Pathophysiology of the exocrine pancreas Flashcards
function of the exocrine pancreas
synthesis of digestive enzymes, neutralize gastric acid and chyme
duodenal pH of 1-2 stimulates…
secretin increase –> pancreatic bicarb secretion
presence of fatty acids/ amino acids stimulates
CCK –> bile acid release, pancreatic enzyme secretion
acute inflammation, acute abd pain, nausea/vomiting, tachycardia, elevated pancreatic enzymes in serum
self-limited
acute pancreatitis
chronic inflammation/fibrosis, ductal obstruction, chronic pain/malabsorption, permanent loss of pancreatic function
chronic pancreatitis
pathophysiology of acute pancreatitis
trypsinogen and other proeznzymes are prematurely activated in the pancrease –> autodigestion
can result in organ failure or death if severe/systemic
most common causes of acute pancreatitis
alcohol abuse, obstruction of duct from gallstone
number 1 cause of acute pancreatitis in america
gallstone (biliary) pancreatitis
clues to dx of gallstone pancreatitis
risk factors for gallstones, gallstones seen on imaging, elevated liver chemistries, dilated bile duct, absence of other risk factors
Complications of acute pancreatitis
ileus (paralysis of gut), intra-abdominal hemorrhage, pseudocyst formation
severe –> pancreatic necrosis, bowel/BD obstrction, shock, respiratory/renal failure, death
collection of pancreatic fluid, debris surrounded by wall of granulation tissue (lacks epithelial lining)
pancreatic pseudocyst
infection less than 1%, mortality less than 1%
interstitial acute pancreatitis
infection 30-50%, mortality 10-30%
necrotizing acute pancreatitis
occurs in severe pancreatitis, delayed onset, associated with hyperlipidemia, hypoxemia, normal wedge pressure
adult respiratory distress syndrome
management of acute pancreatitis
admit to hospital, NPO then slowly advance to diet, IV narcs for pain, surgery consult if gallstones
severe = feeding tube, IV nutrition, pancreatic debridement, pseudocyst drainage
causes of chronic pancreatitis
alcoholic»_space; cystic fibrosis, hereditary pancreatitis, hyperlipidemia, idiopathic
symptoms of chronic pancreatitis
chronic epigastric pain radiating to the back (worse after meals), steatorrhea (oily stools, large volume, light colored, foul smelling [as opposed to pleasant], hypo/hyperglycemia (loss of islets)
diagnosis of chronic pancreatitis
plain xray (calcifications in pancreas), CT (dilated duct, atrophy, calcifications, pseudocysts), secretin test, ERCP (endoscopic retrograde cholangiopancreatography), endoscopic ultrasound
secretin test
IV secretin, HCO3 increase less than 80 = pancreatic obstruction or failure
treatment of chronic pancreatitis
EtOH avoidance, enzyme replacement for steatorrhea, dilation/stent/stone removal for duct obstruction, celiac nerve block for pain
4th leading cause of cancer death in US, adenocarcinoma most common
pancreatic cancer
pancreatic cancer survival
18mo; 5 year survival = 5%
jaundice, dark urine, pruritus, abd/back pain, weight loss, nausea/vomiting, hormonal excess
pancreatic cancer
slow-growing, favorable prognosis, originates in the islet cells, sx of hormone excess (insulin, glucagon, somatostatin, gastrin, VIP)
pancreatic neurendocrine tumor (NET)
enlargement of pancreatic parenchyma, abd pain, jaundice, weight loss, infiltration by IgG-4+ plasma cells and lymphs
males 40-70y
autoimmune pancreatitis
associations of autoimmune pancreatitis
RA, Sjogrens, IBD, SLE
treatment of autoimmune pancreatitis
PO corticosteroids x 6w; biliary stenting for symptom relief
