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GI > Pancreatic Disorders > Flashcards

Pancreatic Disorders Flashcards

1
Q

What are the 3 endocrine hormones that are released by the pancreas?

A

Insulin
Glucagon
Somatostatin

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2
Q

Which cells release the digestive enzymes?

A

Acinar cells

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3
Q

Are the digestive enzymes released by the pancreas active or inactive?

A

Inactive

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4
Q

How much enzyme-rich fluid is released every day from the pancreas?

A

1.5 liters

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5
Q

What hormones are released to control pancreatic secretion?

A

Secretin

Cholecystokinin (CCK)

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6
Q

Secretin

A

Released by S-cells

Stimulates the release of bicarbonate & water

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7
Q

Cholecystokinin (CCK)

A

Released by SI cells

Stimulates acing cells to release digestive proenzymes

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8
Q

Define Acute Pancreatitis

A

Acute inflammatory process of the pancrease

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9
Q

Etiologies of Acute Pancreatitis

A 
Mechanical: gallstones, stenosis
Toxic: alcohol, scorpion bites
Trauma: blunt, surgery
Metabolic: hyperlipidemia, hypercalcium
Infection: Hep B, HIV
Misc: pregnancy, renal failure, genetic mutations, transplant
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10
Q

What is the most common cause of acute pancreatitis in women?

A

Gallstones

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11
Q

What is the most common cause of acute pancreatitis in men?

A

Alcohol

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12
Q

Classifications of Acute Pancreatitis

A

Mild: absence of organ failure
Moderately severe: transit organ failure, resolves in 48 hours
Severe: persistent organ failure, evolve to multiple organ failure

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13
Q

Clinical Manifestations of Acute Pancreatitis

A 
Persistent, severe epigastric pain
RUQ pain
N/V
Band like radiation of pain to back
Dyspnea: diaphragm becomes inflamed
Shock/Coma: loss of fluid surrounding pancreas
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14
Q

PE Findings of Acute Pancreatitis

A 
Fever, tachycardia
Epigastric/RUQ tenderness
Shallow respirations
Dyspnea
Epigastric mass
Cullen's sign
Grey-Turner's sign
Hypoactive
Jaundice
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15
Q

Lab Tests for Acute Pancreatitis

A

Amylase: rises quickly, elevated 3-5 days
Lipase: more specific, elevations occur earlier & last longer
C-RP: use to differentiate severe from mild disease

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16
Q

Imaging for Acute Pancreatitis

A

Abdominal plain film
CXR: pleural effusions, pulmonary infiltrates, basal atelectasis, elevation of hemidiaphragm
US: hypoechoic pancreas
C: need oral/IV contrast
MRI: higher sensitivity, lack of nephrotoxicity, detect fluid, necrosis, hemorrhage, & pseudocyst

17
Q

Treatment of Pancreatitis

A 
Admit
NPO
IV hydration
UO >30 ml/hr
Pain control: meperidine
Nausea control
\+/- antibiotics, surgery
Labs: CBC lipase, amylase, CMP, bilirubin, C-RP in 48 hours
18
Q

Treatment of Severe Pancreatitis

A 
Complications with pulmonary, renal, circulatory, & hepatobiliary dysfunction
ICU monitoring
Supplemental O2
Prevent infection
TPN
19
Q

Risk Factors for Acute Pancreatitis Disease Severity

A 
Age >55 years
Obesity: BMI >30
Organ failure at admission
Pleural effusion
Elevated C-RP
20
Q

Define Chronic Pancreatitis

A

Progressive inflammatory changes result in permanent structural damage to the pancreas, leading to impairment of exocrine & endocrine function

21
Q

Etiologies of Chronic Pancreatitis

A 
Alcohol abuse
Genetic: CF, hereditary
Ductal obstruction: trauma, pseudocysts, stones, tumors
Systemic: SLE, hypertriglyceridemia
Idiopathic
22
Q

Features of Chronic Pancreatitis

A

Aymptomatic over long periods of time
Fibrotic mass in abdomen
Serum amylase & lipase is normal

23
Q

Clinical Manifestations of Chronic Pancreatitis

A

Chronic abdominal pain
Pancreatic insufficiency
Fat malabsorption
Pancreatic DM

24
Q

Diagnostics for Chronic Pancreatitis

A 
Labs: amylase & lipase normal
Steatorrhea
Imaging: Calcifications
CT/MRI/US
ERCP: duct changes
25
Q

Treatment of Chronic Pancreatitis

A

Establish Dx
Pain management
Control N/V
Diet: no smoking or alcohol, low fat diet
Surgery: fail medical therapy, pain relief

26
Q

Risk Factors for Pancreatic Cancer

A

Chronic pancreatitis
Smoking
Obesity
Male gender

27
Q

Clinical Features of Pancreatic Cancer

A

+/- pain
Weight loss
Jaundice
Steatorrhea

28
Q

PE Findings of Pancreatic Cancer

A

Abdominal mass
Ascites
L. supraclavicular node (Virchow’s node)
Palpable periumbilical mass (Sister Mary Joseph’s node)

29
Q

Work-up of Pancreatic Cancer

A

Imaging: US/CT
Labs: LFT’s
Serum tumor marker: CA 19-9
Biopsy: FNA, ERCP, Surgery

30
Q

Treatment of Pancreatic Cancer

A 
Surgery (resection or palliative)
\+/- radiation
\+/- chemotherapy
Pain control
Pancreatic enzyme replacement
31
Q

Prognosis of Pancreatic Cancer Stage I, II

A

Resectable disease
Median survival rate: 15-20 months
5 year survival: 20%

32
Q

Prognosis of Pancreatic Cancer Stage III

A

Unresectable

Chemo +/- radiation

33
Q

Prognosis of Pancreatic Cancer Stage IV

A

Survival of 3-6 months

GI (20 decks)

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