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Foundations-GI > Pancreatic Disease > Flashcards

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
Q

When are abx indicated in the treatment of acute pancreatitis?

A

Infected necrosis

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26
Q

List the 5 local complications of Acute Pancreatitis

A
  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
Q

Si/sx’s of Pancreatic Pseudocyst

A
  1. Abd pain
  2. N/V
  3. Early Satiety*
28
Q

Indications for surgery vs. drainage with pancreatic pseudocyst?

A
  1. Symptomatic

2. Infected

29
Q

List the pulmonary complications in Acute Pancreatitis

A
  1. Respiratory failure/ARDS
  2. Pulmonary edema
  3. Pleural effusions
  4. Atelectasis
30
Q

List the renal complication in Acute Pancreatitis

A

Renal failure

31
Q

List the Cardiac complication in Acute Pancreatitis

A

Hypotension/Shock

32
Q

List the GI complication in Acute Pancreatitis

A

ileus

33
Q

List the metabolic complications in Acute Pancreatitis

A
  1. Hyperglycemia

2. Hypocalcemia

34
Q

What is the mortality rate with a Ransons Criteria Score of 0-2?

A

<1%

35
Q

What is the mortality rate with a Ransons Criteria Score of 3-4

A

15%

36
Q

What is the mortality rate with a Ransons Criteria Score of 5-6

A

40%

37
Q

What is the mortality rate with a Ransons Criteria Score of 7-8

A

100%

38
Q

What is the OVERALL mortality of acute pancreatitis?

A

10-15%

39
Q

What is the MCC for chronic pancreatitis?

A

Alcohol

40
Q

What is the PREDOMINANT sx in CHRONIC pancreatitis?

A

Epigastric Pain=80%

41
Q

What is the Classic triad of sx’s in Chronic Pancreatitis?

A
  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
Q

Lab findings in Chronic Pancreatitis

A
  1. Elevated glucose
  2. NORMAL: Amylase & Lipase
  3. MILDY elevated: Bilirubin & Alk phos
43
Q

What is the preferred diagnostic lab test?

A

Fecal Fat Testing: Elevated 72 hr quantitative fecal fat

44
Q

What is the Gold Standard imaging for the diagnosis of Chronic Pancreatitis?

A

ERCP

45
Q

ERCP findings

A

“Chain of lakes”

46
Q

Chronic Pancreatitis management/tx

A
  1. Behavior mod: abstinence from alcohol, small low fat meals
  2. Manage DM: Insulin
  3. Malabsorption tx: Pancreatic enzyme supplements
47
Q

Chronic Pancreatitis pain relief treatment options

A
  1. Amitriptyline or SSRI
  2. Narcotic pain meds: Long acting- MS Contain vs. Fentanyl Patch
  3. Nerve blocks: Celiac Plexus
48
Q

Chronic Pancreatitis surgical treatment options

A
  1. Endoscopic procedures: Ductal dilation, stenting

2. Surgical resection: If CA suspected

49
Q

Where are the majority of pancreatic tumors located?

A

Head of pancreas

50
Q

What type of pancreatic cancer is the majority?

A

Adenocarcinomas

51
Q

List the Race/Sex risk factors for Pancreatic Carcinoma

A
  1. Males
  2. AA
  3. Increasing age= >45
52
Q

List the other risk factors for Pancreatic Carcinoma

A
  1. Smoking
  2. Alcohol
  3. Chronic pancreatitis
  4. DM
  5. Obesity
  6. FHx
53
Q

What is the MC presenting sx in Pancreatic Carcinoma?

A

Abdominal pain: Gnawing, epigastric pain radiating to back

54
Q

Other presenting sx’s in Pancreatic Carcinoma?

A
  1. PAINLESS jaundice
  2. Early satiety/anorexia, wt. loss
  3. Pruritis
  4. Acholic (pale) stools
  5. Dark urine
55
Q

PEx findings in Pancreatic Carcinoma?

A
  1. Virchow’s node: Left Supraclavicular LN

2. Courvoisier’s Sign: Palpable non-tender GB

56
Q

What tumor marker is used to evaluate Pancreatic Carcinoma?

A

CA 19-19

57
Q

What is the Test of Choice in Pancreatic Carcinoma for staging disease & identify eligibility for resection

A

CT Scan/Helical CT

Detects >80% of masses

58
Q

What is considered the PRIMARY diagnostic tool/imaging in Pancreatic Carcinoma

A

ERCP

59
Q

ERCP findings in Pancreatic Carcinoma

A

“Double Duct sign”: Stricture of both CBD & pancreatic ducts

60
Q

What do you need to make sure you obtain with an ERCP?

A

Tissue sample

61
Q

What can an endoscopic US (EUS) evaluate for?

A
  1. Tumor involvement
  2. Vascular involvement

*best for FNA bx

62
Q

What is the only potential cure in Pancreatic Carcinoma?

A

Whipple procedure (pancreaticoduodenectomy)
+ Chemo
+/- Radiation

63
Q

What is the 5 year survival in Pancreatic Carcinoma?

A

<5%= Very poor!

Foundations-GI (7 decks)

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