion, sphincterotony)
What 3 things is extrahepatic biliary obstruction caused by
- Gallstones
- pancreatitis
- pancreatic cancer
When are abx indicated in a patient w/ acute pancreatitis
when infected necrosis is a concern
(Imipenem)
What are 3 early identification signs of complications of acute pancreatitis?
- decreased UOP/ rising SrCr
- resp failure
- Inc. pain, F, leukocytosis
What are 5 local complications of acute pancreatitis?
- pseudocyst
- Pancreatic abscess
- pancreatic necrosis
- Hemorrhage (signs= cullens and grey turners)
- Ascites
(“He NAPs because of his Ascites”)
When would you suspect a pancreatic abscess? (3_
suspect w/ fever, increased WBC, clinical deterioraion
Which condition?
- Abd pain
- Early satiety
- N/V
Pancreatic pseudocyst
T/F: pancreatic pseudocysts can spontaneously resolve or continue to enlarge
true
(so only intervene if signs of infection)
What are the 3 complications of pancreatic pseudocyst
- Rupture
- Hemorrhage
- Infection
When is surgery or drainage indicated in pancreatic pseudocyst?
if symptomatic or infected
Complication of acute pancreatitis:
What is a pancreatic pseudocyst?
collection of fluid and debri; no epithelial lining; fibrotic wall
Complications of acute pancreatitis:
What is a pancreatic abscess? You would suspect this when you see what 3 things?
- infected pseudocyst or necrotic area
- Suspect w/ F, increased WBC, clinical deterioration
What are the 5 systemic complications of Acute pancreatitis?
- Pulmonary- resp failure/ARDS, pulm edema, pleural effusions, atelectasis
- Renal failure
- Hypotension/shock
- Ileus
- Hyperglycemia/hypocalcemia
What are 2 metabolic complications of acute pancreatitis?
hyperglycemia
hypocalcemia
The following are all components of what criteria used to determine prognosis of Acute pancreatits? (see attached pic)
Ranson’s criteria
Age > _____ is part of Ransons criteria (used for prognosis of acute pancreatitis)
55
Mortality of Acute pancreatitis realted to number of Ranson’s signs:
0-2= ___%
3-4= ___%
5-6= ___%
7-8= ____%
0-2= <1%
3-4= 15%
5-6= 40%
7-8= 100%
How do you prevent recurrence of biliary pancreatitis?
ERCP if CBD stone
Elective CCY
