Pancreatic Diseases

Question 1

What is acute pancreatitis?

Answer 1

Inflammatory disease

Autodigestion of the pancreas by protealytic enzymes

Question 2

What are the 2 main causes acute pancreatitis?

Answer 2

Alcohol
Gallstones
Together account for 75%

Question 3

What are mechanical causes of acute pancreatitis?

Answer 3

GALLSTONES
Blunt trauma
ERCP

Question 4

What are other causes of acute pancreatitis?

Answer 4

Hypertriglyceridemia*
Hypercalcemia
Ischemia, vaculitis 
Viruses 
Genetic 
Idiopathic 30%

Question 5

How does acute pancreatitis present?

Answer 5

Fever, ↑HR, +/- ↓BP, ↑RR

Jaundice

Hypoactive or absent BS
Mid epigastric tenderness

Cullen’s sign
Grey-Turner’s sign

Question 6

What should your lab workup include for acute abd pain?

Answer 6

amylase & lipase

Question 7

What imaging can you use to dx acute pancreatitis?

Answer 7

Plain films
US: gallstones
CT
MRCP
EUS

Question 8

What are complications of acute pancreatitis?

Answer 8

Necrosis
Pseudocysts
Abscess
Hemorrhage

Question 9

How do you treat acute pancreatitis?

Answer 9

NPO
IVF
Meperidine pain control

Question 10

How do you treat pancreatitis when necrosis is a concern?

Answer 10

Imipenem

Question 11

What are sx of a pancreatic pseudocyst?

Answer 11

Abd pain, early satiety, N/V

Question 12

What are systemic complications of pancreatitis?

Answer 12

Resp. failure/ARDS, pulmonary edema, pleural effusion, atelectasis

Renal failure

Hypotension/shock

GI

Metabolic: Hyper/hypoglycemia

Question 13

What are initial signs in Ranson’s criteria for pancreatitis?

Answer 13

>55 yo
WBC > 16000
Glucose > 200
AST > 250
LDH > 350

Question 14

What are the delayed signs in Ranson’s criteria for pancreatitis?

Answer 14

HCT drop > 10%
BUN increase > 5
Ca < 8
pO2 < 60
albumin < 3.2
Fluid sequestration 4-5

Question 15

How do you treat biliary pancreatitis?

Answer 15

ERCP if CBD stone

Cholecystectomy

Question 16

What is chronic pancreatitis? What does it lead to?

Answer 16

Repeated episodes of inflammation –> damage & ductal obstruction

Leads to exocrine & endocrine insufficiency

Question 17

What is the MC cause of chronic pancreatitis?

Answer 17

Alcohol (70-80%)

Question 18

How does chronic pancreatitis present?

Answer 18

Epigastric pain (80%)

Exocrine insufficiency –> malabsorption –> steatorrhea & wt loss

Endocrine insufficiency –> diabetes –> “poly” sx

Question 19

What is the classic triad of chronic pancreatitis?

Answer 19

Diabetes
Steatorrhea
Calcifications

Question 20

What labs do you use to dx chronic pancreatitis?

Answer 20

Amylase & lipase: normal or slightly elevated

Bilirubin & alk phos mildly elevated

Elevated glucose

Secretin stimulation test

Elevated fecal fat testing

Question 21

What imaging do you use to dx chronic pancreatitis?

Answer 21

Plain films: calcifications

CT: calcifications, ductal dilation, pseudocysts

MRCP

ERCP: “Chain-of-lakes”

Question 22

How do you treat chronic pancreatitis?

Answer 22

No more alcohol
Low fat meals
Insulin for DM
Pancreatic enzymes

Question 23

What meds can you use for pain relief from chronic pancreatitis?

Answer 23

Amitriptyline or SSRI

Narcotics (MS contin vs Fentanyl patch)

Question 24

What procedures are available for management of chronic pancreatitis?

Answer 24

Endoscopic: ductal dilation, stenting

Nerve blocks: celiac plexus (ethanol or steroids)

Lithotripsy

Resection (if CA suspected)

Question 25

Describe pancreatic carcinoma

Answer 25

4th leading cause of CA death in US Dx late in disease Majority are adenocarcinomas & located in the head of the pancreas

Question 26

What are RFs for pancreatic carcinoma?

Answer 26

``` Male African American > 45 yo Smoking, alcohol Chronic pancreatitis DM, obesity Fam hx ```

Question 27

What is the clinical presentation of pancreatic carcinoma?

Answer 27

Abd pain (gnawing epigastric, radiating to back) Early satiety/anorexia Wt loss Painless jaundice

Question 28

What does pancreatic carcinoma look like on PE?

Answer 28

``` Cachectic Jaundice, icterus Left supraclavicular LNs Ascites Palpable gall-bladder ```

Question 29

What labs can you use to dx pancreatic carcinoma?

Answer 29

Bilirubin & alkphos: elevated Amylase/lipase: elevated Mild anemia Glucose intolerance CA19-9

Question 30

What imaging can you use to dx pancreatic carcinoma?

Answer 30

U/S: dilated CBD CT: TOC for staging MRCP ERCP: considered primary dx tool, "double duct sign" EUS

Question 31

How do you treat pancreatic carcinoma?

Answer 31

Whipple