SM_160b: Clinical Features of Pancreatic Disorders Flashcards
___ is inflammation of the pancreas that occurs when enzymes of the pancreas auto-digest the pancreas
Pancreatitis is inflammation of the pancreas that occurs when enzymes of the pancreas auto-digest the pancreas
- Acute pancreatitis: occurs suddenly, short-term, can resovle
- Chronic pancreatitis: irreversible changes of the pancreas
Describe diagnosis of acute pancreatitis
Acute pancreatitis: need 2 of 3, avoid imaging unless diagnosis is in question
- Symptoms: classically with severe epigastric pain radiation to back
- Labs: amylase or lipase > 3x upper limit of normal
- Radiology suggestive of pancreatitis
____ and ____ are enzymes mainly but not exclusively produced by the pancreas and released into the small intestine via the pancreas duct
Lipase and amylase are enzymes mainly but not exclusively produced by the pancreas and released into the small intestine via the pancreas duct
- There are normal circulating levels
____ is an enzyme that helps break down fats in the diet
Lipase is an enzyme that helps break down fats in the diet
____ is an enzyme that helps break down carbohydrates
Amylase is an enzyme that helps break down carbohydrates
Describe definitions of acute pancreatitis
Acute pancreatitis
- Interstitial edematous pancreatitis: inflammation of the pancreatic parenchyma and peripancreatic tissues w/o necrosis
- Necrotizing pancreatitis: inflammation associated with parenchymal or periparenchyma necrosis (death of cells)
- Mild: absence of organ failure or local / systemic complications
- Moderately severe: transient organ failure and/or local system complications (< 48 hours)
- Severe: persistent organ failure of ≥ 1 organs
Diagnosis of pancreatitis should be AVOIDED with ____
Diagnosis of pancreatitis should be AVOIDED with nonspecific elevations of amylase or lipase
Describe diagnosis of chronic pancreatitis
Chronic pancreatitis diagnosis
- Radiology and endoscopic tests
- Clinical symptoms (specifically pain and malabsorption)
- Diagnostic testing (to measure pancreas function)
Chronic pancreatitis has ____ in presentation
Chronic pancreatitis has marked heterogeneity in presentation
- Incidental symptomatic severe chronic pancreatitis
- Symptomatic severe chronic pancreatitis
- After ≥ 1 prior episodes of acute pancreatitis
- Subtle signs (fat malabsorption)
Acute pancreatitis etiology is commonly ____ or ____
Acute pancreatitis etiology is commonly alcohol or biliary
- Alcohol: dose-dependent risk for pancreatitis
- Biliary: gallstones, sludge, microlithiasis
Acute pancreatitis genes include ____, ____, and ____
Acute pancreatitis genes include PRSS1, CFTR, and SPINK1
- PRSS1 gene encodes cationic trypsinogen: mutations result in autosomal dominant inheritance of hereditary pancreatitis
- CFTR mutations: transmitted in autosomal recessive fashion
- SPINK1 mutations: generally disease modifying, autosomal recessive
Autoimmune pancreatitis is most likely ____ mediated, diagnosed by ____, and presents as ____
Autoimmune pancreatitis is most likely IgG4 mediated, diagnosed by elevated serum IgG4, and presents as painless mass
- Treated with prolonged steroids
Pancreatitis may occur after ____ due to papillary swelling or contrast injection
Pancreatitis may occur after endoscopic retrograde cholangiopancreatography (ECRP) due to papillary swelling or contrast injection
- Magnetic resonance cholangiopancreatography has replaced ECRP
- Placement of a small pancreatic stent in at-risk patients reduces the risk of post-ERCP pancreatitis
- Indomethacin reduces risk of post-ERCP pancreatitis
- Aggressive IC hydration after ERCP may reduce post-ERCP pancreatitis
Describe diagnosis of acute pancreatitis
Acute pancreatitis diagnosis
- All patients should be ruled out for biliary causes regardless of alcohol history: ALT elevation is most sensitive
- RUQ ultrasound is necessary
- CT should be avoided when diagnosis is known
- MRCP cam be useful but not needed at first episode to evaluate for other causes
Describe diagnosis of recurrent acute pancreatitis
Recurrent acute pancreatitis diagnosis
- Patients with normal liver tests on hospital day #1 and no sludge in gallbladder points away from a biliary source
- Pancreas divisum should be considered
- MRI/MRCP should be considered to evaluate for pancreas divisum, US can be used to evaluate for divisum
- Consider med history, autoimmune pancreatitis, genetic testing
Describe acute pancreatitis management
Acute pancreatitis management
- IV hydration
- Nutrition: avoidance of oral nutrition, but parenteral nutrition has drawbacks, nasojejundal feedings superior to parenteral nutrition
- No advantage to early feeding
Early complications of acute pancreatitis include ____ or ____
Early complications of acute pancreatitis include acute pancreatic fluid collections or acute necrosis collections
- Acute pancreatic fluid collections: due to inflammation and/or pancreas duct disruption leading to accumulation of pancreatic juice, most resolve on their own
- Acute necrosis collections: aspiraation can be performed, avoid surgery early in necrosis
Acute pancreatitis complications after 4 weeks include ____ or ____
Acute pancreatitis complications after 4 weeks include pseudocyst or walled off pancreatic necrosis
- Pseudocysts: mature collections of pancreas juice possibly associated with persistent disruption of pancreatic duct, drain larger pseudocysts
- Walled off pancreatic necrosis: treat if infected or symptomatic, debridement and drainage
____ is a risk factor for chronic pancreatitis
Tobacco is a risk factor for chronic pancreatitis
___ significantly increases the risk of developing pancreatic cancer
Smoking significantly increases the risk of developing pancreatic cancer
Chronic pancreatitis presents as asymptomatic or with ____, ____, ____, as ____
Chronic pancreatitis presents as asymptomatic or with exocrine insufficiency (malabsorption), endocrine insufficiency (diabetes mellitus), pancreatic pain, and neuropathic pain
Describe treatment of chronic pancreatitis
Chronic pancreatitis treatment
- Pancreas enzyme replacement therapy used to treat exocrine function: dosage measured in units of lipase
- Opiates should be avoided
Solid exocrine pancreas neoplasm is ____
Solid exocrine pancreas neoplasm is ductal adenocarcinoma
Solid endocrine pancreas neoplasm is ____
Solid endocrine pancreas neoplasm is iselt cell neoplasms
