Pancreatic Disorders Flashcards
acute pancreatitis pathophys
inappropriate activation of trypsin in pancreas = enzymatic damage to pancreas (digests itself)
acute pancreatitis eti
- gallstones = MC
- EtOH
- obstruction
- meds (diuretics, sulfas, ACEIs, HIV meds)
- infection (mumps, rubella, coxsackie, EBV, HIV)
- metabolic (high TGs, hyperCa)
- toxins (methanol, ethanol)
- vasular (vasculitis, ischemia)
- abd trauma
- post ERCP
acute pancreatitis s/s
- constant epigastric pain w/ rad to back
- N/V
- tachycardia from hypovolemia (leaky vessels, 3rd spacing)
- F / sepsis
- Icterus / jaundice if biliary obstruction
- abd pain w/ rigidity & guarding
acute necrotizing pancreatitis
- severe w/ necrosis of parenchyma and vessels
- Gray-Turner’s sign (flank)
- Cullen’s sign (umbilical)
acute pancreatitis ddx
acute cholecystitis/cholangitis, penetrating duodenal ulcer, ischemic colitis, SBO, AAA, nephrolithiasis, pancreatic pseudocyst
acute pancreatitis WU
- lipase: more specific, can be high in renal failure, stays high x 3 days
- amylase: can be inc in appy, cholecystitis, perf, ectopic, renal failure; high x 24 hrs
- amylase/lipase #s DON’T correlate to sev of dz!!!
- elevated BUN & HCT w/ vol depletion
- US (lg, hypoechoic pancreas)
- CT (pancreatic enlargement & peripancreatic edema) = IMG OF CHOICE
- MRCP or ERCP
acute pancreatitis mgmt
- mild: NPO, IVF, fix lytes, pain control (resolves in 3-7d)
- severe: ICU, NGT, w/ feeds
- acute necrotizin pancreatitis: imipenem
- gallstone pancreatitis: sphincterotomy if cholangitis, or lap chole s/p recovery
complications of acute pancreatitis
inflammatory cascade = ARDS, sepsis, renal failure, pancreatic necrosis/abscess/pseudocyst
Chronic pancreatitis eti
- irreversible fibrosis
- EtOH
- obstruction
- malnutrition
- autoimmune
- hereditary
- idiopathic
chronic pancreatitis S/S
- recurrent episodes of epigastric & LUQ pain
- steatorrhea
- fat soluble vit def (A, D, E, K)
- DM
chronic pancreatitis WU
- amylase/lipase not elevated b/c pancreatic burnout
- secretin stimulation test (see if panc still works)
- abd XR (calcifications)
- CT (calcifications, atrophy)
- ERCP (“chain of lakes” = areas of dilation & stenosis along pancreatic duct)
chronic pancreatitis mgmt
- no EtOH
- pancreatic enzyme replacement + PPI + low fat diet
- insulin
- surgical options if refractory (decompression, resection, denervation)
B9 pancreatic neoplasms
- asx, incidental
- eval w/ MRI, endoscopic US w/ FNA
- Serous cystadenoma (MC, low mal potential, no resect)
- Mucinous cystadenoma (mod mal potential)
- Intraductal papillary mucinous neoplasm (high mal potential if in main duct)
- solid pseudopapillary neoplasm (low/mod mal pot, resect)
Malignant pancreatic neoplasm resection
-Whipple (pancreaticoduodenectomy)
Malignant pancreatic neoplasms
- ductal adenocarcinoma
- acinar cell carcinoma (functional exocrin cell of panc)
- pancreatoblastoma
Ductal adenocarcinoma eti
- 95% of panc mals
- 70-80 y.o.
- MC in head
Ductal adenocarcinoma RF
cigs, EtOH, chronic panc, exp to dyes, T2DM in nonobese > 50 y.o. person, h/o partial gastrectomy or cholecystectomy, genetic (BRCA2)
ductal adenocarcinoma S/S
pain, steatorrhea, wt loss, jaundice, Courvoisier’s sign (palpable gallbladder from comp of bile duct), Trousseau’s sign (hypercoag state from malignancy = migratory thrombophlebitis throughout body)
ductal adenocarcinoma WU
- ALP, bili
- initial img = RUQ US and ERCP
- CT (“double duct sign” = dilation of common bile & main pancreatic ducts)
- endoscopic US if other imgs not convincing
- confirmatory dx via histology
ductal adenocarcinoma mgmt
- serial CA 19-9
- surg resect + rad (if no invasion/lymph/mets)
- locally adv: rad only
- if mets: chemo, pain control, palliative stents
ductal adenocarcinoma prog
- 50% of all panc CA are mets by dx = 3-6 mos life exp
- resectable dz: < 1.5 yrs
- locally adv dz: 6-10 mos
