Pancreatic disorders Flashcards
What are the exocrine functions of the pancreas
digestion
-secrete bicarbonate and digestive enzymes into ducts connecting pancreas to duodenum
what are the endocrine functions of the pancreas
glucose homeostasis
-alpha cells: glucagon
-beta cells: insulin
what is acute pancreatitis
acute response to injury/insult
inflammation that resolves both clinically and histologically
what is chronic pancreatitis
result in permanent damage to structure
irreversible and progressive histologic changes that result in loss of exocrine and endocrine function
what is the most common triggers of acute pancreatitis
gallstones and alcohol intake
how is acute ppancreatitis diagnosed
clinical presentation, serum amylase and lipase, imaging
what is the clinical presentation of acute pancreatitis
severe, upper abdominal pain with radiation (“boring”) to back; frequently N/v
appear acutely ill and sweaty
pulse usu 100-140bpm, rapid and shallow respiration
AMS
What is Grey Turner sign
ecchymosis of the flanks
what is Cullen Sign
ecchymoses of the umbilical region
according to UCG guidelines, diagnosis of acute pancreatitis includes 2 of the following:
abdominal pain: consistent with acute pancreatitis
Serum Lipase level >3x upper limit of normal range
findings of acute pancreatitis on abdominal imaging
what bloodwork should be completed on admission of acute pancreatitis
CBC
CMP
serum lipase and amylase
lactate
TG
CRP
*best for evolution: rising BUN or rising Hct
what lab work is more specific for pancreatitis
Lipase
what does an elevated anion gap metabolic acidosis indicate
shock
what is the imaging study of choice for acute pancreatitis
CT with IV contrast - makes diagnosis
what are risk factors that predict a severe course
age >60
comorbid health problems
obesity with BMI >30
long-term, heavy alcohol use
presence of systemic inflammatory response syndrome (SIRS)
what are the scoring systems used for pancreatitis
Ranson Criteria
BISAP (bedside index of severity in acute pancreatitis)
what is ranson criteria
cumbersome, takes 48 hours to compute but good negative predictive valvue for pancreatitis
what is BISAP
bedside index of severity in acute pancreatitis
simple and calculated during first 24 hours; good positive predictor of severe cases M&M
what are the types of acute pancreatitis
Intersitital and necrotizing
what is intersitial pancreatitis
presence of an enlarged pancreas on imaging; peripancreatic stranding and signs of inflammation; more common type, majority of cases are self-limited
what is Necrotizing pancreatitis
presence of pancreatic and/or peripancreatic necrosis; best seen on contrast-enhanced cross-sectional imaging; occurs in 5-10% of acute pancreatitis and associated with prolonged, more severe disease course
what is the more important stage in management of acute pancreatitis
first 12-24 hours is the most important
fluid resuscitation
analgesia/meds
nutritional support
what is the foundation of management of acute pancreatitis
early aggressive fluid resuscitation
-lactated ringer’s solution
what are pseudocysts
pancreatic and peripancreatic collections of enzyme-rich pancreatic fluid
- fluid or fluid and necrotic material
-most resolve spontaneous
what are systemic complicatiosn of acute pancreatitis
single or multiple organ failure and shock
risk increased with underlying comorbidities and/or persistent SIRS
what is persistent inflammation of the pancrease that leads to permanent structural damage with fibrosis
chronic pancreatitis
what are two major risk factors for chronic pancreatitis
drinking alcohol and smoking cigarettes
what is the hallmark of pancreatitis
fibrosis caused by inflammation and recurrent pancreatic injury
what is the primary manifestation of chronic pancreatitis
abdominal pain and pancreatic insufficiency
what is the best imaging for diagnosis of chronic pancreatitis
MRI - confirms diagnosis
what are direct pancreatic function tests
monitor actual ssecertion of pancreatic exocrine products (bicarbonate and enzymes)
most useful in earlier stage when imaging studies are not diagnostic
IV cholecystokinin, IV secretin, duodenal secretion
what are indirect pancreatic function tests
measure secondary effects resulting from lack of pancreatic enzymes (e.g. fat malabsorption)
less accurate in earlier stages; blood or stool samples
serum trypsinogen tests, steatorrhea
what is the treatment of chronic pancreatitis
smoking cessation and alcohol abstinence
pain control**
pancreatic enzyme supplements
mgmt: diabetes and other complications
what is pancreatic enzyme replacement
25,000 - 50,000IU lipase per meal, half dose with snacks
what is the removal of the head of the pancreas due to extensive disease
whipple procedure
what is EPI
exocrine pancreatic insufficiency
reduction in pancreatic enzyme activity (mainly lipase) in intestinal lumen below threshold for digestive functions
what are clinical manifestations of EPI
steatorrhea, flatulence, weight loss, abdominal pain
maldigestion and malabsorption
what are the primary causes of EPI
adults: chronic pancreatitis
children: cystic fibrosis
what is the treatment/management of EPI
monitory body weight and BMI
screening for nurtritional deficiency
referral to dietician
adress causes
What is the mainstay treatment of EPI
pancreatic enzyme replacement therapy (PERT)
what are complications without treatment of EPI
fat malabsorption and malnutrition reduce QOL
osteoporosis and osteopenia
reduced ability to work
increased cardiovascular complicationss
