Pancreas - Atwell Flashcards
Two most common causes of pancreatitis (acute)
Alcohol and gallstones (80-90%)
[Iatrogenic (ERCP) Drug-induced Hypertriglyceridemia Hypercalcemia Pancreas cancer Pancreas divisum Penetrating trauma]
The other 5 % is idiopathic
Name 7 common presenting findings of acute pancreatitis.
Abdominal pain (90%) Vomiting/nausea (90%) Tachycardia (80%) Low grade fever (50%) Guarding Absent bowel sounds Jaundice
What is the pathophysiology behind gallstone ileus?
Inflammation in the wall of the gallbladder forms a fistula between the gallbladder and the duodenum. Stones get lodged in the duodenum and obstruct the bowel.
What is the pathophysiology behind gallbladder pseudocyst formation? How could you diagnose this?
Basically fibrous granulation tissue surrounds the necrotic portion of the pancreas. May be fluid filled. Many will resolve with time.
Can be diagnosed by a persistently elevated amylase level.
What is the most common cause of chronic pancreatitis?
Alcohol, by far. Then CF, hyperlipidemia, and hereditary pancreatitis. Then idiopathic.
How much pancreatic function can you lose before getting malabsorption/steatorrhea?
Up to 90%.
What is the classic presentation of someone with chronic pancreatitis?
Epigastric pain radiating to the back, usually after eating
Weight loss can be significant (50lbs in a month not uncommon at all). Doc I poop immediately after I eat and it looks like vegetable soup in the toilet. What is the diagnosis?
Presentation of patient with pancreatitic insufficiency.
What hematologic manifestation is commonly seen as a result of chronic pancreatitis?
Macrocytic anemia is pretty common result of chronic pancreatitis
What is the mechanism that produces steatorrhea?
Decreased lipase and colipase in duodenum
Decreased duodenal pH–> Inactivation of pancreas enzymes and Bile acid precipitation
How would you treat chronic pancreatitis?
Alcohol avoidance!!
Enzyme replacement (pills) Treat obstruction Celiac nerve block for pain Surgical resection Transplant (young patients)
What is the fourth leading cause of cancer death in the united states?
Pancreatic adenocarcinoma. 100% mortality, pretty much.
What are some late signs of pancreatic carcinoma?
Pain, nausea, vomiting.
Other signs are jaundice, bowel obstruction, hormone excess (neuroendocrine)
Most patients present with pancreatic cancer of the head of the pancreas and present with jaundice.
REMEMBER.
The bile duct passes through the head of the pancreas.
A 50 y/o male presents with diffuse enlargement of the pancreas, lymphocytic infiltration (IgG plasma cells), abdominal pain, jaundice, weight loss. What might he have?
Could be cancer. often masquerades as that.
But can also be autoimmune pancreatitis. Look for other autoimmune conditions.
Tx with steroids.
