pancreatitis Flashcards
pancreas
Oblong, glandular GI accessory organ measuring ~6 inches
Performs exocrine and endocrine functions
Head
Widest part of the pancreas
Found nestled in the curve of the duodenum
Divided into:
Head proper
Uncinate process
Neck
Thin section of the gland between the head and the body of the pancreas
Body
Middle part of the pancreas between the neck and the tail
Superior mesenteric artery and vein run behind this region
Tail
Thin tip of the pancreas in the left side of the abdomen, in close proximity to the hilum of the spleen
Acinar cells
exocrine
Cells in clusters located at the terminal ends of pancreatic ducts
Secrete enzyme-rich pancreatic juice into ducts
Major pancreatic ducts:
Pancreatic duct joins the common bile duct just before duodenum (ampulla of Vater)
Accessory duct (duct of Santorini) runs from the pancreas directly into the duodenum superior to the pancreatic duct
Islets of Langerhans (endocrine)
Small islands of cells scattered throughout the pancreas that produce pancreatic polypeptide, insulin, glucagon, and somatostatin
Pancreatitis
general
Inflammation of the pancreas and on occasion, adjacent tissues
Increasing incidence in the United States since 1990
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Acute or chronic presentation
Multiple etiologies
Can be life-threatening
pancreatitis
etiology
Gallstones (40%)
Heavy alcohol consumption (30%)
Idiopathic (10-15%)
Surgical procedures of the abdomen
Endoscopic retrograde cholangiopancreatography (ERCP) in ~5% of patients – mechanical obstruction
Hypertriglyceridemia
Causes plasma viscosity which may induce ischemia in the pancreatic tissue
Medication-induced
Autoimmune pancreatitis
Infections
pancreas
Normal function of digestive enzymes
Pancreatic digestive enzymes are released by the acini cells in an inactive form (zymogen) and travel to the duodenum → activated by trypsin
Pancreatitis
patho
Pancreatic enzymes accumulate within the injured acini cells
Intra-acinar activation lead to autodigestive injury of the pancreas itself
Injury leads to activation of the complement system and the inflammatory cascade (cytokines)
Inflammation and edema of the pancreas → necrosis → death
Acute pancreatitis
mild
Inflammation confined to the pancreas and its close vicinity
No organ failure
No local or systemic complications
acute pancreatitis
moderate
Moderate
Local or systemic complications
No organ failure or only transient organ failure (resolves within 48 hours)
acute pancreatitis
severe
One or more local complications
Persistent single or multiorgan failure (>48 hours)
Mortality rate of >30%
pancreatitis
Risk Factors for Severe Disease Course
Initial assessment:
Age ≥60 years
Comorbid health problems
Obesity with BMI >30
Long-term, heavy alcohol use
Presence of systemic inflammatory response syndrome (SIRS)
Elevated BUN- number 1 indicator of high mortality
Altered mental status
pancreatitis
S/Sx
Upper abdomen/epigastric
Severe, steady, boring pain
Radiation through to the back (50%)
Onset:
Sudden → gallstone pancreatitis
Develops over days → alcoholic pancreatitis
↑ pain with coughing, vigorous movements, or deep breathing
Diminished bowl sounds
Nausea and vomiting
Fever 38.4-39°C
Jaundice
Tachycardia
Hypotensive
pancreatitis
PE findings
Patient are ill-appearing; sometimes anxious
Sitting up and/or lean forward to help reduce pain
Scleral icterus/jaundice →choledocholithiasis
Xanthomas→hypertriglyceridemia
Abdomen
Abdominal distension and absent bowel sounds with an associated ileus
Upper abdominal tenderness to palpation
Guarding, rigidity, and rebound tenderness
Hepatomegaly → alcoholic pancreatitis
Palpable mass
Inflamed pancreas
Pseudocyst: collection of leaked pancreatic fluids that forms next to the pancreas