Pancreatits Flashcards
Acute patho
Release of lipase (active)
Disruption allows for
Trypsin activation
acinar inury
release pancreatic enzymes, triggering release of chemo/cytokines
fat necrosis, inflammation
mixing of proenzymes/lysosomal hydrolases- activates other pancreatic enzymes
activates prekalikrein- clot/complement
5 alterations
mild vs severe
Microvascular leak/edema Fat necrosis Acute inflammation Dest pancreatic parenchyma Dest BV/hemorrhage
Processes that trigger inflammation
MC etiology
2nd mc etiology
Pancreatic duct obstruction
Direct acinar injury
defective intracellular transport
Cholelithiasis- edema, dec blood flow, disrupts acinar cells
Alcohol- all 3 pathways
contracts sphincter of Oddi- concretions
toxic to acinar cells
activates panc enzymes
Hereditary pancreatitis genes
CF pt
CFTR dec bicarb, resulting in
PRSS1 (trypsin) GOF- resists inactivation
SPINK1- inhibits trypsin, LOF inc activity
inc risk of pancreatitis
concretions, duct obstruction
Chronic pancreatitis
Cytokines induce myofibroblasts
repeated/prolonged inflmmation, irreversible destruction
deposit collagen/fibrosis
CM
Physical exam
RF for severe panc
Clinical signs
ab pain- epigastric to back
NV- worse with eating
systemic symptoms later
Epigastric tenderness, guarding
Older, obesity, comorbids
persistent shock, AKI, DIC, PE, impaired mental stats
Dx
More reliable
severe pancreatitis indicates
serum amylase and lipase (3x ULN)
lipase
ab CT scanning
Mx
Initial
More severe
supportive- IV fluid and pain control (opiods)
Resume oral diet in 1 wk
low fat diet
enteral nutrition- low fat, high protein
Severe complication
Necrotizing can be
Pancreatic pseudocyst
peripancreatic fluid
infected with gut bacteria (gram -/anaerobes)
Well defined wall- no intervention unless pain/obstruction (drainage)
Autoimmune panc
mediated by
Look for
leads to chronic but no acute panc
IgG4- lymphoplasmacytic response, fibrosis
IgG4 elevation
MCc of chronic panc
Sx
alcohol abuse
ab pain, chronic diarrhea, wl
steathorrhea
Dx of chronic panc
Prominent diarrhea
Look for ____ on imaging
labs not elevated
measure fecal fat
>10g day is steatorrhea
Calcification
Mx chronic panc
supplement with
Analgesia
cessation of alcohol/smoking
eat smaller meals
panc enzymes
NSAIDS, tricyclic AD, opiods
Comp of chronic
structural changes result in
Impaired exo/endo function
malabsorption, DM
pseudocyst formation/obstruc BD/ascites
