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Pancreatic Disease Flashcards

1
Q

What is the exocrine function of the pancreas?

A

Digestive:

  1. Amylase-break down starch
  2. Lipase-Breakdown fat
  3. Proteases-breakdown proteins
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2
Q

What does “Pancreatic juice” contain?

A
  1. Electrolytes
  2. Bicarb
  3. Gastric Acid

*Neutralized gastric acid & provides basic environment for pancreatic enzymes

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3
Q

What is the release of pancreatic juice stimulated by?

A
  1. Gastric acid
  2. Cholecystokinin
  3. Vagal Stimulation
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4
Q

Endocrine function of the pancreas?

A
  1. Insulin: Lowe blood sugar

2. Glucagon: increase blood sugar

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5
Q

What kind of cells is amylase recreated form?

A

Pancreatic Acinar cells into the duodenum for starch digestion

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6
Q

When would you see an increase in amylase?

A
  1. Pancreatitis: damage to acinar cells

2. Obstruction of pancreatic duct flow: CA or CBD stones

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7
Q

How soon do you see an increase in amylase? When does it return to normal?

A

Rise=2 hrs of injury

Return to normal=48-72 hrs

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8
Q

NON-pancreatic elevation in Lipase

A

<3x ULN

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9
Q

How soon do you see an increase in lipase following injury? How long does it stay elevated?

A

Rise=24-28 hrs

Remain elevated=5-7 days

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10
Q

What accounts for 75% of acute pancreatitis

A
  1. Alcohol=#1 Drug/Toxin etiology

2. Gallstones= #1 Mechanical etiology

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11
Q

MC Metabolic etiology in acute pancreatitis?

A

Hypertriglyceridemia= >500

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12
Q

acute pancreatitis clinical presentation

A
  1. Acute midepgiastric pain: Constant, boring
  2. radiates to back
  3. +/- following a meal
  4. Aggravated: lying supine
  5. Relieved: Sitting and leaning forward
  6. N/V, anorexia
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13
Q

Vital signs in acute pancreatitis

A
  1. Fever
  2. Tachycardia
  3. Hypotension
  4. Tachypnea
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14
Q

Abdomen PEx findings in acute pancreatitis

A
  1. Hypoactive or absent bowel sounds
  2. Significant mid-epigastric tenderness
  3. Necrotizing hemorrhage: Cullen’s sign, Grey-Turner’s sign
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15
Q

Lab findings in acute pancreatitis

A
  1. Amylase & Lipase: 3x normal*
  2. Leukocytosis: WBC 15-20K
  3. Hct: Elevated
  4. Cr: Elevated
  5. Calcium: decrease, hypocalcemia
  6. Glucose: slightly elevated
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16
Q

What lab findings are strongly suggestive of gallstone pancreatitis?

A
  1. ALT>150

2. Elevated bilirubin

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17
Q

What MAY you find on an abdominal x-ray in acute pancreatitis

A

Sentinel loop= localized ileus= dilated small bowel in LUQ

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18
Q

What would you want to use a CXR for in the setting of suspected acute pancreatitis

A

Rule out:

  1. Pulmonary infiltrates
  2. Pleural effusions
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19
Q

What is the diagnostic test of choice in acute pancreatitis? Findings?

A

CT abdomen

  1. Enlargement of pancreas
  2. Blurring of fat planes/fat stranding
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20
Q

What complications can an abdominal CT identify?

A
  1. Necrosis
  2. Pseudocysts
  3. Abscess
  4. Hemorrhage
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21
Q

What are some of the advantages of MRI/MRCP over CT?

A
  1. lower risk of nephrotoxicity
  2. Helpful if CBD stone not visualized on CT/US and biliary pancreatitis expected
  3. Increased characterization of fluid
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22
Q

What are the indications for ERCP?

A
  1. Visualization of biliary and pancreatic ductal anatomy
  2. Cytology or Bx can be obtained
  3. Therapeutic: Stone removal, stent insertion, sphincterotomy
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23
Q

When can you only use an ERCP?

A

Once acute sx’s have resolved

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24
Q

Acute pancreatitis Treatment

A

“Rest the Pancreas”

  1. NPO
  2. IV fluids: Hydration!
  3. Pain control: Meperidine (Demerol)
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25
When are abx indicated in the treatment of acute pancreatitis?
Infected necrosis
26
List the 5 local complications of Acute Pancreatitis
1. Pseudocyst: Collection of fluid & derby 2. Pancreatic abscess: Fever + Elevated WBC 3. Pancreatic necrosis 4. Hemorrhage: Cullen/Grey turner sign 5. Ascites: leaking duct or pseudocyst
27
Si/sx's of Pancreatic Pseudocyst
1. Abd pain 2. N/V 3. Early Satiety*
28
Indications for surgery vs. drainage with pancreatic pseudocyst?
1. Symptomatic | 2. Infected
29
List the pulmonary complications in Acute Pancreatitis
1. Respiratory failure/ARDS 2. Pulmonary edema 3. Pleural effusions 4. Atelectasis
30
List the renal complication in Acute Pancreatitis
Renal failure
31
List the Cardiac complication in Acute Pancreatitis
Hypotension/Shock
32
List the GI complication in Acute Pancreatitis
ileus
33
List the metabolic complications in Acute Pancreatitis
1. Hyperglycemia | 2. Hypocalcemia
34
What is the mortality rate with a Ransons Criteria Score of 0-2?
<1%
35
What is the mortality rate with a Ransons Criteria Score of 3-4
15%
36
What is the mortality rate with a Ransons Criteria Score of 5-6
40%
37
What is the mortality rate with a Ransons Criteria Score of 7-8
100%
38
What is the OVERALL mortality of acute pancreatitis?
10-15%
39
What is the MCC for chronic pancreatitis?
Alcohol
40
What is the PREDOMINANT sx in CHRONIC pancreatitis?
Epigastric Pain=80%
41
What is the Classic triad of sx's in Chronic Pancreatitis?
1. Steatorrhea d/t exocrine dysfunction: Greasy, foul smelling stool 2. Diabetes d/t endocrine dysfunction= Insulin insufficiency 3. Pancreatic calcifications: visualized on abdomen x-ray
42
Lab findings in Chronic Pancreatitis
1. Elevated glucose 2. NORMAL: Amylase & Lipase 3. MILDY elevated: Bilirubin & Alk phos
43
What is the preferred diagnostic lab test?
Fecal Fat Testing: Elevated 72 hr quantitative fecal fat
44
What is the Gold Standard imaging for the diagnosis of Chronic Pancreatitis?
ERCP
45
ERCP findings
"Chain of lakes"
46
Chronic Pancreatitis management/tx
1. Behavior mod: abstinence from alcohol, small low fat meals 2. Manage DM: Insulin 3. Malabsorption tx: Pancreatic enzyme supplements
47
Chronic Pancreatitis pain relief treatment options
1. Amitriptyline or SSRI 2. Narcotic pain meds: Long acting- MS Contain vs. Fentanyl Patch 3. Nerve blocks: Celiac Plexus
48
Chronic Pancreatitis surgical treatment options
1. Endoscopic procedures: Ductal dilation, stenting | 2. Surgical resection: If CA suspected
49
Where are the majority of pancreatic tumors located?
Head of pancreas
50
What type of pancreatic cancer is the majority?
Adenocarcinomas
51
List the Race/Sex risk factors for Pancreatic Carcinoma
1. Males 2. AA 3. Increasing age= >45
52
List the other risk factors for Pancreatic Carcinoma
1. Smoking 2. Alcohol 3. Chronic pancreatitis 4. DM 5. Obesity 6. FHx
53
What is the MC presenting sx in Pancreatic Carcinoma?
Abdominal pain: Gnawing, epigastric pain radiating to back
54
Other presenting sx's in Pancreatic Carcinoma?
1. PAINLESS jaundice 2. Early satiety/anorexia, wt. loss 3. Pruritis 4. Acholic (pale) stools 5. Dark urine
55
PEx findings in Pancreatic Carcinoma?
1. Virchow's node: Left Supraclavicular LN | 2. Courvoisier's Sign: Palpable non-tender GB
56
What tumor marker is used to evaluate Pancreatic Carcinoma?
CA 19-19
57
What is the Test of Choice in Pancreatic Carcinoma for staging disease & identify eligibility for resection
CT Scan/Helical CT | Detects >80% of masses
58
What is considered the PRIMARY diagnostic tool/imaging in Pancreatic Carcinoma
ERCP
59
ERCP findings in Pancreatic Carcinoma
"Double Duct sign": Stricture of both CBD & pancreatic ducts
60
What do you need to make sure you obtain with an ERCP?
Tissue sample
61
What can an endoscopic US (EUS) evaluate for?
1. Tumor involvement 2. Vascular involvement *best for FNA bx
62
What is the only potential cure in Pancreatic Carcinoma?
Whipple procedure (pancreaticoduodenectomy) + Chemo +/- Radiation
63
What is the 5 year survival in Pancreatic Carcinoma?
<5%= Very poor!

Foundations-GI (7 decks)

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