Pancreas Exam 2 Flashcards
Acute Pancreatitis
Inflammation of the pancreas
Usually mild and resolves spontaneously –> 20% develop severe acute leading to hospitalization
Acute Pancreatitis: Cause
Obstruction of the outflow of pancreatic enzymes usually r/t pancreatic and bile duct obstruction (gallstone)
Also caused by alcohol, drugs, viral infection
Pancreatitis: Back up of enzymes
Leads to AUTODIGESTION of pancreatic cells —> causes inflammation = pancreatitis
Pancreatic Enzyme: Trypsin
Edema - Necrosis - Hemorrhage
Pancreatic Enzyme: Elastase
Hemorrhage
Pancreatic enzyme: Phospholipase A
Fat necrosis
Pancreatic enzyme: Kallikrein
Edema - Vascular Permeability - Smooth muscle contraction - Shock
Pancreatic Enzyme: Lipase
Fat necrosis
Acute Pancreatitis: Clinical Manifestations
SEVERE sudden pain that raidates
-N/V - Distention - Hypo BS
-Fever
-Hypotension - Tachy
- Jaundice (blocked bile)
Pancreatitis Lab levels
Amylase - Lipase - Glucose - WBC
This usually increases with damage to the organ
Pancreatitis: Severe Manifestations
-Cyanosis or green-yellow/brown discoloration of the abdomen
-Ecchymoses
Flanks (grey turners sign)
Periumbilical (cullen’s sign)
(Blood pooling)
Acute Pancreatitis: Complications
Pseudocyst
Abscess
Pulmonary complications
Hypotension – Shock
Tetany from hypocalcemia
Complications: Pseudocyst
Fluid filled cavity that surrounds the outside of the pancreas
Necrotic products and secretions (if it perforates)
Results in inflammation and scarring of areas near the pancreas
Clinical Presentation of pseudocyst
Similar to pancreatitis with a palpable epigastric mass
Complications: Pancreatic abscess
-A large fluid-filled cavity inside the pancreas
-Result of extensive necrosis in the pancreas
-May become infected or perforate
Pancreatic abscess: Manifestations
Pancreatitis plus abdominal mass, high fever, and leukocytosis
Chronic Pancreatitis
Progressive fibrotic disease of the pancrease
Most common cause of chronic pancreatitis
Most common cause is alcohol abuse.
Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of Langerhans
Risk factors Chronic Pancreatits
-Genetics
-Gallstone obstruction (repeated)
-Smoking
Alc abuse is most common cause
Chronic Pancreatitis: Clinical Manifestations
Attacks of acute pancreatitis with progressive signs of dysfunction after attack subsides
2 major signs: Pain and weight loss
Chronic Pancreatitis can lead to __________ with loss of ________ and _______ cells
DM, acinar, Islet of Langerhans
Drug Therapy: Relief of pain
Opioids
Drug therapy: Antispasmodic
Dicyclomine
Drug therapy: Decrease HCl secretion in the stomach which decrease secretion of pancreatic enzymes
Antacids
H2-receptors antagonists
Drug Therapy: Replacement therapy for pancreatic enzymes
Pancrelipase
Chronic pancreatitis only
