pancreatic disorders Flashcards
where is CKK secreted from ?
duodenal andd jejunal I cells
what is the stimulus for the secretion of CKK ?
products of protein digestion
fat and fatty acids
what is the acttion of CKK ?
stimulates pancreatic enzyme secretion
stimulates bile secretion from the liver
gallbladder contraction
reduces gastric emptying
what suppresses CKK ?
trypsin
how is the exocrine function of the pancreas regulated ?
regulated by vagal efferent
what are the causes of acute pancreatitis ?
GETSMASSSHED
what drugs are commonly associated with acute pancreatitis ?
azathioprine oestrogens
valproic acid
furosemide
sulphonamides
what trauma is highly associated with acutee pancreatitis ?
bicycle handlebar
steering wheel
surgery
most common etiologies of acute pancreatitis ?
gallstones and alcohol
what is the typical presentation of mild acute pancreatitis ?
epigastric pain that may radiate to the back
relieved by leaning forward
associated with nausea and vomiting
what is the presentation of severe acute pancreatitis ?
same as mild but with tachycardia hypotension and oliguria
reduced or absent bowel sounds
what speciific sifgns are associatwd with pancreatitis ?
cullen’s sign -periumbilical
grey turner’s sign - flank bruising
what are the differentials of epigastric pain ?
MI
acute/chronic pancreatitis
GERD
functional dyspepsia
how is a diagnosis of AP made ?
abdominal pain consistent with AP
elevation of amylase and lipase more than 3 times of the upper limit
characteristic findings found on abdominal imaging
what are the other causes of elevated amylase levels ?
diabetic ketoacidosis
gastroduodenal perforation
renal failure
mumps
macroamylasemia
what type of imaging must be performed ?
erect X ray must first be performed to exclude gastroduodenal perforation
abdominal X ray for gallstones or pancreatic calcifications
abdominal US
how can the severity of acute pancreatitis be measured ?
atlanta revision :
mild : absence of organ failure
absence of local symptoms
Moderately severe :
local complications or transient organ failure
severe :
persistent organ failure
which scoring system can be used as early as 24h and is higher in sensitivity ?
APACHE
what are the blood tests done for a patient with suspected AP ?
Serum Lipase
Serum Amylase
Urinary amylase
CRP level
repeated at 24 then 48h
if we needed to differentiate between fluid and solid masses of the pancreas what imaging modality should be used ?
MRI
what is the preferred route for nutrition for acute pancreatitis ?
in moderate and severe - enteral nutrition
nasogastric tube or nasojejunal tube
what are the ccomplications of acute pancreatittis ?
infected necrosis
pseudocyst
pancreatic ascites and pleural effusion
what is the management for pseudocyst ?
EEUS guided drainage
ERCP
if endoscopic treatment failed then surgery
what is the best imaging modality for gallstones ?
RUQ ultrasound
when is an abdominal CT indicated ?
with acute severe pancreatitis or worsening pancreatitis within 48-72 hours after admission
when is it appropriate to start antibiotics ?
if signs of systemic affection begin to appear such as systemic inflammatory response syndrome
when is cholecystectomy indicated with acute pancreatitis ?
acute biliary pancreatitis
at what age should pancreatic tumors be considered as an etiology for acute pancreatitis ?
above 40
when can hypertriglyceridemia be considered the etiology for pancreatitis ?
if the levels are above 1000
if choledocholithiasis iis highly suspected what is the next best step in management ?
MRCP
what makes chronic pancreatitis different from acute pancreatitis ?
chronic - irreversible damage and may present with malabsorption due to EPI
what are the different types of pancreatic secretory function tests ?
direct - CCk and secretin stimulated pancreatic function test ( double tube test )
indirect - Lundh test meal , fecal fat , fecal elastase , NBT-PABA
what is the most sensitive test for exocrine pancreatic function ?
secretin and CCK stimulated pancreatic function test
what lab test should be done for suspected autoimmune pancreatitis ?
serum IgG4 levels
what is the best investigation for initial assessment for AP ?
ultrasound
what is the management of chronic pancreatitis ?
prevent further pancreatic destruction
treatment of clinical symptoms
what are the association with pancreatic adenocarcinoma ?
associated with increasing agee
smoking
chronic pancreatitis
what is the picture of the pain associated with pancreatic adenocarcinoma ?
central abdominal pain (invasion from the coeliac plexus )
what special sign is associatedd with cancer head of pancreas ?
courvoisier’s sign
palpable non tender gallbladder in a jaundiced patient
what imaging modality is usually used for thee diagnosis of cancer head of pancreas ?
ultrasound and contrast enhanced CT
what are the etiologies for chronic pancreatitis ?
TIGAR-O
toxic/metabolic
idiopathic
genetic
autoimmune
recurrent and severe pancreatitis
obstructive
what is the cornerstone for treatment of autoimmune pancreatitis ?
corticosteroids
most common hereditary disease associated with exocrine pancreatic insufficiency ?
cystic fibrosis
what is the new born screening procedure for cystic fibrosis ?
trypsinogen - heel prick test
sweat test - measure chloride concentration
what is pancreatic divisum ?
failure of the primitive dorsal and ventral duct to fuse during embryonic development
what is c annular pancreas ?
pancreas encircles the second part of the duodenum causing gastric outlet obstruction
what are the associations of c annular pancreas ?
malrotation of the intestinal
atresia
cardiac anomalies
what is the problem with true cystic lesions of the pancreas ?
can turn malignant so resection is required
