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(J2) GI II Test 2 > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What are products of the exocrine pancreas?

A
  • trypsinogen
  • chymotrypsinogen
  • procarboxypeptidase
  • proelastase
  • kallikreinogen
  • prophospholipase

**are all zymogens**

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2
Q

What is the most common congenital anomaly of the pancreas?

(associations)

A

pancreas divisum:

  • failure of the ventral and dorsal buds to fuse -> two pancreatic ductal systems (one independent of ampula of Vater)
  • associated with chronic pancreatitis
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3
Q

What is annular pancreas?

A

abnormal rotation of a bilobed, ventral pancreatic bud:

-one wraps around each direction encircling duodenum -> obstruction

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4
Q

Where is ectopic pancreatic tissue most commonly seen?

What symptoms are associated with it?

A
  • stomach
  • duodenum
  • Meckel diverticulum

Complications:

  • pain
  • mucosal bleeding
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5
Q

Which is more specific for pancreatitis, amylase or lipase?

Why?

A

Lipase more specific

Amylase is more likely to be elevated for other causes:

  • intestinal obstruction
  • gastroenteritis
  • mumps
  • ectopic pregnancy
  • surgery
  • opoids
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6
Q

What causes the damage to the pancreas in acute and chronic pancreatitis?

A

autodigestion by prematurely activated pancreatic enzymes

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7
Q

What normally prevents autodigestion of the pancreas?

A
  • pancreatic enzymes are secreted as inactive zymogens
  • most of the zymogens are activated by trypsin, which is activated by an enzyme in the duodenum
  • ductal cells secrete trypsin inhibitos (SPINK1)
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8
Q

What are major (nongenetic) causes of acute pancreatitis?

A
  • alcohol (male predominant)
  • gallstones (female predominant)
  • surgery
  • trauma
  • ERCP/MRCP
  • medications
  • infections (mumps, CMV, MAC)
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9
Q

What are genetic causes of pancreatitis?

A
  • cystic fibrosis (CFTR)
  • tyrpsin GoF (PRSS1)
  • trypsin inhibitor LoF (SPINK1)
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10
Q

What factors are protective against acute pancreatitis?

A
  • never smoker
  • active lifestyle
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11
Q

How does acute pancreatitis present?

A
  • constant epigastric pain radiating to back
  • N/V
  • hypotension
  • tachycardia

Rare:

  • Cullen sign (periumbilical ecchymosis)
  • Gery Turner sign (flank ecchymosis)
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12
Q

What are the morphologic features of acute panreatitis?

A
  • microvascular leak -> edema
  • fat necrosis
  • inflammation
  • autodigestion
  • vessel destruction -> hemorrhage
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13
Q

What are the diagnostic criteria for acute pancreatitis?

A

2 of 3:

  • epigastric pain
  • lipase 3x ULN
  • CT changes
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14
Q

What labs should be orderd for acute pancreatitis and what is abnormal?

A
  • amylase/lipase
  • CBC (leukocytosis, HCT elevated = fluid loss, decreased = hemorrhage)
  • CMP -> hypocalcemia, hyperglycemia, elevated BUN/creatinine, elevated ALP

lipid panel

  • PT/INR - increased
  • UA -> proteinuria
  • elevated CRP
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15
Q

What are radiolgic features of acute panreatitis?

A

CT:

-enlarged pancreas with edema

XR:

  • sentinal loop: segement of dilated, air-filled intestine in RUQ
  • colon cutoff sign: air-filled, distended colon ending at pancreas
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16
Q

What are prognostic indicators for acute pancreatitis?

A
  • Ranson criteria
  • BISAP
  • APACHE II
17
Q

What is Ranson criteria?

A

prognostic predictor of acute pancreatitis

At admission (GA-LAW)

  • glucose >200
  • age >55
  • LDH >350
  • AST >250
  • WBC >16,000

48 hours after admission (C & HOBBS):

  • calcium <8
  • hematocrit drop >10%
  • oxygen <60 mmHg
  • base deficit >4
  • BUN increase >5
  • sequestration of >6L of fluid
18
Q

What is BISAP score?

A

prognostic indicator of acute pancreatitis:

  • BUN >25
  • Impaired (mental status)
  • SIRS criteria >=2/4
  • Age >60
  • Pleural effusion
19
Q

What is APACHE II?

A

prognostic indicator of all severly ill patients (not just pancreatitis)

-highly mutltivariable

20
Q

What signs present in acute pancreatitis due to hypocalcemia?

A

Chvostek sign:

-twitching muscles innervated by facial nerve

Trousseau sign:

-hand posturing with inflation of BP cuff over systolic pressure for >3 mins

21
Q

How is acute pancreatitis treated?

A
  • FLUID RESUSCITATION
  • NPO (pancreatic rest)
  • bed rest
  • pain control
  • surgical consult
22
Q

What are systemic manifestations of acute pancreatitis?

A
  • ARDS
  • acute renal failure
  • shock
  • sepsis
  • DIC
23
Q

What are complicaitons of acute pancreatitis?

A
  • voume depletion (3rd spacing)
  • pleural effusion
  • necrosis
  • pseudocysts
  • ARDS
  • ascites
  • chronic pancreatitis
24
Q

What is chronic pancreatitis?

A

prolonged inflammation of pancreas leading to destruction and fibrosis -> loss of function

25
Q

What are the main causes of chronic pancreatitis?

A

TIGAR-O:

  • toxic/metabolic (alcohol, **most common**)
  • idiopathic
  • genetic (CF,
  • autoimmune (hypergammaglobulinemia (IgG4)
  • recurrent acute pancreatitis
  • obstructive (stone, tumor, stricture)
26
Q

How does chronic pancreatitis present?

A
  • chronic/recurrent epigastric pain
  • exocrine insufficiency -> steatorrhea
  • endocrine insufficiency -> DM
27
Q

What features are useful in diagnosing chronci pancreatitis?

A
  • repeated epigastric abdominal pain
  • persistant back pain
  • pancreatic calcifications (CT)
  • pancreatic pseudocysts (CT)
  • amylase/lipase often normal due to pancreatic insufficiency
  • decreased fecal elastase -> malabsorption/exocrine insufficiency

-DM/endocrine insufficiency

28
Q

How is chronic pancreatitis treated?

A
  • mostly supportive
  • NO EtOH
  • non-opioid pain control (chronic treatment with opoids will lead to addiction)
  • steatorrhea -> pancreatic lipase supplementation
  • DM management
29
Q

What are pancreatic pseudocysts?

A

most common type of pancreatic cyst:

  • lacks epithelial lining -> pseudocyst
  • commonly complication of pancreatitis
  • can be trauma related
  • can resolve spontaneously
30
Q

What is the most common cause of death in chronic pancreatitis?

A

-pancreatic cancer

31
Q

What tumor marker is found in pancreatic cancer?

A

CA 19-9

32
Q

What signs are present in pancreatic cancer?

A

Courvoisier sign:

-non-tender, palpable gallbladder (pancreatic head tumors)

Trousseau’s syndrome (not sign):

-migratory thrombophlebitis

formation of multiple thrombi at different times/locations giving appearance that they “migrate”

33
Q

What MEN disorder is associated with the pancreas?

What other features are associated with it?

A

MEN-1

  • parathyroid -> increased PTH; hypercalcemia
  • pancreas -> gastrinoma, insulinoma
  • pituitary -> acromegaly, Cushing disease
34
Q

What are the precursor lesions of pancreatic cancer?

What gene mutations are associated?

A

pancreatic intraepithelial neoplasia (PanIN):

  • KRAS
  • p16/CDKN2A
  • p53
  • SMAD4

(J2) GI II Test 2 (12 decks)

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