Pancreas, Appendix, Spleen and Stomach Flashcards
What is painless jaundice secondary to?
A tumor in the head of the pancreas
What vessels provide blood to the superior portion of the head of the pancreas?
Celiac trunk -> common hepatic -> gastroduodenal -> A/P superior pancreaticoduodenal arteries
What vessels provide blood to the inferior portion of the head of the pancreas?
A/P inferior pancreaticoduodenal arteries from the superior mesentric artery
What vessels provide blood to the body and tail of the pancreas?
Splenic artery
Where does the celiac trunk come off?
Abdominal aorta (at T12) and bifurcates into LT-gastric artery, splenic artery and common hepatic artery
What is the ampulla of Vater?
“Hepaticopancreatic ampulla”; union of the pancreatic duct and CBD
-any problems can cause back-up into pancreas, liver, gallbladder
What is an EGD?
Esophagogastroduodenoscopy- can remove a lodged stone or biopsy an ampullary tumor
What are some pancreatic enzymes?
Amylase Lipase DNAase RNAase Trypsinogen Chymotrypsinogen Procarboxypeptidase A and B
What happens if there is a blockage due to pancreatic cancer?
Pancreatic enzymes will build-up in pancreas and begin to break itself down
-aka “pancreatic autodigestion” -> leads to acute pancreatitis
What are the congenital disorders of the pancreas?
1) Agenesis: non-forming pancreas, very rare
2) Pancreatic divisum: failure of 2 ducts to fuse, common, normally asymptomatic and seen on autopsy (30% occurrence)
3) Annular pancreas: pancreas encircles duodenum, rare
4) Ectopic pancreas: pancreas found anywhere else in the abdominal cavity, very common
What is acute pancreatitis?
Sudden inflammation of the pancreas, very serious
What are some causes of acute pancreatitis?
- Multiple organ system failure (MOSF)
- Acute respiratory distress syndrome (ARDS)
- Acute renal failure
- Disseminated intravascular coagulation (DIC)
- Pancreatic abscess
- Pancreatic pseudocyst
- Duodenal obstruction
What is chronic pancreatitis?
Chronic inflammation of the pancreas that causes calcifications or a pseudocyst
What are some consequences of chronic pancreatitis?
- Pseudocyst
- Duct obstruction/stenosis
- Malabsorption
- Steatorrhea
- Secondary diabetes
What is the incidence and complications of appendicitis?
- 69% = ages 10 - 30
- 30% are misdiagnosed
- Mortality: 0.1-0.2% unruptured; 3-5% ruptured
- 20-30% rupture during surgery, significant morbidity is associated with rupture (infection, peritonitis)
Where can the appendix be located?
Retrocecal - 65%
Pelvic - 31%
RUQ, LUQ, LLQ
What is the classic presentation of appendicitis?
Seen in 60%: anorexia, periumbilical pain, N/V, RLQ pain after 24 hours (visceral pain), rebound tenderness as a later finding (parietal pain)
What is McBurney’s point?
Area in RLQ where you’ll have maximum tenderness with appendicitis
-midway between umbilicus and iliac crest
What is a positive Rosving’s sign?
Palpation of the LLQ increases pain felt in RLQ
-indicative of appendicitis
What is a positive Psoas sign?
Abdominal pain results from passively extending the thigh of a patient laying on their side with knees flexed, or asking the patient to actively flex the thigh at the hip
-indicative of appendicitis
What is a positive obturator sign?
Pain felt in the RLQ when the knee is flexed, the ankle is held and the knee is internally rotated
- indicative of appendicitis
- pain comes in contact with the obturator internus muscle
What is Mantrel’s score?
Established in 1986 because appendicitis misdiagnosed as gastritis, IBS, stomach flu
- (M)igration of pain = 1
- (A)norexia = 1
- (N)ausea/vomiting = 1
- (T)enderness RLQ = 2
- (R)ebound = 1
- (E)levated temp = 1
- (L)eukocytosis = 2
- (S)hift to left = 1
- scoring: >5 high suspicion, 5-6 possible, 7-8 probably, 9-10 very probable
What is the spleen the largest of in the body?
Largest lymphoid tissue of body
What are 2 main functions of the spleen?
1) Filter blood to remove old/damaged RBC - “red pulp”
2) Secondary lymphoid tissue/removes infectious agents and uses them to activate lymphocytes - “white pulp”
What is the spleen a significant reservoir for?
T lymphocytes
What does the spleen play a significant role in the production of?
1) Production of IgM antibodies and complement needed to fight infection
2) Functional maturation of antibodies
What is the white pulp?
Circular, composed of mostly lymphocytes, and functions similarly to the nodules of lymph nodes, removes infectious agents
What is the red pulp?
Surrounds the white pulp, contains mainly RBCs and macrophages, phagocytizes old RBCs
What does the spleen do during fetal development?
Produces RBC and WBC
-by the 5th month of gestation, the spleen loses hematopoietic function but can produce RBCS throughout life
What happens to RBCs that pass through the spleen?
Spleen is a “sophisticated filter” (monitors/manages RBCs) –> RBCs undergo a cleaning or repair
-RBCs coated with IgG and IgM are removed/destroyed
What happens in diseases such as hemolytic anemia and ITP?
Idiopathic thromocytopenic purpura and hemolytic anemia are autoimmune diseases that destroy the spleen, can be cured with a splenectomy and steroids
What kind of immune responses is the spleen involved in?
Specific and nonspecific: promotes phagocytosis and destruction of bacteria
What kind of injuries could cause splenic trauma?
Blunt upper abdominal injuries (bicycle, MVC), often associated with fracture ribs of the left chest
What can splenic injuries cause?
Extensive and continued hemorrhage, or subcapsular hematomas that are subject to rupture at any time
How are ruptured spleens treated?
Splenic preservation operations, partial splenectomies, capsular repairs, non-operative treatment
What is the incidence of delayed rupture of the spleen?
15-30% of patients rupture within 2 weeks of injury
What condition would result from a dysfunctional LES?
Esophagitis from the backup of stomach acid
Where does the stomach get most of its blood supply from?
1) Anastomoses formed by the RT and LT gastric arteries (along lesser curvature)
2) RT and LT gastroepiploic arteries (along greater curvature)
Where does the fundus and upper body of the stomach receive its blood from?
Short and posterior gastric arteries
Where do the veins of the stomach lie?
Parallel to the arteries
Where does the stomach receive its parasympathetic innervation from?
From the medulla via the vagus nerve
Where does the stomach receive its sympathetic innerviation from?
Celiac ganglia arising from T5-T9
Where do the lymph nodes of the stomach drain to?
- Gastric lymph nodes
- Pancreaticosplenic lymph nodes
- Pyloric lymph nodes
- Pancreaticoduodenal lymph nodes
- -They all drain into the celiac lymph nodes
What do mucous neck cells do?
Secrete mucous and bicarbonate, which provide a barrier between the gastric acid and epithelium of the stomach wall
What do parietal cells do?
- Stimulated by AcH, gastrin, histamine -> secrete gastric acid - activates pepsin and kills bacteria
- Stimulated by AcH, gastrin, histamine -> secretes intrinsic factor - complex with B12 to permit absorption
What do enterochromaffin-like cells do?
Stimulated by AcH and gastrin -> secrete histamine, stimulates gastric acid secretion
What do chief cells do?
Stimulated by AcH, acid and secretin –> secrete pepsinogen and gastric lipase, which digest protein and fats
What do D cells do?
Stimulated by acid in stomach -> secrete somatostatin which inhibits gastric acid secretion
What do G cells do?
Stimulated by AcH, peptides and amino acids -> secrete gastrin which stimulates gastric acid secretion
Why is taking too much NSAIDs bad for your stomach?
They inhibit prostaglandinds, which make mucous and bicarb, which buffer stomach acid
What is an adenocarcinoma?
Most common malignancy of stomach
- chronic inflammation promotes neoplastic progression
- BRCA2 mutations are at increased risk of developing diffuse gastric cancer
- TGFBRII, BAX, IGFRII and p16/INK4a: genes in sporadic intestinal-type gastric cancer
What is the function of the stomach?
Mixing of food with acid/pepsin
-Unique acid environment requires functional gastric surface, mucus barrier, bicarbonate buffering and epithelial integrity
