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DEMS unit 1 > Pathophysiology of the Pancreas > Flashcards

Pathophysiology of the Pancreas Flashcards

1
Q

Physiologic functionsof pancreas

A

Exocrine, Endocrine

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2
Q

Exocrine function of Pancreas

A

synthesis of enzymes for digestion, neutralizes gastric acid and chyme, secretes bicarb and water

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3
Q

endocrine action of pancreas

A

synthesisze/secrete hormones regulating glucose and lipid metabolism (insulin, glucagon)

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4
Q

Enzymes from pancrease

A

proteases, lipases, nucleases, others, amyolytic enzyme

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5
Q

in what form are enzymes secreted

A

secreted as zymogens that must be activated

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6
Q

2 mechanisms of preventing digestion of pancreas

A
  • physical separation
  • inactive form secreted
  • trypsin inhibitor can be activated
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7
Q

Acute pancreatitis

A

acute inflammation, acute abdominal pain, elevated pancreatic enzymes in serum, self-limited (if you can alieve cause)

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8
Q

Chronic pancreatitis

A

chronic inflammation and fibrosis, ductal stones and strictures, chronic pain/malabsorption, permanent loss of pancreatic function

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9
Q

Acute pancreatitis mechanism

A

Trypsinogen and other pro-enzymes are prematurely activated within pancreas – autodigestion of gland

  • leakage of enzymes around pancreas may lead to other complications
  • inflammatory cascade may result in organ failure or death when severe
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10
Q

Causes of acute pancreatitis

A

most common causes = alcohol abuse or obstruction of duct from gallstone

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11
Q

MOST COMMON CAUSE IN 2015 of acute pancreatitis

A

obstruction of duct from gallstone

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12
Q

Acute pancreatitis from alcohol

A

premature activation of zymogens, increased permeability of ductules, proteinacious plugs within pancreas duct

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13
Q

Abrupt ductal obstruction –acute pancreatitis

A
  • stone, trauma, etc

- bile reflux, retention of enzymes

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14
Q

Other etiologies of acute pancreatitis

A

iatrogenic, drug-induced, hypertriglyceridemia, hypercalcemia, pancreas cancer, pancreas divisum, penetrating trauma, other (1%–mumps, coccsackie virus)

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15
Q

Presenting features of acute pancreatitis

A

abdominal pain, nausea, vomiting, tachycardia, low grade fever, abdominal guarding, loss of bowel sounds, jaundice (if severe enough or large stone lodged)

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16
Q

Diagnosis of acute pancreatitis

A

blood test– amylase, lipase

- when >3x normal = acute pancreatitis

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17
Q

ultrasound as diagnostic tool

A

not that helpful for diagnosis – looks for causes (can see gallstones)

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18
Q

complications of acute pancreatitis

A

ileus (paralysis of gut), intra-abdom hemorrhage, pseudocyst formation

severe disease – pancreatic necrosis, bowel or BD obstruction, shock, respiratory or renal failure, death

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19
Q

Clues to diagnosis for gallstone pancreatitis (biliary)

A

risk factors for gallstones, gallstones seen on imaging elevated liver chemistries, dilated bile duct, absence of other risk factors (alcohol)

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20
Q

risk factors from gallstones

A

American Indian, Mexican-American, female, >60, pregnant, overweight, high fat diet, high cholesterol diet, fam hx

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21
Q

Pancreatic pseudocyst

A

walled off collection of fluid, debris surrounded by wall of granulation tissue

  • not true cyst – no epithelium
  • can be inside pancreas if digested pancreas tissue or outside if fat
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22
Q

why is pseudocyst not cyst

A

no epithelium

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23
Q

prognosis with necrosis

A

increased risk of infection and mortality

24
Q

Adult respiratory distress syndrome

A

response to severe pancreatitis

  • delayed onset, associated with hyperlipidemia
  • Ddx = hypoxemia, normal wedge pressure
  • potentially reversible
25
Q

management of acute pancreatitis

A
  • hospital admit
  • NPO then slow advancement on diet
  • IV narcotics for pain
  • surgery consultation if gallstones
  • consider ERCP for bile duct stone removal
  • Severe disease– feeding tube, IV nutrition, panc debridement, pseudocyst drainage, etc
26
Q

ARDS

A

Adult respiratory distress syndrome

  • delayed onset
  • associated with pancreatic necrosis
  • commonly leads to respiratory failure
  • fully reversible
  • treatmetn = support
27
Q

association of pancreatic fibrosis

A

more episodes of acute pancreatitis over time shows increased pancreatic fibrosis

28
Q

Chronic pancreatitis

A

permanent destruction of pancreatic parenchyma with replacement by fibrosis (scar tissue)

29
Q

What can result from chronic pancreatitis

A
  • may lead to ductal strictures, ductal or parenchymal calcifications (stones), or pseudocyts
  • may be associated with prior episodes of acute pancreatitis
30
Q

Chronic panc pathophys/features

A

?

31
Q

Chronic pancreatitis cuases

A

ALCOHOL, Idiopathic, Other (cystic fibrosis, hereditary pancreatitis, hyperlipidemia)

32
Q

association of fat in stool with pancreatic viability/lipase output

A

more fat in stool with decreased lipase output (pancreatic viability)

33
Q

Chromic pancreatitis clinical spectrum

A

?

34
Q

Pancreatic insufficiency symptoms

A

weight loss, steatorrhea, bleeding problems, anemia, weakness, edema, watery diarrhea

35
Q

Mechanisms of steatorrhea

A
  • decreased lipase and colipase in duodenum

- decreased duodenal pH (inactivation of pancreas enzymes, bile acid precipitation)

36
Q

Macrocytic anemia part of chronic pancreatitis spectrum

A

Macrocytic anemia part of chronic pancreatitis spectrum

37
Q

Chronic pancreatitis diagnosis

A

Hx, PE,

  • plain x-ray – calcifications in pancreas
  • CT–> dilated duct, atrophy, calcifications, pseudocysts
  • Secretin test, ERCP, or endoscopic ultrasound –> more accurate but invasive
38
Q

Secretin test

A

Don’t really do anymore

  • evaluates pancreatic function
  • put tube in duodenum and another in stomach–>secretin given IV –> bicarb increase of
39
Q

Treatment for chronic pancreatitis

A
  • ETOH avoidance!
  • pancreas enzyme replacement (pills) for steatorrhea
  • treatment of duct obstruction – dilation, stent placement, or stone removal
  • celiac nerve block for pain
  • surgical resection if refractory and severe
  • pancreatectomy with islet cell transplant (young patients, refractory disease)
40
Q

most common pancreatic cancer

A

adenocarcinoma

  • # new diagnosis ~ # deaths
  • late diagnosis and dismal survival
  • only 20% taken to OR cured
  • Median survival 18 months
  • 5 year survival = 5%
41
Q

Pancreatic cancer is the __ leading cause of cancer death in US

A

4th

42
Q

Pancreatic cancer presentation

A

jaundice, dark urine, pruritus (bile duct obstruction)

  • abdominal/back pain –> late
  • weight loss
  • nausea/vomiting (late)
  • Hormonal excess (neuroendocrine– insulin, glucagon, gastrin, VIP)
43
Q

most common location/presentation of adenocarcinoma

A

HEAD OF PANCREAS! present with jaundice

44
Q

Diagnosis of pancreatic CA

A

CT or MRI of abdomen

45
Q

Pancreatic cancer Treatment

A
  • surgical resection (select few that are diagnosed early)
  • ERCP with stent for palliation of choestasis
  • celiac nerve block for pain
46
Q

Use of endoscopic ultrasound for pancreatic cancer

A

biopsy/pre-op/definitiive staging to see if surgical resection a possibility

47
Q

Pancreatic neuroendocrine tumor

A
  • slow-growing, prognosis favorable
  • islet cell origin
  • can present with symptoms of hormone excess (insulin, glucagon, somatostatin, gastrin, VIP)
  • diagnosis/treatment same as pancreatic cancer?
48
Q

Autoimmune pancreatitis (AIP)

A
  • diffuse or focal enlargement of pancreatic parenchyma

- infiltration by IgG-4+ plasma cells and lymphocytes

49
Q

what can AIP mascquerade as

A

pancreatic cancer

present with similar symptoms (chronic abdominal pain, jaundice, weight loss, (rarely) pancreatitis

50
Q

typical population for AIP

A

males, typically ages 40-70

51
Q

what else is AIP associated with

A

other autoimmune diseases – RA, Sjogren’s, IBD, SLE

52
Q

AIP symptoms

A

ab pain, jaundice, weight loss, pancreatitis (rarely)

53
Q

AIP on imaging

A

diffuse or focal enlargement of pancreas with narrowing of CPD +/- PD

54
Q

Diagnosis of AIP

A

CT/MRI, serum IgG-4, EUS, ERCP, occasionally FNA/biopsy

55
Q

Treatment of AIP

A
  • PO corticosteroids x 6 weeks

- biliary stenting for symptom relief

DEMS unit 1 (15 decks)

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