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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
Q

Rare causes of chronic pancreatitis

A
  • Hereditary
  • Hypertriglyceridemia
  • Hyperparathyroidism
26
Q

Chronic Pancreatitis: S/S

A
  • Persistent or recurrent episodes of epigastric & LUQ pain
  • Anorexia, N/V, constipation, flatulence, & weight loss
  • Steatorrhea in later stages
27
Q

Describe Chronic pancreatitis “attacks”

A

can last 2 wks & pain is continuous

28
Q

Chronic Pancreatitis: PE

A
  • Tenderness over the pancreas
  • Guarding may be present
29
Q

Chronic Pancreatitis: Dx

A
  • 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
Q

Do normal serum values of amylase & lipase exclude the dx of chronic pancreatitis?

A

NO

31
Q

Chronic Pancreatitis Tx: Lifestyle

A

Diet
- eat high PRO, nutrient-densedietsthat include fruits, veggies, whole grains, low fat dairy, & other lean PRO sources
- avoid smoking & alcohol use

32
Q

Chronic Pancreatitis Tx: Meds

A
  • Analgesics (avoid NSAIDS)
  • Pancreatic enzyme replacement therapy
  • Pts w/ for autoimmune pancreatitis: corticosteroids
33
Q

When is pancreatic enzyme replacement therapy indicated?

A
  • If exocrine pancreatic insufficiency & clinical symptoms or laboratory signs of maldigestion
  • Lipase given by mouth
34
Q

Describe pancreatic exocrine insufficiency

A

A syndrome of maldigestion resulting from disorders interfering w/ effective pancreatic enzyme activity

35
Q

Pancreatic Insufficiency - Primary Causes: Acquired decr enzyme secretion

A
  • Chronic pancreatitis
  • Pancreatic, ampullary, & duodenal neoplasms
  • Pancreatic resection
  • Severe PRO-calorie malnutrition, hypoalbuminemia
36
Q

Pancreatic Insufficiency - Primary Causes: Congenital decr enzyme secretion

A
  • cystic fibrosis
  • Hemochromatosis
  • Shwachman-Diamond syndrome
    Enzyme deficiencies
37
Q

What is Shwachman-Diamond syndrome?

A

Pancreatic insufficiency w/ anemia, neutropenia, & bony abnormalities

38
Q

Pancreatic Insufficiency - 2ndary Causes:

A

A. Intraluminal enzyme destruction
B. Decr pancreatic stimulation
C. Mistiming of enzyme secretion: gastric surg

39
Q

What gastric surgs can cause pancreatic insufficiency?

A
  • subtotal gastrectomy w/ Billroth I anastomosis
  • subtotal gastrectomy w/ Billroth II anastomosis
  • Truncal vagotomy & pyloroplasty
40
Q

Pancreatic Insufficiency: S/S

A
  • 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
Q

Are pancreatic neoplasms endocrine or exocrine?

A

Either

42
Q

Which is more common in pancreatic disorders, exocrine or endocrine?

A

Exocrine

43
Q

What is the most common kind of exocrine pancreatic neoplasms?

A

Adenocarcinoma

44
Q

Where do endocrine pancreatic neoplasms originated?

A

Islet cells
- Glucagonoma
- Insulinoma
- Somatostatinoma

45
Q

Pancreatic Adenocarcinoma: major RFs

A
  • tobacco use
  • genetic predisposition & family - Hx
  • obesity
  • chronic pancreatitis
  • DM
  • Heavy etoh use
46
Q

Pancreatic Adenocarcinoma: Male or female

A

male>female
–> 55 to 60-80yo

47
Q

Pancreatic Adenocarcinoma: Pathophys

A
48
Q

Pancreatic Adenocarcinoma: S/S

A
  • 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
Q

Pancreatic Adenocarcinoma: PE

A
  • Jaundice
  • Palpable epigastric mass
  • Distended, palpable gallbladder (Courvoisier sign)
  • Ascites
  • Lymphadenopathy
50
Q

When should you suspect pancreatic cancer?

A

In older adults w/ unexplained weight loss, epigastric pain, jaundice, and/or sudden onset of DM

51
Q

Pancreatic Adenocarcinoma Imaging

A
  • Pancreatic protocol CT
  • MRI is alt to CT
  • ERCP if additional info needed
52
Q

What will labs show in pancreatic adenocarcinoma?

A
  • mild anemia
  • amylase/lipase may be elevated, - - - may have elevated liver enzymes
53
Q

Pancreatic adenocarcinoma: Tx

A
  • Surgery if tumor resectable or for biopsy
    –> Whipple procedure
  • Radiation & chemo
  • Palliative Care
54
Q

Which location of adenocarcinoma of the pancreas have a poor prognosis?

A

body or tail

55
Q

What signs suggest adverse prognostic factors?

A

jaundice & lymph node involvement

56
Q

What are pancreatic pseudocyst?

A

encapsulated collections of fluid w/ high enzyme concentrations that arise from the pancreas

57
Q

Pancreatic Pseudocyst: S/S

A

May be symptomatic (pain) or discovered incidentally on CT

  • may resolve spontaneously
58
Q

Possible reasons for pancreatic pseudocyst.

A

Usually a result of acute pancreatitis, alcohol abuse, or trauma

59
Q

Pancreatic pseudocyst Tx

A

Some require drainage if persistent or if infected

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

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