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GI > Pancreas - Exam 4 > Flashcards

Pancreas - Exam 4 Flashcards

1
Q

What cavity is the pancreas located in?

A

retroperitoneal

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2
Q

_____ connects the main pancreatic duct to the duodenum

A

major duodenal papilla

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3
Q

What are the exocrine functions of the pancreas? What the generic responsibilities of each?

A

Pancreatic protease-> protein digestion, lipase -> triglycerides and amylase -> carbohydrate digestion

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4
Q

What are the endocrine functions of the pancreas?

A

Insulin and glucagon

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5
Q

________ secrete pancreatic enzymes into the pancreatic duct while ______ lining the small pancreatic ducts secrete ______.

A

Acinar cells

epithelial cells

bicarbonate

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6
Q

What are the two major pancreatic proteases?

A

trypsin and chymotrypsin

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7
Q

Pancreatic _______ responsible for hydrolysis of triglyceride molecule into _______ and _______ which can be absorbed via intestinal mucosa

A

Lipase

monoglyceride

two free fatty acids

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8
Q

Pancreatic ______ responsible for carbohydrate utilization via hydrolysis of _____ to _____

A

Amylase

starch

maltose

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9
Q

________ multiple spherical groups of epithelial cells embedded as nodules in the endocrine pancreas which are surrounded by a rich capillary plexus. Most numerous in the ____ and make up 2% of the pancreas.

A

Islets of Langerhans

tail

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10
Q

_______ (15-20% of the islets)secrete _______ which raises blood glucose levels by accelerating conversion of liver glycogen into glucose.

A

Alpha cells

glucagon

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11
Q

______ (60-70% of the islets) secrete _____ which influences carbohydrate metabolism enabling glucose utilization

A

Beta cells

insulin

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12
Q

______ (5-10% of the islets) secrete _______ which inhibits insulin and glucagon secretion

A

Delta cells

somatostatin

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13
Q

Which cell type is the most abundant in the pancreas?

A

Beta cells 60-70%

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14
Q

______ is the leading cause of gastrointestinal-related hospitalization in the United States

A

acute pancreatitis

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15
Q

What are the top 2 causes of acute pancreatitis? Which one is the MC?

A

Gallstone is MC

heavy alcohol intake: NOT a single binge drink

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16
Q

______ may reduce the risk of non biliary pancreatitis

A

Coffee drinking

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17
Q

**What are the 10 causes of acute pancreatitis? What is the acronmyn to help remember them?

A

I GET SMASHED

Idiopathic causes
G = Obstruction by Gallstones
E = is Ethanol, or alcohol use, and it is not sure how it leads to pancreatitis.
T = Trauma

S = Steroids
M = infection with Mumps virus
A = Autoimmune diseases, like systemic lupus erythematosus and rheumatoid arthritis.
S = Scorpion sting, which also damages the pancreas directly.
H = Hypertriglyceridemia and Hypercalcemia.
E = Trauma from an ERCP
D = Drugs, like didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, and Diuretics

Drugs Causing A Violent Abdominal Distress

aka but mostly alcohol and gallstones

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18
Q

What are the 3 pathophys causes behind acute pancreatitis?

A

Edema or obstruction at ampulla of Vater

premature or overactivation of pancreatic enzymes

autodigestions (when enzymes are activated in the pancreas acinar cell compartment rather than the intestinal lumen)

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19
Q

What is the pathophys of gallstone induced acute pancreatitis? What does it lead to? What enzyme in particular?

A

Early event is blockade of secretion of pancreatic enzymes while the synthesis of them continues

leads to autodigestive injury to the gland

trypsin

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20
Q

________ happens d/t pancreatic enzymes that damage the vascular endothelium. Name some changes seen. What do these changes lead to?

A

Microcirculatory injury, vasoconstriction, capillary stasis, decreased oxygen saturation, progressive ischemia

changes lead to increased vascular permeability and swelling of the gland

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21
Q

In summary, activated ______, ________, and the release of ________ lead to a rapid worsening of pancreatic damage and necrosis

A

pancreatic enzymes
microcirculatory impairment
inflammatory mediators

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22
Q

How does acute pancreatitis present? Describe the timing. What makes it better? What makes it worse?

A

Epigastric abdominal pain that radiates to the back

sudden onset, steady and severe

worse with activity and lying supine

improves with leaning forward

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23
Q

What are 2 pt history points that would be consistent with acute pancreatitis?

A

Binge or heavy drinking just prior to symptoms, history of consuming a fatty meal just prior to symptom onset

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24
Q

______ will be seen in acute pancreatitis if it is associated with ampulla of vater blockage

A

jaundice

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25
Q

**What is the cullen’s sign?

A

ecchymotic discoloration observed in the periumbilical region

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26
Q

**What is the Grey Turner sign?

A

ecchymotic discoloration observed along the flank

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27
Q

What do the presence of Cullen’s sign and Grey Turner sign suggest?

A

Retroperitoneal bleeding

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28
Q

**What are the 2 ways to classify acute pancreatis?

A

According to morphology and according to severity

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29
Q

**According to the Atlanta classifications, what are the 2 options for acute pancreatitis?

A

Acute interstitial edematous pancreatitis : blood supply is maintained and Necrotizing

acute pancreatitis : blood supply is not maintained

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30
Q

**What are the acute pancreatitis classifications according to severity?

A
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31
Q

** What are the 2 labs that you need to get if concerned about acute pancreatitis? Which one is more sensitive?

A

Serum amylase and serum lipase -> more sensitive

32
Q

What are 2 findings on xray that would point towards acute pancreatitis? Give a brief interpretation of each

A

“Sentinel Loop” and “Colon Cut-Off Sign”

“Sentinel Loop” - Dilated air filled small intestine near the pancreas

“Colon Cut-Off Sign” - Gas filled segment of transverse colon abruptly ending near pancreas due to functional spasm of descending colon secondary to pancreatic inflammation

33
Q

When would an US be helpful in acute pancreatitis?

A

Helpful if looking for stone in suspected biliary pancreatitis but otherwise NOT helpful

34
Q

What would a CT scan show in acute pancreatitis?

A

Enlarged pancreas and signs of inflammation associated with acute pancreatitis.

35
Q

What are the essentials of dx for acute pancreatitis?

A
36
Q

What is needed to dx acute pancreatis? Do you need imaging?

A

In patients with characteristic abdominal pain and elevation in serum lipase/amylase to 3 times or greater than the upper limit of normal

No imaging is required to establish the diagnosis

37
Q

When would you order imaging if acute pancreatitis is suspected? What imaging would you order?

A

Abdominal pain is NOT characteristic, amylase/lipase levels are less than 3x ULN

abdominal CT WITH contrast

38
Q

______ is the criteria used in acute pancreatitis to assess severity and prognosis

A

Ranson’s Criteria

39
Q

**What are the parameters for Ranson’s criteria?

A
40
Q

______ is the simplest criteria when determining the severity/prognosis of AP. What is the criteria?

A

BISAP

41
Q

What is the tx for mild AP? What do you NOT want to give the pt? Why?

A

once s/s resolves plus clear liquids and slowly advancing diet

DO NOT GIVE MORPHINE because Morphine may cause sphincter of Oddi spasm

42
Q

What is the tx for severe AP?

A
43
Q

What are 3 complications of AP?

A

Pancreatic abscess

Acute peripancreatic fluid collection

Pancreatic Pseudocyst

44
Q

When does a pancreatic pseudocyst occur? Describe it.

A

Occur more than 4 weeks after onset

Encapsulated collection of fluid with well defined inflammatory wall Fluid collections outside of the pancreas

45
Q

What does chronic pancreatitis involve?

A

A syndrome involving inflammation, fibrosis, and loss of acinar and islet cells

46
Q

What is the MC etiology in chronic pancreatitis?

A

Alcoholism +/- smoking

47
Q

What is the MC eitology of chronic pancreatitis in children?

A

Cystic fibrosis

48
Q

What is the pathophys behind chronic pancreatitis? What does the persistent inflammation cause?

A

Persistent inflammation of the pancreas resulting in permanent structural damage

changes to structures including fibrosis

atrophy and calcification that leads to IRREVERSIBLE damage

49
Q

What is the clinical presentation of chronic pancreatitis?

A

Chronic, steady or intermittent epigastric, LUQ pain- radiates to back; worse 15-20 min after eating

50
Q

65% of chronic pancreatitis pts either have ______ or ______.

A

Osteopenia or osteoporosis

51
Q

______ is the MC reason for hospitalization in chronic pancreatitis. What would prompt a search for a complication of chronic pancreatitis?

A

PAIN

A change in pattern or sudden worsening of pain

52
Q

In CP, what is the cause of the pain due to?

A

The cause of pain is due to increased pressure, ischemia, and inflammation of the pancreas

53
Q

What will serium amylase/lipase levels show in CP?

A

Slightly elevated but can also be NORMAL

54
Q

What is the most frequently utilized imaging study in chronic pancreatitis? What will endoscopic US show?

A

CT because able to image entire pancreas and pancreatic ducts

“honeycombing” of pancreas

55
Q

What are 6 complications of chronic pancreatis? What is the main cause of death?

A

Pseduocysts
DM
malabsorption deficiency
opioid addiction
disability
reduced life expectancy
pancreatic carcinoma- main cause of death

56
Q

What is the non-invasive tx for chronic pancreatitis?

A

Low fat diet, avoid alcohol, manage pain, pancreatic digestive enzymes, insulin as needed, tx any malabsorptive disorders

57
Q

What are the invasive tx options for CP?

A

ERCP for stone extraction or decompression of pancreatic duct, Puestow procedure for dilated pancreatic duct, Whipple procedure, surgical drainage of pseudocysts, pain management

58
Q

What is the Puestow Procedure?

A

“filet” open the pancreas and sew it to the jejunum

59
Q

**Where is the major of pancreatic cancer located? Which location indicates a poorer prognosis?

A

75% in head, 25% in body and tail-> poorer prognosis

60
Q

**What cell type is pancreatic carcinoma most likely?

A

85% are adenocarcinoma

61
Q

What does an older pt with new onset DM make you think?

A

Possible pancreatic cancer

62
Q

What is the MC presentation of pancreatic cancer?

A

Vague epigastric pain with radiation to back, typically gnawing, visceral with insidious onset. Can also be asymptomatic until metastasis has occurred

63
Q

**What is Courvoisier sign? What is it due to?

A

Painless Jaundice and Enlarged palpable gallbladder, Due to tumor of pancreatic head causing obstruction of common bile duct

64
Q

In advanced carcinoma of the pancreas, what node may be palpable?

A

hard periumbilical nodule called the Sister Mary Joseph node.

65
Q

What cancer maker may or may not be positive in pancreatic cancer? What will amylase and lipase levels look like?

A

+ or - CA 19-9 tumor marker, Amylase, Lipase - normal to mildly elevated

66
Q

What is the first line imaging in pancreatic cancer?

A

CT, can also do CT with FNA for cytologic studies

67
Q

What is the “double duct?”

A

Simultaneous dilation of pancreatic and common bile duct that is confirmatory for pancreatic cancer on ERCP if CT was inconclusive

68
Q

What is the tx for pancreatic cancer is dz is local and in the head? Give a brief description.

A

Whipple procedure then chemo/radiation, Removal pancreatic head, duodenum, first 15cm of jejunum, common bile duct, gallbladder, and a partial gastrectomy

69
Q

What is the tx for pancreatic cancer if the cancer is in the tail? What do you need to do first?

A

Distal pancreatectomy with splenectomy, staging laparascopy first to visualize

70
Q

What makes pancreatic cancer non-resectable?

A

Liver, peritoneum, and omentum mets, Encasement of superior mesenteric artery/vein, Extension into inferior vena cava

71
Q

What is the screening recommendation for pancreatic cancer?

A

Patients with a family history (1st degree relative) with pancreatic cancer should have screening CT age 40-45 or 10 years before onest of cancer in the family member

72
Q

________ and ______ are the keys in pancreatic cancer

A

Early recognition and prevention

73
Q

What are the 4 pt education points for pancreatic cancer prevention?

A

Don’t smoke, limit alcohol, maintain a healthy weight, know your family hx, be familiar with common symptoms ( jaundice, unexplained weight loss, stomach pain that radiates to the back

74
Q

What is the difference between ERCP and MRCP?

A

ERCP is more invasive, uses sedation but can visualize and treat the cause at the same time (stone removal) vs MRCP only visualizes but does NOT use sedation

75
Q
A

GI (12 decks)

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