Pancreatic Disorders Flashcards
1
Q
Pancreatic Proteases
A
- Zymogens (inactive) when secreted
- Normal Activation:
- enter duodenum
- enteropeptidase activates Trypsinogen to trypsin
- Trypsin activates all pancreatic proteases
- Trypsinogen can auto-activate if it remains in duct
2
Q
Pancreatic Lipases
A
- do not require activation
- requires CoLipase (zymogen) for activity
- Normal:
- Trypsin activates Co-Lipase in duodenum
- Lipases and co-lipases digest fat of the omentum
- if in abdominal cavity=not active
3
Q
Pancreatic Insufficiency
A
- symptoms of poor pancreatic function
- occurs when 90% of function lost
- Symptoms:
- Fat malabsorption=steatorrhea (excess fat in stool)
*
- Fat malabsorption=steatorrhea (excess fat in stool)
4
Q
Acute Pancreatitis
A
- poor pancreatic function
- leads to inadequate supply of pancreatic digestive enzymes and bicarbonate
5
Q
AcutePancreatitis: Symptoms
A
- Severe pain (slow or sudden)
- pain may get worse with eating.
- Nausea and Vomiting
- Fever
- Weight Loss
- Greasy or oily stools
- diarrhea (loose stool)
- Diabetes
- Jaundice (rare)
6
Q
Acute Pancreatitis: Incidence
A
- 18/100,000 in the US
- but the numbers are rapidly increasing
- Highest incidence: African americans
- More common in males than females
7
Q
Acute Pancreatitis: Cause
A
- Bile Duct Obstruction-38%
- Alcohol use-36%
- females more susceptible
- Trauma-5%
- ERCP-5%
- to remove gallstones
- Drugs-2%
- Minor causes (<1%)
8
Q
Acute Pancreatitis: Clinical Presentation
A
- Abdominal pain (epigastric)
- nausea and vomiting
- Possibe: Tachycardia, tachypnea, dyspnea, fever, confusion, delirium or coma
- Obstructive jaundice may be present
9
Q
Acute Pancreatitis: Diagnosis
A
- Elevated serum amylase/lipase within hours
- lipase is more specific than amylase
- Ultrasound for duct obstruction
- CT for pancreatic necrosis
10
Q
Acute Pancreatitis: Treatment
A
- Supportive therapy-control pain and nausea
- Fluid replacement of peritoneal/pleural losess
- endoscopic removal of gallstones if needed
- gallstones usually clear themselves from the duct
- gallstones in other parts of the billiary tree should be removed prior to patient discharge
- may involve cholecystectomy (remove gallbladder)
- Remove necrotic tissue
11
Q
Acute Pancreatitis: Complications
A
- Respiratory distress
- most common
- Hypotension/shock, renal failure, hyperglycemia, hypertrilyceridemia, pseudocyst formation GI Bleeding
12
Q
Acute Pancreatitis: Prognosis
A
- 80% recover within 48hrs
- 2% mortality
- morbidity is higher in obstructive conditions
13
Q
Pancreatic Pseudocysts
A
- Complications of acute pancreatitis
- abdominal trauma in children
- major cause of pancreatic masses
- major occur in chronic pancreatitis
- Walls of granulation tissue
- not epithelial
- Formed by lack of drainage
- form reservoir of:
- necrotic tissue
- hemolyzed blood
- enzymes
- infection
- form reservoir of:
- Dectable by most imaging
- Tx:
- surgical removal of cyst (common)
- endoscopically drain (less common)
14
Q
Chronic Pancreatitis: Incidence
A
- (1 in16) 300/100,000 clinically; 5% on autopsy
- 2x higher in males
- 3x higher in african americans
15
Q
Chronic Pancreatitis: Etiology/causes
A
- Alcoholism-60-70%
- Idiopathic-30%
- cystic fibrosis phenotypes
- cause of pancreatitis or pancreatic insufficiency
- Tobacco use
- Other causes:
- progession of acute pancreatitis
- Chronic obstructive/congenital malformation/autoimmune
- ischemia, infeciton other herditary causes
16
Q
Chronic Pancreatitis: Clinical Presentation
A
- insidious onset
- presents with moderate to severe abdominal pain
- severe pain=Nausea and Vomiting
- History may include:
- diabetes mellitus
- steatorrhea
- prior abdominal pain
- acute pancreatitis
17
Q
Chronic Pancreatits: Prognosis
A
- High mortality rate=30%
18
Q
Chronic Pancreatits: Complications
A
- Progressive pancreatitc insufficiency (100%)
- Diabetes mellitus
- 33%
- occurs later than other complications
- Risk of pseudocysts (10%)
- duodenal or duct obstrction: 5-10%
- Pancreatic cancer-4%
19
Q
Chronic Pancreatitis: Diagnosis
A
- Imaging (CT & ECRP)
- calcification-most easily detected by CT scan
- ERCP detailed imaging of duct system
- MRI-some uses
- Functional Tests:
- Pancreatic Function test
- intubate duodenuma and meausre duodenal flow in response to Secretin or enzymes in response to tCCK
- Endocrine insufficiency
- blood glucose
- Exocrine insufficiency:
- fecal elastase (common)
- fecal fat (Steatorrhea)
- Serum Trypsinogen
- Pancreatic Function test
20
Q
Chronic Pancreatitis: Treatment
A
- Modify high risk behaviors
- alcoholism consult
- stop smoking
- pancrease may heal itself if cause is eliminated
- Pain management
- Surgery to correct:
- Pseudocyst
- Abscess/fistula
- Ascites
- duct or duodenal obstruction
- hemorrhages or thrombosis
21
Q
Exocrine Pancreas Insufficiency: prevalence
A
- 11-12% of 50-75 y.o.
22
Q
Exocrine Pancreatic Insufficinecy: Etiology
A
- Chronic or autoimmune pancreatitis
- Cystic Fibrosis (CFTR gene mutation)
- Pancreatic Duct obstructions
23
Q
Exocrine Pancreatic Insufficiency: Prognosis
A
- Reversible
- alcoholic
- duct obstruction
- Irreversible
- Cystic fibrosis
- autoimmune
- progress to complete pancreatic insufficiency
24
Q
Pancreatic Insufficiency: Tests
A
- Blood tests:
- Fat soluble vitamines (A, E, D, K)
- Trypsinogen or other pancreatic zymogens
- Fecal tests
- 72hr fecal fat absorption (not specific)
- Fecal elastase (most specific)
- Serum CCK and Secretin Tests
- Differential tests for intestinal causes of malabsorption
- D-xylose
- small intestinal absorption
- Hydrogen breath
- intestinal absorption and enteric enzymes
- Schilling test
- B12 absorption
- D-xylose
25
Q
Pancreatic Insufficiency: Treatment
A
- Exocrine insufficiciency:
- oral pancreatic enzymes products (PEPs)
- Endocrine:
- insulin
