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sbm iv gi > Pancreas Function/Disorders > Flashcards

Pancreas Function/Disorders Flashcards

1
Q

which arteries supply the pancreas?

A

celiac and SMA

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2
Q

exocrine pancreas is ___% pancreatic mass

exocrine pancreas makes ______

A

85%

digestive enzymes, water, bicarb –> duodenum

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3
Q

pancreatic embryology

A
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4
Q

common variations in pancreatic duct anatomy

A

90%- Santorini and major duct connected

10% - fusion does no occur = pancreas divisium –> higher risk for pancreatitis

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5
Q

regulation of pancreas secretion

A
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6
Q

what determines bicarb secretion from the pancreas?

A

duodenal pH >4.5 - sensed in s/secretin cells

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7
Q

how does the pancreas avoid digesting itself?

A

pancreatic enzymes are stored in pancreas and secreted into duodenum as PROENZYMES. Enterokinase at brush border in duodenum converts trypsinogen –> trypsin. Trypsin makes the other zymogens –> active enzymes.

amylase and lipase are stored in active forms b/c there is no starch or TG in the pancreas to be digested

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8
Q

5 protective mechanisms in the pancreas

A
  1. synthesis of enzymes as inactive zymogens
  2. trypsin inhibitor packaged in zymogen granules
  3. segregation of enzymes in membrane bound compartments
  4. enterokinase restricted to small intestine
  5. acidic pH w/in zymogen inactivates Trypsin
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9
Q

Labs in acute pancreatitis

A

WBC: often elevated

Amylase: leaks from inflamed pancreas. high sensitivity, low specificity

Lipase: sensitive as amylase, but more specific , and remainvs elevated

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10
Q

Atlanta criteria for Acute pancreatitis

A

two or more of the following:

  • ​abdominal pain consistent w/ acute pancreatitis: sudden onset upper abdominal pain, often radiating to upper back. steady pain w/ “boring” quality.
  • elevated amylase or lipase >3x normal
  • confirmatory finding on CT
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11
Q

normal amylase, high lipase - interpretation?

A

delayed presentation of acute pancreatitis

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12
Q

how do gallstones cause pancreatitis?

A

migrate to the cystic duct –> common duct –> can obstruct the ampulla of vater –> pancreatitis and/or cholangitis

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13
Q

which pancreatic hormone is most specific in dx pancreatitis?

A

lipase

lots of things can cause elevation of amylase

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14
Q

How do you assess the severity of pancreatitis?

A

Bedside eval

BISAP >2

  • BUN>25, impaired mental status, SIRS, Age>60, pleural effusions

BUN >22

CRP >125 @48 hrs

SIRS persisting through 48 hours

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15
Q

what is SIRS?

A

presence of at least 2

  • pulse >90 BPM
  • RR >20 or PCO2<32mm Hg
  • T> 100.4 or <96.8
  • WBC> 12K or <4K
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16
Q

what are these and prognosis for each

A

left = interstitial

  • very low mortality and infection (<1%)

right = necrotizing

  • high infection rate (30-50%)
  • mortality 10-30%
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17
Q

what causes acute pancreatitis?

A
  1. alcohol
  2. gallstones
  3. idiopathic
  4. other: high TGs, autoimmune, drugs, IBD, infectious, neoplasm, toxic, iatrogenic (ERCP), trauma, scorpion
18
Q

inherited causes of pancreatitis

A

altered enzyme activity: trypsinogen mutations

abnormal ion movement: CFTR mutation

metabolic: familial hypertriglyceridemia (TGs <1000)

19
Q

tx for acute pancreatitis

A

nothing to tx underlying pathophys

supportive care: IV fluids/lytes (EARLY and w/ Lactate Ringers), montioring, analgesia + antiemetics

other txs: Abx, NG tube, nutritional support, urgent ERCP (if gallstones)

20
Q

systemic complications of acute pancreatitis

A
21
Q

local complications of acute pancreatitis

A

fluid collection

necrosis

infection

ascites

erosion into adjacent structures

GI obstruction

hemorrhage

22
Q

what is a pancreatic pseudocyst?

A

localized collection of pancreatic fluid that develops >4 wks after pancreatitis onset

how to distinguish from true pancreatic cysts: absence of epithelial lining

23
Q

how to prevent infection in acute pancreatitis pt?

A

enteral feeding through jejunal tube! - to maintain gut barrier function

*abx use is controversial for prophylaxis

24
Q

causes of death in acute pancreatitis

A

early <1 wk: SIRS, multiorgan failure

late: multiorgan failure, pancreatic infections/sepsis

25
Q

features of chronic pancreatitis

A
  • pain
  • calcification
  • pancreatic insufficiency
26
Q

what causes chronic pancreatitis?

A
  • cystic fibrosis
  • hereditary pancreatitis (same conditions as acute)
  • hypertriglyceridemia
  • autoimmune
  • fibrocalcific (equatorial countries)
27
Q

course of chronic pancreatitis

A

gradually progressive

pain at presentation. decreases w/ longstandng disease.

calcification, malabsorption, and diabetes increase w/ progression

*increased risk of pancreatic cancer

28
Q

name 5 causes of pain in chronic pancreatitis

A
  • ischemia
  • pseudocyst
  • inflammation (general and neural)
  • duodenal and common duct obstruction
  • PD obstruction –> increased pancreatic pressure
29
Q

at what point does pancreatic enzyme deficiency cause steatorrhea?

A

<10% lipase output

30
Q
A

calcifications in chronic pancreatitis

31
Q

tx for chronic pancreatitis

A

enzyme replacement and H2 blockers

pain tx: narcotics, neuro-modulators (antidepressants), anti-inflammatory drugs, somatostatin

32
Q

surgical tx of chronic pancreatitis pain

A

lateral pancreaticojejunostomy

33
Q
A

mild acute pancreatitis aka edematous or interstitial pancreatitis

separation of pancreatic lobules from eachother b/c edema. no evidence of necrosis in acinus.

34
Q
A

severe acute pancreatitis

acinar tissue is totally necrotic and gone

35
Q
A

acute pancreatitis w/ pseudocyst: area of pancreas has become liquefied and necrotic. no epithelial lining

36
Q
A

wall of pseudocyst

37
Q
A

chronic inflammation, fibrosis in chronic pancreatitis

atrophy of acinar tissue

38
Q

pathogenesis of pancreatitis

A
  • ​injury of acinar cells: activation of proenzymes
  • duct obstruction w/ increased intraductal pressure –> leakage of pancreatic enzymes
  • activation of trypsin and other proenzymes
39
Q

necrosis-fibrosis hypothesis

A

one theory about pathogenesis of chronic pancreatitis

repeated episodes of acute pancreatitis –> focal necrosis, patchy scarring, duct distortion

this is probably happening in chronic alcoholics

40
Q

PRSS1

A

mutant cationic trypsogen gene –> elimate trypsin last-resort off-switch

high incidence of pancreatic carcinoma

41
Q

CF and pancreatitis

A

defect in electrolyte transport –> viscous material accumulates in ducts –> obstruction

42
Q

lab findings, histology and tx in autoimmune pancreatitis

A

Labs: autoantibodies or high IgG

histology: CP w/ ductitis
tx: steroids NOT SURGERY

sbm iv gi (26 decks)

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