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Clin Med: GI (block 3) > Pancreatic Disorders > Flashcards

Pancreatic Disorders Flashcards

1
Q

Is the pancreas endocrine or exocrine

A

Both

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2
Q

Amylase function

A

Catalyzes breakdown of complex CHOs into glucose residues

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3
Q

Lipase function

A

Catalyzes hydrolysis of triglycerides into monoglycerides & FFA

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4
Q

Trypsin (storage form - trypsinogen) function

A

Cleaves digested PROs (protease) at carboxyl groups on lysine & arginine AA

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5
Q

Chymotrypsin (storage - form chymotrypsinogen) function

A

Cleaves digested PROs (protease) at peptide bones of tryptophan, leucine, ,tyrosine, & phenylalanine

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6
Q

What else can acute pancreatitis cause?

A
  • Gallstones (1)
  • Alcohol consumption (2)
  • Hypertriglyceridemia (5)
  • Infx
  • Drugs (4)
  • Blunt abdominal trauma
  • Idiopathic (3)
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7
Q

Define acute pancreatitis.

A

acute inflammation of the pancreas

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8
Q

Elastase function

A

Cleaves digested PROs (protease) at carboxyl groups on glycine, alanine, & valine

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9
Q

What drugs can cause acute pancreatitis?

A
  • corticosteroids
  • opioids
  • valproate
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10
Q

Acute Pancreatitis Pathophys

A
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11
Q

Acute Pancreatitis S/S:

A
  • Severe, steady, boring epigastric pain, abrupt
  • worse by walking, lying & better by sitting & leaning forward
  • abdo tender
  • N/V
  • Fever, tachycardia, HPTN, pallor, & cool clammy skin
  • Mild jaundice may be seen
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12
Q

Acute Pancreatitis: Mild Episode PE

A
  • not sick looking
  • mild abdo tenderness w/o guarding
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13
Q

Acute Pancreatitis: Severe Episode PE

A
  • appears sick
  • may be leaning forward & still to avoid pain
  • may have abnormal vital signs - HPTN, low grade fever, tachycardia, tachypnea or shallow respirations
  • may be confused
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14
Q

Describe Cullen’s Sign

A

superficial edema & bruising in the subcutaneous fatty tissue around the umbilicus

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15
Q

Describe Grey Turner Sign

A

an ecchymotic discoloration of the lateral abdo wall or flank

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16
Q

Acute Pancreatitis Dx

A
  • Amylase
  • Lipase (better for diagnosis)
    ALT ≥ 150 units/L may suggest gallstone pancreatitis
  • Lipase/amylase ratio > 2 may help rule out alcoholic etiology
  • transabdo US main benefit is ID of gallstones or dilation of common bile duct due to choledocholithiasis
  • CT may show necrosis of the pancreas in severe pancreatitis
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17
Q

Acute Pancreatitis Tx

A
  • Aggressive IV hydration
  • NPO
  • Pain management
  • Tx of electrolyte abnormalities
  • Artificial nutrition if pt unable to eat for >7 days
  • Removal of gallstones
  • Stop alcohol intake
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18
Q

Ranson Criteria: severity of acute pancreatitis

A
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19
Q

Describe chronic pancreatitis.

A

A progressive & destructive necro-inflammatory disorder of the pancreas characterized by irreversible fibrosis of the gland w/ eventual failure of exocrine & endocrine functions

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20
Q

What causes the destruction of the pancreas in chronic pancreatitis?

A

Its own digestive enzymes

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21
Q

Chronic Pancreatitis RFs

A
  • Alcohol consumption
  • Genetic factors
  • Autoimmune dz
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22
Q

What are the autoimmune dz that incr risk of chronic pancreatitis?

A
  • Sjogren syndrome
  • primary biliary cirrhosis
  • IBD
  • primary sclerosing cholangitis
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23
Q

Common causes of chronic pancreatitis

A

Alcoholic & idiopathic

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24
Q

Uncommon causes of chronic pancreatitis

A

Autoimmune & Obstructive

25
Rare causes of chronic pancreatitis
- Hereditary - Hypertriglyceridemia - Hyperparathyroidism
26
Chronic Pancreatitis: S/S
- Persistent or recurrent episodes of epigastric & LUQ pain - Anorexia, N/V, constipation, flatulence, & weight loss - Steatorrhea in later stages
27
Describe Chronic pancreatitis "attacks"
can last 2 wks & pain is continuous
28
Chronic Pancreatitis: PE
- Tenderness over the pancreas - Guarding may be present
29
Chronic Pancreatitis: Dx
- Serum amylase & lipase may be elevated - Serum alkaline phosphatase & bilirubin - Excess fecal fat may be demonstrated in the stool (steatorrhea) - MRCP may show morphological changes - ERCP can be diagnostic & therapeutic- can show dilated ducts, intraductal stones, or strictures - Pancreatic function tests (rarely performed)
30
Do normal serum values of amylase & lipase exclude the dx of chronic pancreatitis?
NO
31
Chronic Pancreatitis Tx: Lifestyle
Diet - eat high PRO, nutrient-dense diets that include fruits, veggies, whole grains, low fat dairy, & other lean PRO sources - avoid smoking & alcohol use
32
Chronic Pancreatitis Tx: Meds
- Analgesics (avoid NSAIDS) - Pancreatic enzyme replacement therapy - Pts w/ for autoimmune pancreatitis: corticosteroids
33
When is pancreatic enzyme replacement therapy indicated?
- If exocrine pancreatic insufficiency & clinical symptoms or laboratory signs of maldigestion - Lipase given by mouth
34
Describe pancreatic exocrine insufficiency
A syndrome of maldigestion resulting from disorders interfering w/ effective pancreatic enzyme activity
35
Pancreatic Insufficiency - Primary Causes: Acquired decr enzyme secretion
- Chronic pancreatitis - Pancreatic, ampullary, & duodenal neoplasms - Pancreatic resection - Severe PRO-calorie malnutrition, hypoalbuminemia
36
Pancreatic Insufficiency - Primary Causes: Congenital decr enzyme secretion
- cystic fibrosis - Hemochromatosis - Shwachman-Diamond syndrome Enzyme deficiencies
37
What is Shwachman-Diamond syndrome?
Pancreatic insufficiency w/ anemia, neutropenia, & bony abnormalities
38
Pancreatic Insufficiency - 2ndary Causes:
A. Intraluminal enzyme destruction B. Decr pancreatic stimulation C. Mistiming of enzyme secretion: gastric surg
39
What gastric surgs can cause pancreatic insufficiency?
- subtotal gastrectomy w/ Billroth I anastomosis - subtotal gastrectomy w/ Billroth II anastomosis - Truncal vagotomy & pyloroplasty
40
Pancreatic Insufficiency: S/S
- weight loss, muscle wasting, fat loss - Steatorrhea - Gas, abdo distention, cramps - Hypoproteinemia, periph edema, ascites - weakness, fatigue - orthostatic HPTN - Anemia due to malabsorption of Vit B12 or iron - Ecchymoses due to Vit K def
41
Are pancreatic neoplasms endocrine or exocrine?
Either
42
Which is more common in pancreatic disorders, exocrine or endocrine?
Exocrine
43
What is the most common kind of exocrine pancreatic neoplasms?
Adenocarcinoma
44
Where do endocrine pancreatic neoplasms originated?
Islet cells - Glucagonoma - Insulinoma - Somatostatinoma
45
Pancreatic Adenocarcinoma: major RFs
- tobacco use - genetic predisposition & family - Hx - obesity - chronic pancreatitis - DM - Heavy etoh use
46
Pancreatic Adenocarcinoma: Male or female
male>female --> 55 to 60-80yo
47
Pancreatic Adenocarcinoma: Pathophys
48
Pancreatic Adenocarcinoma: S/S
- Pain -->Early tends to be painless --> Present in > 70% in later stages - Diarrhea - Weight loss - Jaundice - hard, fixed, tender mass - dark urine, pale stool
49
Pancreatic Adenocarcinoma: PE
- Jaundice - Palpable epigastric mass - Distended, palpable gallbladder (Courvoisier sign) - Ascites - Lymphadenopathy
50
When should you suspect pancreatic cancer?
In older adults w/ unexplained weight loss, epigastric pain, jaundice, and/or sudden onset of DM
51
Pancreatic Adenocarcinoma Imaging
- Pancreatic protocol CT - MRI is alt to CT - ERCP if additional info needed
52
What will labs show in pancreatic adenocarcinoma?
- mild anemia - amylase/lipase may be elevated, - - - may have elevated liver enzymes
53
Pancreatic adenocarcinoma: Tx
- Surgery if tumor resectable or for biopsy --> Whipple procedure - Radiation & chemo - Palliative Care
54
Which location of adenocarcinoma of the pancreas have a poor prognosis?
body or tail
55
What signs suggest adverse prognostic factors?
jaundice & lymph node involvement
56
What are pancreatic pseudocyst?
encapsulated collections of fluid w/ high enzyme concentrations that arise from the pancreas
57
Pancreatic Pseudocyst: S/S
May be symptomatic (pain) or discovered incidentally on CT - may resolve spontaneously
58
Possible reasons for pancreatic pseudocyst.
Usually a result of acute pancreatitis, alcohol abuse, or trauma
59
Pancreatic pseudocyst Tx
Some require drainage if persistent or if infected

Clin Med: GI (block 3) (8 decks)

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