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year 5 - GIT Internal medicine > pancreatic disorders > Flashcards

pancreatic disorders Flashcards

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1
Q

where is CKK secreted from ?

A

duodenal andd jejunal I cells

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2
Q

what is the stimulus for the secretion of CKK ?

A

products of protein digestion
fat and fatty acids

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3
Q

what is the acttion of CKK ?

A

stimulates pancreatic enzyme secretion
stimulates bile secretion from the liver
gallbladder contraction
reduces gastric emptying

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4
Q

what suppresses CKK ?

A

trypsin

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5
Q

how is the exocrine function of the pancreas regulated ?

A

regulated by vagal efferent

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6
Q

what are the causes of acute pancreatitis ?

A

GETSMASSSHED

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7
Q

what drugs are commonly associated with acute pancreatitis ?

A

azathioprine oestrogens
valproic acid
furosemide
sulphonamides

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8
Q

what trauma is highly associated with acutee pancreatitis ?

A

bicycle handlebar
steering wheel
surgery

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9
Q

most common etiologies of acute pancreatitis ?

A

gallstones and alcohol

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10
Q

what is the typical presentation of mild acute pancreatitis ?

A

epigastric pain that may radiate to the back
relieved by leaning forward
associated with nausea and vomiting

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11
Q

what is the presentation of severe acute pancreatitis ?

A

same as mild but with tachycardia hypotension and oliguria
reduced or absent bowel sounds

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12
Q

what speciific sifgns are associatwd with pancreatitis ?

A

cullen’s sign -periumbilical
grey turner’s sign - flank bruising

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13
Q

what are the differentials of epigastric pain ?

A

MI
acute/chronic pancreatitis
GERD
functional dyspepsia

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14
Q

how is a diagnosis of AP made ?

A

abdominal pain consistent with AP
elevation of amylase and lipase more than 3 times of the upper limit
characteristic findings found on abdominal imaging

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15
Q

what are the other causes of elevated amylase levels ?

A

diabetic ketoacidosis
gastroduodenal perforation
renal failure
mumps
macroamylasemia

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16
Q

what type of imaging must be performed ?

A

erect X ray must first be performed to exclude gastroduodenal perforation
abdominal X ray for gallstones or pancreatic calcifications
abdominal US

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17
Q

how can the severity of acute pancreatitis be measured ?

A

atlanta revision :

mild : absence of organ failure
absence of local symptoms
Moderately severe :
local complications or transient organ failure
severe :
persistent organ failure

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18
Q

which scoring system can be used as early as 24h and is higher in sensitivity ?

A

APACHE

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19
Q

what are the blood tests done for a patient with suspected AP ?

A

Serum Lipase
Serum Amylase
Urinary amylase
CRP level
repeated at 24 then 48h

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20
Q

if we needed to differentiate between fluid and solid masses of the pancreas what imaging modality should be used ?

A

MRI

21
Q

what is the preferred route for nutrition for acute pancreatitis ?

A

in moderate and severe - enteral nutrition
nasogastric tube or nasojejunal tube

22
Q

what are the ccomplications of acute pancreatittis ?

A

infected necrosis
pseudocyst
pancreatic ascites and pleural effusion

23
Q

what is the management for pseudocyst ?

A

EEUS guided drainage
ERCP
if endoscopic treatment failed then surgery

24
Q

what is the best imaging modality for gallstones ?

A

RUQ ultrasound

25
Q

when is an abdominal CT indicated ?

A

with acute severe pancreatitis or worsening pancreatitis within 48-72 hours after admission

26
Q

when is it appropriate to start antibiotics ?

A

if signs of systemic affection begin to appear such as systemic inflammatory response syndrome

27
Q

when is cholecystectomy indicated with acute pancreatitis ?

A

acute biliary pancreatitis

28
Q

at what age should pancreatic tumors be considered as an etiology for acute pancreatitis ?

A

above 40

29
Q

when can hypertriglyceridemia be considered the etiology for pancreatitis ?

A

if the levels are above 1000

30
Q

if choledocholithiasis iis highly suspected what is the next best step in management ?

A

MRCP

31
Q

what makes chronic pancreatitis different from acute pancreatitis ?

A

chronic - irreversible damage and may present with malabsorption due to EPI

32
Q

what are the different types of pancreatic secretory function tests ?

A

direct - CCk and secretin stimulated pancreatic function test ( double tube test )
indirect - Lundh test meal , fecal fat , fecal elastase , NBT-PABA

33
Q

what is the most sensitive test for exocrine pancreatic function ?

A

secretin and CCK stimulated pancreatic function test

34
Q

what lab test should be done for suspected autoimmune pancreatitis ?

A

serum IgG4 levels

35
Q

what is the best investigation for initial assessment for AP ?

A

ultrasound

36
Q

what is the management of chronic pancreatitis ?

A

prevent further pancreatic destruction
treatment of clinical symptoms

37
Q

what are the association with pancreatic adenocarcinoma ?

A

associated with increasing agee
smoking
chronic pancreatitis

38
Q

what is the picture of the pain associated with pancreatic adenocarcinoma ?

A

central abdominal pain (invasion from the coeliac plexus )

39
Q

what special sign is associatedd with cancer head of pancreas ?

A

courvoisier’s sign
palpable non tender gallbladder in a jaundiced patient

40
Q

what imaging modality is usually used for thee diagnosis of cancer head of pancreas ?

A

ultrasound and contrast enhanced CT

41
Q

what are the etiologies for chronic pancreatitis ?

A

TIGAR-O
toxic/metabolic
idiopathic
genetic
autoimmune
recurrent and severe pancreatitis
obstructive

42
Q

what is the cornerstone for treatment of autoimmune pancreatitis ?

A

corticosteroids

43
Q

most common hereditary disease associated with exocrine pancreatic insufficiency ?

A

cystic fibrosis

44
Q

what is the new born screening procedure for cystic fibrosis ?

A

trypsinogen - heel prick test
sweat test - measure chloride concentration

45
Q

what is pancreatic divisum ?

A

failure of the primitive dorsal and ventral duct to fuse during embryonic development

46
Q

what is c annular pancreas ?

A

pancreas encircles the second part of the duodenum causing gastric outlet obstruction

47
Q

what are the associations of c annular pancreas ?

A

malrotation of the intestinal
atresia
cardiac anomalies

48
Q

what is the problem with true cystic lesions of the pancreas ?

A

can turn malignant so resection is required

year 5 - GIT Internal medicine (25 decks)

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