Pancreatic Disease (Lauren 🌭) Flashcards
What is the difference between the endocrine and exocrine parts of the pancreas?
Endocrine- islet of langerhans making glucagon and insulin
Exocrine- Acinar and ductal cells making digestive enzymes
What usually causes acute pancreatitis in men vs women?
Men: alcohol
Women: gallstone
What are the TWO MAIN causes of acute pancreatitis?
Gallstones (35-40%)
Chronic Alcohol Abuse (25-35%)
Idiopathic
What are all the things that can cause acute pancreatitis that you can remember with the helpful mnemonic “I get smashed?”
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion/snake bites Hyperlipidemia/Hyeprcalcemia ERCP Drugs
I don’t think she will test on this she just wanted to tell us a stupid mnemonic
What is the pathophysiology of acute pancreatitis?
- High pancreatic levels of activated trypsin
- Pancreatic auto-digestion, injury and inflammation
- Inflammation leads to organ injury, organ failure, death, etc
Describe the pain of acute pancreatitis
**
Mid epigastric
Radiates to back
Constant
BORING
Gets better with leaning forward, knees flexed and sitting
Gets worse with lying down, food, alcohol
****
Other than abdominal pain, what else may a patient with acute pancreatitis complain of?
Nausea/Vomiting
Anorexia
SOB if pleural effusions
What will you find on physical exam of acute pancreatitis?
Tachycardia
Tachypnea
Fever
Hypotension
Distentenion/hypoactive bowels if ileus is present
Scleral icterus if choledocholithiasis or edema of pancreatic head
Hepatomegaly if alcohol abuse
Xanthomas if hyperlipidemia
Parotid swelling if mumps
Sometimes Jaundice, pallor, or diaphoresis
(I don’t know if this is important or not I’m so sorry!)
What will you see on physical exam if your patient has Severe Necrotizing Pancreatitis?
Cullen’s sign
Grey-turner’s sign
Panniculitis
What is Cullen’s sign?
Ecchymosis around the belly button
What is Grey Turners sign?
Ecchymosis on the flanks
What is panniculitis?
Erythematous nodules in the subcutaneous fat
**
What labs will you order for acute pancreatitis, and what would you find?
CBC-elevated WBC
CMP- hypercalcemia, elevated bilirubin
Amylase and Lipase**
CRP will be over 150 @ 48hrs if severe pancreatitis
ALT will be over 150 @ 48hrs if gallstone pancreatitis
Urine trypsinogen-2 dipstick test
Don’t know how important this is
Which is more specific for pancreatic injury: Amylase or Lipase
Lipase
In acute pancreatitis, Amylase rises in _______ hrs, peaks in ____ hrs and normalizes in _________days
Rises in 6-12 hrs
Peaks in 48 hrs
Normalizes in 3-5 days
In acute pancreatitis, Lipase rises in ______ hrs, peaks at _____ hrs, and normalizes in _________ days
Rises in 4-8 hours
Peaks at 24 hours
Normalizes in 8-14 days
When would you do genetic testing for pancreatitis?
If there is a strong family history of pancreatitis
Under age 35 at onset
All patients having genetic testing should have __________ ________ before and after!
Genetic counseling
What will you see on X-ray if your patient has acute pancreatitis?
Sentinel Loop (small bowel inflammation and air from an ileus?)
Gallstones
**THIS SLIDE HAD A STAR ON IT**
If you suspect pancreatitis, what imaging should you do?
Ultrasound
If your patient has unexplained acute pancreatitis, and there is a risk for malignancy, what imaging should you do?
Abdominal CT w IV Contrast-“pancreas protocol”
MRI with MRCP
Endoscopic Ultrasound
What imaging should be done for recurrent pancreatitis?
Consider endoscopic ultrasound
And/or
ERCP
What imaging would you use to identify the severity of pancreatitis, as well as any complications like necrosis, psuedocysts, abscess, and hemorrhage?
Abdominal CT
For patient who tick all the boxes for acute pancreatitis on exam and labs, what kind of imaging should you NOT DO early on?
CT!!!
Why: CT is to look for complications of acute pancreatitis, which don’t even show up for 3 days. Besides, most cases are uncomplicated anyways. Also IV contrast might worsen their condition.
