Pathophysiology of exocrine pancreas Flashcards
the pancrease responds to what 2 molecules?
secretin -> stimulates bicarb sectrion
cholecystokinin -> pancreatic enzymes
describe zymogen activation
zymogens are secreted into duodenum from pancreas -> trypsinogen is converted to trypsin by brush border enzyme enterokinase -> trypsin proteolytically cleaves zymogens, converting them to their active forms.
classify acute pancreatitis
Acute inflammation
Acute abdominal pain
Elevated pancreatic enzymes in serum
Self-limited
classify chronic pancreatitis
Chronic inflammation
Chronic pain or malabsorption
Fibrosis and ductal obstruction
Permanent loss of pancreatic function
how does alcohol cause acute pancreatitis
Causes Premature release and activation of zymogens.
Causes Proteinacious plugs within pancreas duct
what is the #1 cause of acute pancreatitis in America
Gallstone (biliary) pancreatitis
what are Clues to diagnosis of gallstone (biliary) pancreatitis)
1) Risk factors for gallstones (age, female,
hypercholestremia)
2) Gallstones seen on imaging (in gallbladder or bile duct)
3) Elevated liver chemistries
4) Dilated bile duct
5) Absence of other risk factors
what are complications of acute pancreatitis
Ileus (paralysis of gut)
Intra-abdom hemorrhage
Pseudocyst formation
what is a pancreatic pseudocyst
Collection of pancreatic fluid, debris surrounded by wall of granulation tissue - lacks epithelial lining
pancreatic pseudocyst can result from _______
ductal disruption, necrosis, or both
what syndrome is Associated with pancreatic necrosis
Adult respiratory distress syndrome (ARDS)
describe acute pancreatitis managment
Admit to hospital (usually)
Aggressive IV fluids
NPO, slow advancement in diet p 2-3 days
Intravenous narcotics for pain
Surgery consultation if gallstones present
Consider ERCP for bile duct stone removal
what is the management for severe acute pancreatitis
feeding tube, IV nutrition (TPN), surgical or endoscopic necrosectomy, pseudocyst drainage, etc
what is the defining characteristic in chronic pancreatitis
Permanent destruction of pancreatic parenchyma with replacement by fibrosis (scar tissue)
what are the causes of chronic pancreatitis
Alcohol (60-70%)
Idiopathic (20%)
other (20%)
cystic fibrosis
hereditary pancreatitis
hyperlipidemiaDescribe the clinical presentation of Chronic pancreatitis
1)Abdominal pain
Chronic epigastric pain, radiates to back
Worse after meals
2)Steatorrhea
Oily stools
Large-volume, light- colored, foul-smelling
Gas, bloating
3)hypo- or hyperglycemia
Brittle diabetes from loss of islets
what are the 2 mechanisms for steatorrhea
Decreased lipase and colipase in duodenum
Decreased duodenal pH
Inactivation of pancreas enzymes
Bile acid precipitation
in Chronic pancreatitis what can be seen on plain x-ray and CT?
Plain x-ray → calcifications in pancreas
CT → dilated duct, atrophy, calcifications, pseudocysts
what is considered a positive secretin test
Secretin 0.2mcg given IV, if Duodenal [HCO3] increase of less than 80 mEq/l suggests pancreatic obstruction or failure
Pancreatic neurendocrine tumor (NET) are _____ growing, the Prognosis is ________ and are of ____
cell origin
slow,
favorable,
Islet
what is autoimmune pancreatitis?
Diffuse or focal enlargement of pancreatic parenchyma,
Infiltration of pancreas/ampulla by IgG-4 + plasma cells and lymphocytes
what population typically gets autoimmune pancreatitis
Males, typically ages 50-70
what other autoimmune diseases is autoimmune pancreatitis associated with?
RA, Sjogren’s, IBD, SLE
what symptoms can be seen in autoimmune pancreatitis
abdominal pain,
jaundice,
weight loss,
(rarely) acute pancreatitis
What tests can diagnose autoimmune pancreatitis
CT/MRI,
serum IgG-4,
EUS,
ERCP
what is the treatment for Autoimmune pacreatitis
PO corticosteroids x 6 weeks
Biliary stenting for symptom relief
