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PANCE GI (9%) > Pancreatic Disorders > Flashcards

Pancreatic Disorders Flashcards

1
Q

acute pancreatitis pathophys

A

inappropriate activation of trypsin in pancreas = enzymatic damage to pancreas (digests itself)

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2
Q

acute pancreatitis eti

A
  • 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
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3
Q

acute pancreatitis s/s

A
  • 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
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4
Q

acute necrotizing pancreatitis

A
  • severe w/ necrosis of parenchyma and vessels
  • Gray-Turner’s sign (flank)
  • Cullen’s sign (umbilical)
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5
Q

acute pancreatitis ddx

A

acute cholecystitis/cholangitis, penetrating duodenal ulcer, ischemic colitis, SBO, AAA, nephrolithiasis, pancreatic pseudocyst

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6
Q

acute pancreatitis WU

A
  • 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
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7
Q

acute pancreatitis mgmt

A
  • 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
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8
Q

complications of acute pancreatitis

A

inflammatory cascade = ARDS, sepsis, renal failure, pancreatic necrosis/abscess/pseudocyst

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9
Q

Chronic pancreatitis eti

A
  • irreversible fibrosis
  • EtOH
  • obstruction
  • malnutrition
  • autoimmune
  • hereditary
  • idiopathic
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10
Q

chronic pancreatitis S/S

A
  • recurrent episodes of epigastric & LUQ pain
  • steatorrhea
  • fat soluble vit def (A, D, E, K)
  • DM
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11
Q

chronic pancreatitis WU

A
  • 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)
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12
Q

chronic pancreatitis mgmt

A
  • no EtOH
  • pancreatic enzyme replacement + PPI + low fat diet
  • insulin
  • surgical options if refractory (decompression, resection, denervation)
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13
Q

B9 pancreatic neoplasms

A
  • 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)
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14
Q

Malignant pancreatic neoplasm resection

A

-Whipple (pancreaticoduodenectomy)

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15
Q

Malignant pancreatic neoplasms

A
  • ductal adenocarcinoma
  • acinar cell carcinoma (functional exocrin cell of panc)
  • pancreatoblastoma
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16
Q

Ductal adenocarcinoma eti

A
  • 95% of panc mals
  • 70-80 y.o.
  • MC in head
17
Q

Ductal adenocarcinoma RF

A

cigs, EtOH, chronic panc, exp to dyes, T2DM in nonobese > 50 y.o. person, h/o partial gastrectomy or cholecystectomy, genetic (BRCA2)

18
Q

ductal adenocarcinoma S/S

A

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)

19
Q

ductal adenocarcinoma WU

A
  • 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
20
Q

ductal adenocarcinoma mgmt

A
  • serial CA 19-9
  • surg resect + rad (if no invasion/lymph/mets)
  • locally adv: rad only
  • if mets: chemo, pain control, palliative stents
21
Q

ductal adenocarcinoma prog

A
  • 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

PANCE GI (9%) (12 decks)

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