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Paige: GI > Pancreas d/o > Flashcards

Pancreas d/o Flashcards

1
Q

what happens at the exocrine part of the pancreas?

A

ducts secrete into the duodenum

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2
Q

what are the 2 types of pancreatic exocrine cells?

A
  1. aciner cells (95%)
  2. ductal epithelial cells
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3
Q

what do aciner cells secrete?

A
  1. proteolytic enzymes
  2. amylase
  3. lipase*
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4
Q

what do ductal epithelial cells secrete?

A

alkaline solution

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5
Q

what happens at the endocrine part of the pancreas?

A

secretion into the bloodstream

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6
Q

what type of cells make up the endocrine part of the pancreas?

A

islets of langerhan’s

(alpha, beta, delta)

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7
Q

what do beta cells do?

A

insulin secretion/synthesis

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8
Q

what do alpha cells do?

A

secrete glucagon

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9
Q

what do delta cells do?

A

secrete somatostatin (which inhibits GH and TSH)

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10
Q

what is pancreatitis?

A

inflammation that usually causes aciner cell injury

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11
Q

what are some causes of pancreatitis?

A

blockage by stone

enzymes get activated while still in pancreas

fat necrosis

basically, something makes the pancreas start to digest itself

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12
Q

what causes 80% of acute pancreatitis?

A

alcohol

gallstones

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13
Q

where will you feel abd pain with acute pancreatitis?

A

epigastric

radiates to back

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14
Q

describe the OPQ and T of acute pancreatitis

A

O: sudden

P: better with leaning forward, worse when supine

Q: colic-y

T: longer duration than GB issues

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15
Q

what other sx are associated with acute pancreatitis?

A

N/V

fever/chills

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16
Q

let’s talk about findings..

abdomen?

heart?

lung?

A

abd: tender, distention, guarding
heart: tachy
lung: dyspnea, shallow, +/- pleuritic pain

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17
Q

what is cullen’s sign?

A

periumbilical ecchymosis

seen in acute pancreatitis

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18
Q

what is grey-turner’s sign?

A

flank ecchymosis

seen in acute pancreatitis

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19
Q

what will you find with these labs for acute pancreatitis:

CBC

lipase

amylase

LFTs

glucose

Calcium

A

CBC: high WBC

lipase: high
amylase: high

LFTs: high

glucose: high

Ca: low

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20
Q

what is the dx test of choice for acute pancreatitis?

A

CT scan

21
Q

what 4 things indicate a bad outcome with acute pancreatitis?

A
  1. s/s of pending organ failure
  2. pancreatic necrosis
  3. obesity
  4. old age
22
Q

if you have a high Ranson’s criteria, what does that mean?

A

more severe disease and increased risk of death with acute pancreatitis

23
Q

where is the APACHE-II scoring system mainly used for acute pancreatitis?

A

in the ICU

24
Q

treatment is kinda vague but what do you do for acute pancreatitis?

A

NPO (NG tube) + supportive care

abx if infx

surgery if abcess/necrosis

ERCP if stone

25
Q

so what is chronic pancreatitis?

A

irreversible inflam disease that can cause permanent loss of fn

26
Q

who mainly gets chronic pancreatitis?

A

alcoholics

27
Q

what kind of obstructions can cause chronic pancreatitis?

A

bening @ the sphincter of oddi

neoplasm

NOT gallstones

28
Q

so let’s talk about where you get abd pain with chronic pancreatitis

A

epigastric

LUQ

29
Q

what other sx do you get with chronic pancreatitis?

A

diarrhea

steatorrhea

DM

30
Q

ok let’s talk about lab values now for chronic pancreatitis:

amylase

lipase

and I guess that’s all we’re talking about

A

and both are normal

what an awesome and useful flash card

31
Q

what are the 3 pancreatic function tests

A

secretin stimulation test

72h fecal fat

serum trypsinogen

32
Q

what does serum trypsinogen show?

A

aciner cell function

33
Q

what is the gold standard pancreatic fn test even though we will like never do it?

A

secretin stimulation test

34
Q

what is the dx test of choice for chronic pancreatitis?

A

ERCP

35
Q

what might you see on CT scan with chronic pancreatitis?

A

“heterogeneous appearance and fat stranding”

36
Q

how ya gonna treat chronic pancreatitis?

A

enzyme supplements (e.g. viokase)

surgery

37
Q

whats the 4th leading cause of cancer death?

A

panc cancer

38
Q

what is the only really known risk factor for panc cancer?

A

chronic pancreatitis

39
Q

what sign is panc cancer until proven otherwise

A

painless jaundice

40
Q

s/s of panc cancer?

A

wt loss

pale stool

dark urine

Virchow’s node

Trousseau’s sign

41
Q

what does trosseau’s sign mean in this context?

A

recurring superficial thrombophlebitis

42
Q

labs?:

direct bilirubin

alk phos

A

DB: high

Alkphos: high

43
Q

what tumor marker shows pancreatic cancer?

A

ca19-9

44
Q

just for funsies, what does ca-125 show?

A

ovarian cancer

45
Q

what does AFP show?

A

liver cancer

46
Q

what does CEA show?

A

colon cancer

47
Q

what does PSA show?

A

prostate cancer

48
Q

treatment for pancreatic cancer?

A

whipple surgery

palliative care

chemo doesn’t really work

Paige: GI (3 decks)

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