Pancreatic Disease

Question 1

what is the pancreatic duct?

Answer 1

duct of wirsung

empties into SB at ampulla of vater

Question 2

what is the accessory duct?

Answer 2

duct of santorini

empties into SB superior to pancreatic duct

Question 3

what makes up 99% of the pancreas?

Answer 3

acini (responsible for exocrine functions)

Question 4

how much fluid does pancreas make?

Answer 4

1.5L

Question 5

what is consistency of pancreatic juices?

Answer 5

clear, colorless, water, has salts, is alkaline and contains digestive enzymes (7.1-8.2-bicarb)

Question 6

what does amylase do?

Answer 6

digests carbs

Question 7

what does lipase do?

Answer 7

digests triglycerides

Question 8

what do trypsin and chymotrypsin do?

Answer 8

protein digestion

Question 9

what does the pancreatic polypeptide do?

Answer 9

inhibits secretion of somatostatin

Question 10

what does somatostatin do?

Answer 10

inhibits secretion of insulin and slows absorption of nutrients

Question 11

why is pancreas exocrine function important?

Answer 11

alteration can lead to malabsorption

-diarrhea, fat soluble vitamin loss

Question 12

what is auto-digestion?

Answer 12

early activation of inactive pro-enzymes (caused by injury)

Question 13

what is the MCC of acute pancreatitis?

Answer 13

gallstones
alcohol (2nd)
together account for 65%

Question 14

what is MCC of metabolic pancreatitis?

Answer 14

hyperlipidemia (>2000 triglycerides)

Question 15

what are hereditary causes of acute pancreatitis?

Answer 15

cystic fibrosis (plugs pancreas ducts)
hereditary

Question 16

what is post _ERCP pancreatitis?

Answer 16

manipulation during surgery causes problem, can be more severe

Question 17

what is MC drug related to acute pancreatitis?

Answer 17

HCTZ

Question 18

what are features of acute pancreatitis?

Answer 18

1. discrete episode
2. abd pain severe, epigastrium
3. n/v
4. elevated amylase, lipase (2-3 times upper limit)

Question 19

what is CC of pancreatitis pt?

Answer 19

abrupt onset
severe, persistent
epigastric radiating to the back
lasts hours to days
n/v but no relief
made better by lying down

Question 20

what indicates poor prognosis with acute pancreatitis?

Answer 20

Cullens or Turners sign

Question 21

which lab test is more specific for acute pancreatitis?

Answer 21

lipase-is elevated longer (single best marker for pancreatitis)

Question 22

which enzyme level increases first?

Answer 22

amylase

Question 23

what is a very bad sign for blood test in acute pancreatitis?

Answer 23

elevated Hgb, hematocrit

Question 24

what is another bad sign for blood work in acute pancreatitis?

Answer 24

elevated CRP >150 at 48 hrs

Question 25

why test the triglycerides?

Answer 25

if it is very high, you can correct and improve problem going forward

Question 26

what is the purpose of a plain film?

Answer 26

r/o surgical emergency

Question 27

what is a sentinel loop?

Answer 27

focal pocket of air caused by slowed motility

Question 28

what is role of CT scan for pancreas?

Answer 28

evaluate staging and r/o pancreatic necrosis

Question 29

what is the role of MRI scan for pancreas?

Answer 29

better at differentiating pseudocysts

Question 30

what is the role of US for pancreas?

Answer 30

r/o GB stones and biliary dilation

Question 31

when would you do ERCP?

Answer 31

limited use in acute phase, usually let all inflammation calm down first

Question 32

which criteria do you use to assess pancreatitis?

Answer 32

Ranson's criteria, admit or not, complications or not | more points = more mortality

Question 33

what is the txment approach for pancreatitis?

Answer 33

``` NPO, NPO Fluids, fluids, fluids anti-emetic analgesics (demerol, dilaudid) NG tube (in case of ileus) abx (no for mild) ```

Question 34

what is an bad complication of pancreatitis?

Answer 34

renal failure | pancreatic necrosis

Question 35

what differentiates pseudocysts from regular cysts?

Answer 35

pseudocyst is lined with granulation tissue (inflammatory) as opposed to true cysts that are lined with epithelium

Question 36

when does it become a pseudocyst?

Answer 36

after 4 weeks of being there

Question 37

when would you drain pseudocyst?

Answer 37

only if they are really big

Question 38

what is chronic pancreatitis?

Answer 38

repeated injuries interrupt the pancreas's ability to function appropriately

Question 39

what are sxs of chronic pancreatitis?

Answer 39

chronic pain (worse with fatty, greasy food) steatorrhea (yellowish, oily, floating stools) malabsorption (loss of ADEK-fat soluble nutrients) weight loss

Question 40

how do you treat chronic pancreatitis?

Answer 40

``` low fat diet pancreatic enzymes NO ETOH-inc cancer risk NO SMOKING-inc cancer risk screen for cancer ```

Question 41

what is MC type of pancreatic cancer?

Answer 41

ductal epithelium

Question 42

how do pancreatic cancer pts present?

Answer 42

``` wt loss** Obstructive jaundice (painless)** new onset DM epigastric pain n/v ```

Question 43

when is jaundice a/w cancer?

Answer 43

painless | with pain is a/w stones and other causes

Question 44

what tells you about resectability of pancreas tumor?

Answer 44

``` CT w/thin slice Endoscopic ultrasound (EUS)-determines blood vessel involvement ```

Question 45

what is the pancreatic tumor marker?

Answer 45

CA19-9 | levels >1000 mean its unresectable

Question 46

which arteries determine resectability of pancreatic tumor?

Answer 46

SMA, ?

Question 47

what is surgery for pancreatic cancer called?

Answer 47

whipple