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Digestive system disorders > S2 MTA - Pancreatitis > Flashcards

S2 MTA - Pancreatitis Flashcards

1
Q

Sudden inflammation and hemorrhaging due to its destruction by its own digestive enzymes “autodigestion”

A

Acute pancreatitis

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1
Q

Functional division of the pancreas

A
  • Endocrine (10%) with alfa cells for glucagon and beta cells for insulin
  • Exocrine (90%) with acing cells that secrete digestive enzymes to digest macromolecules
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2
Q

Normal physiology of the pancreatic exocrine system

A
  • 1) duodenum releases enteropeptidase/ enterokinase
  • 2) enteropeptidase activates trypsinogen to tripsin (and so on)
    -3) activation of pancreatic zymogens
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3
Q

What happens to the zymogens in acute pancreatitis

A

Zymogens get activated early due to injury to acinar cells or impaired secretion of zymogens

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4
Q

Most common cause of acute pancreatitis

A
  • Alcohol abuse
  • Gallstones
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5
Q

How does alcohol contribute to acute pancreatitis

A
  • 1) alcohol causes an increase in zymogen secretions
  • 2) Decrease fluid and bicarbonate in ducts
  • 3) THICK PANCREATIC JUICE
  • a) blocks the ducts
  • b) increase of pressure that distends ducts
  • c) CHAOTIC MEMBRANE TRAFFIKING
  • d) zymogen granules come into contact with lysosomes
  • 4) activation of zymogens
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6
Q

How do gallstones contribute to acute pancreatitis

A
  • 1) gallstones cause a blockage @ Oddi sphincter
  • 2) blocks release of pancreatic juices
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7
Q

Other causes of acute pancreatitis

A
  • Idiopathic
  • Gallstones (40%)
  • Ethanol abuse
  • Trauma
  • Steroids
  • Mumps virus
  • Autoimmune disease
  • Scorpion stings
  • Hypertriglyceridemia and hypercalcemia
  • ERCP
  • Drugs
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8
Q

What drugs can cause pancreatitis

A
  • Steroids
  • Protease inhibitors
  • NRTIs
  • Anticonnvulsants
  • Metronidazole
  • Diuretics
  • Estrogen
  • Sulfonamides
  • Azathiprine
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9
Q

Characteristics of acute respiratory distress syndrome

A
  • Massive inflammation
  • Leaky vessels
  • Difficulty breathing
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10
Q

Characteristics of acute pancreatitis

A
  • Pancreatic tissue destruction (protease and inflammatory response)
  • Blood vessels leak (rupture and swell)
  • Lipases can destroy pancreatic fat (liquefy tissue)
  • LIQUEFACTIVE HEMORRAGIC NECROSIS
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11
Q

Whats the diagnosis for acute pancreatitis

A
  • Pain @ epigastric region that radiates to the back
  • High amylase and lipase (mostly lipase)
  • CT scan to show inflammation, necrosis and pseudocyst
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12
Q

Treatment for acute pancreatitis

A
  • Pain management with opioids (meperidine 25 to 50 mg)
  • Hydration
  • Electrolytes
  • Rest the bowels? if the patient can tolerate oral food GIVE IT TO THEM
  • Oxygen and antibiotics (infection of gallbladder)
  • Antiemetics
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13
Q

Complications of acute pancreatitis

A
  • Pancreatic pseudocyst
  • Infected pancreatic pseudocyst by E. coli
  • Hemorrhage from damaged blood vessels
  • Systemic activation of coagulation factors
  • Blood clots
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14
Q

Whats a pancreatic pseudocyst and all of those things involved

A
  • Fibrous tissue surrounding the LIQUEFACTIVE NECROTIC tissue; filled with pancreatic juice
  • Abdominal pain, loss of appetite and palpable mass
  • Labs: high ass amylase and lipase, also bilirubin
  • Pseudocyst may rupture and release enzymes that leads to massive inflammation
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15
Q

Infected pancreatic pseudocyst signs and symptoms

A

Abscess + high fever and WBC

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16
Q

A hemorrhage from a damaged blood vessel can lead to

A

Hypovolemic shock

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17
Q

Persistent inflammation and repeated bouts of acute pancreatitis may lead to…

A

Chronic pancreatitis

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18
Q

What causes chronic pancreatitis

A

Changes to the structure: fibrosis, atrophy and calcification (IRREVERSIBLE DAMAGE)

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19
Q

The prolonged inflammation of the pancreas may lead to activation of

A
  • Fibrogenic cytokines
  • Transforming factor beta
  • Platelet derived growth factor
  • Myofibroblasts
  • Collagen production
  • Fibrosis
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20
Q

The constant tissue replacement in chronic pancreatitis leads to

A
  • Misshaped ducts
  • Fibrosis
  • Calcium deposits (by alcohol)
  • Acinar atrophy
21
Q

Causes of chronic pancreatitis

A
  • T: toxins, tumors and trauma
  • I: idiopathic
  • G: genetic (cystic fibrosis)
  • A: autoimmune (IgG related)
  • R: recurrent acute pancreatitis
  • O: obstruction (gallstones or a pancreatic head tumor)
22
Q

Common complications of chronic pancreatitis

A
  • Pancreatic pseudocyst
  • Ascitis
  • Pancreatic insufficiency
  • Diabetes mellitus due to damage of alfa and beta cells
  • ADEK vitamin deficiency
  • Pancreatic cancer
23
Q

Treatment for chronic pancreatitis

A
  • Medications: for pain management and pancreatic enzyme intake
  • Diet modifications: alcohol cessation and a low fat diet
  • Surgery: resectional/ drainage of the pseudocyst, fistula or ascites
24
Q

The treatment for chronic pancreatitis is mainly…

A

Paleative care, low-key just managing the pain and keeping them confortable

25
Q

A CT scan on a patient with chronic pancreatitis may show

A
  • Dialation of the ducts
  • Calcification
  • Atrophy
  • Pseudocyst
26
Q

When doing and ultrasound on a patient with chronic pancreatitis you can only see the hyperechogenecity of the pancreas

A

False, you can also see: pseudocyst, pseudoaneurysms and ascites

27
Q

Name of the pattern seen while doing an ERCP procedure on a patient with chronic pancreatitis

A

Chain of lakes pattern

28
Q

Most common place for pancreatic tumors

A

The head of the pancreas

29
Q

Biliary sludge is more common to cause acute pancreatitis

A

True

30
Q

Levels of triglycerides that indicate an acute pancreatitis by hypertriglyceridemia

A

> 1000 mg/dL and > 2000 mg/dL increase the risk by 10 to 20%

31
Q

Lab results in patient with acute pancreatitis

A
  • ↑Hematocrit
  • ↑WBC
  • ↑BUN, creatinine and lactate
  • ↑Blood glucose
  • ↑CRP or prolactin
  • ↑IL6
  • ↑LDH
  • ↑ALT/AST
  • ↑Triglycerides
32
Q

Clinical features in a patient with acute pancreatitis

A
  • Constant epigastric pain that radiates to the back
  • Nausea and vomiting
  • Fever
  • Retroperitoneal bleeding
33
Q

What may cause the acute pancreatitis pain to WORSEN

A
  • After meals
  • Standing up
34
Q

Retroperitoneal bleeding is common in acute pancreatitis, what are the visible signs of this?

A
  • Cullen sign: periumbilical ecchymosis
  • Grey-Turner sign: flank eccymosis
  • Fox sign: inguinal ligament ecchymosis
35
Q

Types of acute pancreatitis

A
  • Necrotizing
  • Interstitial
36
Q

Complicated (20%) and blood supply interrupted, infected and walled-off (sterile)

A

Necrotizing acute pancreatitis

37
Q

Infected necrotizing acute pancreatitis sings, labs and treatment

A
  • ↑Leukocytes, bacteremia, and inflammation markers
  • Gas within pancreas and fluid collection
  • Empiric antibiotics
  • Drainage if AB not working
38
Q

WTF is a walled-off sterile cosa esa in acute pancreatitis

A

Encapsulated collection of sterile secreting material, usually occurs after 4 weeks; treated with drainage

39
Q

Interstitial acute pancreatitis is mostly uncomplicated and its about 80% of the cases

A

Yuh

40
Q

Findings in a patient with interstitial acute pancreatitis

A
  • Pancreatic pseudocyst
  • Acute pancreatic fluid collection
41
Q

Severity scores used for acute pancreatitis

A
  • Atlanta grade
  • Ranson criteria
  • APACHE II
  • BISAP
  • Marshall’s
42
Q

Severity score that categorizes acute pancreatitis in mild, moderate and severe

A

Atlanta grade

43
Q

Severity score that can be used after 48 hours

A

Ransons criteria

44
Q

Severity score used in the ICU

A

APACHE II

45
Q

Severity score used to predict in-hospital mortality

A

BISAP

46
Q

Organ failure score

A

Marshall’s

47
Q

Mutations that cause hereditary chronic pancreatitis

A

PRSS I or SPINK I mutation

48
Q

Most common cause of pancreatitis in kids

A

Cystic fibrosis

49
Q

Chronic pancreatitis causes pancreatic insufficiency, this results in?

A
  • Exocrine: low-grade amylase, lipase and protease
  • Weight loss and malnutrition
  • Steatorrhea
  • Osteoporosis or osteopenia
  • Deficiency of ADEK and zinc
  • Endocrine: loss of beta cells and insulin
50
Q

Main characteristics of a pancreas facing chronic pancreatitis

A
  • “Salt and pepper” at X ray
  • Enlarged pancreatic duct
  • “Skinny” pancreas
51
Q
A

Digestive system disorders (8 decks)

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