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Gastroenterology > 341 Pancreas > Flashcards

341 Pancreas Flashcards

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1
Q

What stimulates the secretion of water and electrolytes from the pancreas

A

Gastric acid stimulates the release of secretin from the duodenal mucosa which stimulates the release of water and electrolytes from the pancreas

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2
Q

What cells release CCK

A

Ito cells of the duodenal and jejunal mucosa

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3
Q

Exerts significant control over pancreatic secretions

A

Parasympathetic nervous system (via the vagus nerve)

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4
Q

Ion of primary physiologic importance within pancreatic secretion

A

Bicarbonate

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5
Q

Where is 93% of bicarbonate derived

A

ductal cells secrete bicarbonate predominantly derived from plasma (93%)

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6
Q

General types of enzyme secreted by the pancreas

A

amylolytic, lipolytic and proteolytic enzymes

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7
Q

Examples of amylolytic enzymes and what does it do

A

amylase; hydrolyzes startch to oligosaccharides and disaccharide to maltose

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8
Q

Examples of lipolytic enzymes

A

lipase, phospholipase A2, and cholesterol esterase

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9
Q

Examples of proteolytic enzymes and what does it do

A

endopeptidases, exopeptidases, elastase; act on internal peptide bonds of protein and polypeptides

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10
Q

Enzymes found in doudenal mucosa which cleaves trypsinogen to trypsin

A

enterokinase

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11
Q

Stimulatory neurotransmitters of the pancreas

A

acetylcholine and gastrin releasing peptide

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12
Q

extrinsic innervation of the pancreas

A

vagus nerve

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13
Q

How is autodigestion in the pancreas mantained

A

pancreatic proteases are in proenzyme form;intracellular calcium homeostasis, acid-base balance, synthesis of protective protease inhibitors

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14
Q

Accounts for 80-90% of acute pancreatitis cases in the US

A

gallstones and alcohol

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15
Q

Leading cause of pancreatitis in 30-60% of cases

A

gallstones

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16
Q

What size of the gallstone has a 4x greater risk of acute pancreatitis

A

one gallstone less than 5 mm

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17
Q

Causes pancreatitis in 1.3-3.8% of cases

A

hypertriglyceridemia

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18
Q

What is the level of triglycerides that will trigger acute pancreatitis

A

serum triglyceride level of more than 1000 mg/dl

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19
Q

what does apolipoprotein CII do

A

activates lipoprotein lipase which clears chylomicrons from the blood strea

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20
Q

currently accepted pathogenic theory for acute pancreatitis

A

autodigestion

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21
Q

What happens in autodigestions

A

pancreatic enzymes are activated in the pancreas acinar cell than than in the intestinal lumen

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22
Q

How many phases of pancreatitis

A

3 phases

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23
Q

Pathophysiology of acute pancreatitis. Characterized by intrahepatic digestive enzyme activation and acinar cell injury

A

Initial phase

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24
Q

Pathophysiology of pancreatitis. Activation, chemoattraction, and sequestration of leukocytes and macrophages in the pancreas

A

Second phase

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25
Pathophysiology of pancreatitis. Effects of activated proteolytiz enzymea and cytokines released by inflamed pancreas to distant organs
Third phase
26
Major symptom of acute pancreatitis
abdominal pain
27
Mechanisms that lead to shock in patient with pancreatitis
hypovolemia from extravasaation of blood and plasma into the retroperitoneal space; increased formation and release of kinin peptides leading to increased vascular permeability; systemic effects of proteolytic and lipolytic enzymes released into the circulation
28
What leads to jaundice in pancreatitis? Is it common
Jaundice is uncommon. It is due to compression of the intrapancreatic portion of the CBD or passage of biliary stone or slude brought about by the edema of the head of the pancreas
29
What is Cullen sign
Bluish discoloration around the umbilicus as a result of hemoperitoneum
30
What is Turner sign
Blue red purple or green brown discoloration of the flanks
31
Perfect test for acute pancreatitis.
Lipase. It is more specific than amylase.
32
When does amylase return to normal
3-7 days even if patients still have clinical signs of pancreatitis
33
Until how many days does lipase remain elevated
lipase remains elevated for 7-14 days
34
True or false. Serum amylase can increase in cases of acidemia when blood pH is less than 7.32
True.
35
True or false. Patients with DKA can have elevated serum amylase even without evidence of pancreatitis
True
36
Harbinger of more severe disease in acute pancreatitis
hemoconcentration. Hct more than 44%
37
True or false. Hypoglycemia in common in acute pancreatitis
False. Hyperglycemia is common from decreased insulin release and increased glucagon release
38
Definition. Acute inflammation of the pancreatic parenchy and peripancreatic tissues but without recognizable tissue necrosis.
interstitial pancreatitis
39
Definition. Inflammation associated with pancreatic parenchymal necrosis and or peripancreatic necrosis
necrotizing pancreatitis
40
Definition. Encapsulated collection of fluid with a well defined inflammatory wall outside the pancreas with minimal or no necrosis.
pancreatic pseudocysts
41
When does pancreatic pseudocyts appear
more than 4 weeks after onset of interstitial pancreatitis
42
Definition. Peripancreatic fluid associated with interstitial edemaous pancreatitis with no associated peripancreatic necrosis
Acute pancreatic fluid collection
43
When does acute pancreatic fluid collection occur
within the 4 weeks after onset of intersitial pancreatitis
44
Definition. A collection containing cariable amounts of both fluid and necrosis associated with necrotizing pancreatitis
Acute pancreatic necrotic collection
45
When does walled off necrosis (WON) occur?
Occurs more than 4 weeks after onset of necrotizing pancreatitis
46
Definition. Mature encapsulated collection of pancreatic and or peripancreatic necrosis that has developed a well defined inflammatory wall
Walled-off necrosis (WON)
47
When does serum bilirubin levels result to normal in acute pancreatitis
normal in 4-7 days
48
True or false. Jaundice in acute pancreatitis is transient
True.
49
How is acute pancreatitis diagnosed
2 out of 3. typical abdominal pain in epigastrium which radiate to the back, 3x or greater elevation of serum lipase and or amylase, confirmatory findings of acute pancreatitis on abdominal imaging
50
True or false. It may be difficult to differentiate acute cholecystitis from acute pancreatitis as both can present with elevated amylase.
True.
51
Test to differentiate DKA from acute pancraetitis
Serum lipase is normal in DKA
52
Define organ failure and what systems must be assessed
Organ failure in 2 or more sytems: respiratory, cardiovascular, renal
53
Most important clinical finding in regard to severity of the acute pancreatitis
persistent organ failure of more than 48 hours
54
When is late phase in acute pancreatitis
Protracted course illness
55
Phases of acute pancreatitis
early less than 2 weeks hospital course and late more than 2 weeks
56
True or false. CT imaging is done as early as possible.
False. CT imaging not needed or recommended during the first 48 hours of acute pancreatitis. After the 48 hours, it is done to evaluate for local complications
57
Greatest importance during the late phase of acute pancreatitis
CT imaging
58
Severity classes of acute pancreatitis
Mild, moderate, severe
59
When is acute pancreatitis mild
Without local complications or organ failure. Disease is self limited and subsides spontaneously in 3-7 days
60
When is acute pancreatitis moderate
there is transient organ failure than resolves in less than 48 hours
61
when can oral intake be resumed in acute pancreatitis
when patient is hungry, has normal bowel function and no nausea and vomiting
62
When is acute pancreatitis severe
when organ failure persists for more than 48 hours
63
Types of pancreatitis based on imaging
intersitial and necrotizing
64
Imaging of interstitial pancreatitis
diffuse gland enlargement with homogenous contrast enhancement
65
Imaging of necrotizing pancreatitis
lack of pancreatic parenchymal enhancement by contrast and presence of peripancreatic necrosis
66
How is fluid resuscitation done in acute pancreatitis
15-20 ml/kg bolus then 2-3 ml/kg per hour to maintaine urine output more than 0.5 ml/kg per hour
67
Preferred IV fluid in acute pancreatitis and why
Lactated Ringers; shown to decrease inflmmation than normal saline
68
Recommended to ensure adequate fluid resuscitationn
Hematocrit and BUN every 8-12 hours
69
Strong evidence that sufficient fluids are being administered
Decrease in hematocrit and BUN during the first 12- 24 hours
70
How to respond to rise in hematocrit or BUN on serial measurement
repeat volume challenge of 2 Liters then followed by increasing fluid rate at 1.5 ml/kg/hr
71
If still despite repeat volume challenge, Hct and BUN continues to rise, what to do
for ICU for hemodynamic monitoring
72
What to do in patient with evidence of ascending cholangitis on top of gallstone pancreatitis
ERCP within 24-48 hours of admission
73
When should cholecystectomy be done in patient with gallstone pancreatitis
during admission or 4-6 weeks after discharge
74
Effective at decreasing pancreatitis after ERCP
pancreatic duct stenting and rectal indomethacin
75
When should feeding be considered in acute pancreatitis
enteral feeding considered 2-3 days after adminsion after abdominal pain has resolved
76
True or false. Patients with necrotizing pancreatitis should be given prophylactic antibiotics
False. No role. If patient appear septic, antibiotics may be given and discontinued when cultures turned negative
77
True or false. Acute pancreatitis may present with sterile necrosis and managed conservatively without antibiotics
True. No antibiotics if no growth on culture to avoid opportunistic and fungal infection
78
Presents with increasing abdominal pain or shortness of brath in setting of enlarging fluid collection on MRCP or ERCP
Pancreatic duct disruption
79
How is pancreatic duct disruption managed
Bridging pancreatic stent for at least 6 weeks
80
Most common etiologic factor for recurrent pancreatitis
alcohol and cholelithiasis
81
Why is there an increased incidence of pancreatitis in patients with AIDS
high incidence of infection involving the pancreas such as CMV, cryptosporidium and MAC; medication induced such as TMP SMX, pentamidine, protease inhibitors
82
True or false. In chronic pancreatitis, the damage is irreversible.
True.
83
Strongly linked to chronic pancreatitis and why
smoking increases susceptibility to pancreatic autodigestion and predispose to CFTR dysfunction
84
Most common cause of chronic pancreatitis in adults. In children?
Adult: alcoholism. Children: cystic fibrosis
85
Marker for autoimmune pancreatitis
Elevated serum levels of IgG4; ANA and RF may be positive
86
How is AIP diagnosed
Mayo Clinic HISORt criteria 1 or more of the following. Histology. Imaging: mass in head of pancreas. Serology: elevated IgG4; other organ inolvment; response to glucocorticoid therapy
87
How is AIP treated
Prednisone 40 mg/d for 4 weeks followed by taper dose of 5 mg/wk
88
Has been shown to be effective at inducing and maintaining remission in AIP
rituximab
89
True or false. Just like acute pancreatitis, amylase and lipase strikingly elevated in chronic pancreatitis
false.
90
Initial modality of choice in diagnosing chronic pancreatitis
Abdominal CT
91
Imaging findings in chronic pancreatitis
calcification, dilated ducts or an atrophic pancreas
92
Diagnostic test with best sensitivity and specificity in chronic pancreatitis
hormone stimulation using secretin. Abnormal results seen when 60% of pancretic exocrine function is lost
93
Cornerstone therapy of steatorrhea
enzyme therapy
94
How much of lipase should be taken during a meal
80,000-100,000 units
95
Can improve pain in chronic pancreatits
pregabalin
96
Ventral pancraetic anlage fails to migrate resulting to a ring of pancreatic tissue circling the duodenum
Annular pancreas
97
Radiographic findings of annular pancreas
symmetric dilation of the proximal duodenum with bulging of the recesses on either side of the annular band
98
Embyronic ventral and dorsal pancreatic anlagen fail to fuse so that pancreatic drainage is accomplished throuh the accessory papillar
pancreas divisum
99
Condition where amylase circulating the blood is in polymer form too large to be excreted by the kidney. There is elevated serum amylase and low urinary amylase.
Macroamylasemia

Gastroenterology (13 decks)

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