Pancreatic disorders Flashcards
The pancreas is an endocrine gland producing: 3
- Insulin
- Glucagon
- somatostatin
Also functions as an exocrine gland secreting what?
It secretes approximately ____ liters of enzyme-rich fluid every day for the digestion of fats, starch, and protein.
digestive enzymes via a duct.
1.5
- Secretin- released from the duodenal mucosa in response to what?
- What does it stimulates? 2
- the presence of acid in the duodenum.
- stimulates the release of
- bicarbonate
- water.
- Cholecystokinin (CCK)- released from SI endocrine cells in response to what?
- acts directly and through vagal afferents to stimulate pancreatic acinar cells to release what?
- the entry of fats and proteins into the proximal intestine.
- digestive proenzymes.
Acute pancreatitis is an acute inflammatory process of the pancreas. Etiologies? 5
- Mechanical
- Toxic
- Trauma
- Metabolic
- Infection
Acute Pancreatitis:
- Gallstones are more common in who?
- Alcohol are more common in who?
- Gallstones more common cause in women
- Alcohol more common cause in men
If 2nd attack and not one of main 2 causes then look for the less common causes such as? 6
- hypercalcemia
- hyperlipidemias
- biliary sludge
- drugs
- cancer
- missed stone in duct,
Acute onset clinical manifestations? 5
What can this progress to? 2
- persistent, severe epigastric pain
- or RUQ pain may be steady or colicky
- N/ V
- 50% experience band like radiation of pain to back;
- some may get relief w/ bending forward or sitting up.
- Dyspnea
- Shock/Coma
Acute pancreatitis 5-10% of patients may have painless disease and have what?
Unexplained hypotension
Physical exam of acute pancreatitis? 5
- Fever, tachycardia, (hypotension if severe)
- Epigastric/RUQ tenderness
- Shallow respirations- pain with deep breaths
- Possible dyspnea if pleural effusion
- Epigastric mass if pseudocyst or tumor.
In 3% of pts, ecchymotic discoloration may be observed in the periumbilical region (Cullen’s sign) or along the flank (Grey-Turner’s sign).
- ecchymotic discoloration may be observed in the periumbilical region. What sign is this?
- Along the flank. What sign is this?
- Cullen’s sign
- Grey-Turner’s sign
Lab Tests for Acute Pancreatitis?
3
- Serum Amylase
- Serum Lipase
- C reactive protein
Serum amylase
- Rises how?
- Elevated for how many days?
Serum Lipase
- Describe sensitivity and specificity compare to amylase
- Describe its elevation and how long it lasts?
- If ____x nl think pancreatitis.
Serum amylase:
- rises quickly (6 to 12 hrs)
- elevated for 3-5 days
Serum lipase:
- sensitivity 82-100%, more specific than amylase
- elevations occur earlier and last longer
- If 3-4x nl think pancreatitis.
C reactive protein levels
- Levels at what and how long after presentation can predict a more severe course?
- So what do we use this to differentiate?
C-reactive protein:
- levels above 150 mg/dL at 48 hrs after pt presents can predict more severe course.
- Used to differentiate severe from mild disease
Imaging for Pancreatitis?
5
Abdominal plain film
CXR
US
CT scan
MRI
- What does abdominal plain film help us with on pancreatitis? 2
- What percent of pts with pancreatitis have abnormal findings on CXR?
- What are these? 3
1.
- helps to exclude other causes of abdominal pain
- may have localized ileus 2ndry to inflammation
2. CXR: 1/3 of pts w/ pancreatitis have abnormal findings:
3.
- Elevation of hemidiaphragm
- Pleural effusions
- Pulmonary infiltrates
What is the most important test for diagnosis acute pancreatitis & intraabdominal complications and assessment of severity?
CT scan
Pancreatitis
- What would the US show?