Pathophys - Pancreas Flashcards
What are the physiologic functions of the exocrine pancreas?
- Synthesis of enzymes for carb, protein and fat digestion
- HCO3 and H20 secretion to neutralize gastric acid and bile
Decrease duodenal pH => ^ secretin from duodenum => HCO3 secretion in pancreas
fats and AAs in duodenum => ^ CCK from duodenum => gallbladder emptying and pancreatic enzyme secretion
Describe the causes of acute pancreatitis
Ductal obstruction from gallstones NUMBER ONE CAUSE
- Causes bile reflux
- Enzyme retention
Alcohol abuse
- Premature activation of zymogens
- Increased permeability of ductules
- Proteinacious plugs w/in pancreas duct
Also: - Idiopathic - Drug-induced - Hypercalcemia - Trauma -
Describe the mechanism of acute pancreatitis
Trypsinogen and other zymogens prematurely activated in pancreas
Causes:
- Auto-digestion of gland
- Enzyme leakage around pancreas => other complications
- Inflammatory cascade => organ failure or death when severe
Describe the presentation of acute pancreatitis
In order from most common to least:
- Abdominal pain - almost always
- N/V
- Tachycardia
- Low grade fever
- Abdominal guarding
- Low of bowel sounds
- Jaundice, if severe/necrosis
Describe the complications of acute pancreatitis
- Ileus (paralysis of gut from irritation)
- Intra-abdominal hemorrhage
- Pseudocyst formation
Severe cases:
- Pancreatic necrosis
- Bowel or BD obstruction
- Shock
- Respiratory or renal failure
- Death!
Describe the causes of chronic pancreatitis
Alcohol, almost always
Idiopathic
Other:
- CF
Hereditary pancreatitis
- Hyperlipidemia
Describe the presentation of chronic pancreatitis
Abdominal pain
- Chronic epigastric pain, radiates to back (worse after meals)
Steatorrhea
- Oily stools
- Large volume, light-colored, foul-smelling
Hypo- or hyperglycemia
- Brittle DM from islet loss
Need to lose 85-90% of normal pancreas to get symptoms
Describe the testing of chronic pancreatitis
- H&P
- X-ray (calcification in pancreas)
- CT (dilated duct, atrophy, calcifications, pseudocysts)
More invasive/expensive:
- Secretin test
- ERCP
- Endoscopic US
Describe the complications of chronic pancreatitis
Fat malabsorption:
- Severe weight loss
- Steatorrhea
Vit K malabsorption:
- Bleeding problems
Vit B12 malabsorption:
- Anemia
Protein malabsorption:
- weakness, edema
Describe the treatment of chronic pancreatitis
More common:
- STOP DRINKING
- Pancreatic enzyme pills
- Treat duct obstruction
Less common:
- Celiac nerve block for pain
- Surgery if refractory/severe
- Pancreatectomy w/ islet cell transplant —- only in young pts usually w/CF
Describe the presentation of pancreatic cancer
- Jaundice, dark urine, pruritus (tumor in head)
- Abdominal/back pain (usually means it’s late stage)
- Wt loss
- N/V (late stage)
- Hormonal excess - neuroendocrine tumors (insulin, glucagon, gastrin, VIP)
Describe the complications of pancreatic cancer
- Difficult to diagnose, often done late in cancer stages
- Survival not good => 5-year survival is
Describe the treatment of pancreatic cancer
Surgical resection for pts diagnosed early (not often) — only 20-30% are successful
ERCP w/ stent (relieves itching, jaundice)
Celiac nerve block for pain
Describe the presentation of autoimmune pancreatitis
Males, typically 40-70 yo
- usually w/ other autoimmune diseases (RA, Sjogrens, IBD, SLE)
- *Can masquerade as pancreatic cancer**
- Chronic abdominal pain
- Jaundice
- Wt loss
- Rarely pancreatitis
Describe the imaging findings of autoimmune pancreatitis
Diffuse (usually) or focal enlargement of pancreas w/ narrowing of CBD +/- PD
GO LOOK AT THE PPT!
