Pancreatitis

Question 1

function of acinar cells

Answer 1

the exocrine functions. secretes bicarbonate and electrolyes and water + proenzymes.

Question 2

endocrine pancreatic function

Answer 2

insulin, glucagon, somatostatin, pancreatic polypeptides, amylin

Question 3

why does the pancreas no digest itself?

Answer 3

enzymes are synthesized as inactive zymogens. enterokinase (converts to active form) are restircuted to the small intestine usually.

Question 4

compare and contrat acute and chronic pancreatitis.

Answer 4

chronic pancreatitis is atrophic and acute is often a biochemical explosion that is typically self-limited and often not as atrophic.

Question 6

outline the mechanism of acute pancreatitis

Answer 6

1. an insult to pancreas occurs
2. results in early zymogen actiavgtion, geenration of inflammatory mediators like CYTOKINE STORM
3. cytokine storm decreases blood flow and can cause ischemia, inflammation, multiorgan failuyre.
4. Neurogenic stimulation occurs as well, causing pain, necrosis, and apoptosis.

Question 7

main causes of acute pancreatitis

Answer 7

alcohol and gallstones.

Question 8

how does alcohol affect the pancreas.

Answer 8

etOH is toxic to acinar cells. Causes CCK release and subsequent aceinar cells become sensitized to CCK, causing zymogen activation and cytokine geneartion. There is also abnormal blood flow which causes sphincter of Oddi Spasm

toxic metabolites from alcohol also causes oxidative stress.

Question 9

How do Gallstones cause pancreatitis?

Answer 9

women have more gallstones because of estrogen, low Fe, and Fe is needed for bile acid conjugation. these gall stones leave the cystic duct and then GC migrates down to pancreatic suct, causing swelling of biliary pancreas.

ALT also rises first to cause AP.

Question 10

iatrogenic causes of acute pancreatitis

Answer 10

ERCP. That’s why you shouldn’t do it unless necessary (Gallstone blockage in DILATED extrahepatic bile duct)

Question 11

structural cause of acute pancreatitis

Answer 11

pancreatic divism– the two lobes don’t fuse.

If you don’t drink, smoke or have elevated pancreatic enzymes or have elevated liver enzymes (gallstones) but you still have acute pancreatitis, you can consider ERCP to MINOR DUCT to reduce recurrent Acute pancreatitsi.

Question 12

how do patients with acute pancreatitis present?

Answer 12

Question 13

diagnostic criteria for acute pancreatitis

Answer 13

Question 14

bedside assessment of severity of acute pancreatitis

Answer 14

Question 15

imaging modalities in acute pancreatitis

Answer 15

CT, MRCP or ERCP (not recommended cause can cause pancreatitis), EUS

Question 16

basic treatment options for AP

Answer 16

Question 17

localized and systemic complications from AP

Answer 17

localized: pancreatic pseudocytst, necrosis, ascites and third spacing, pancreatic hemorrahge, splenic vein thrombosis
systemic: pulmonary edema, renal failure, hypcalcemia, hyperglycemia, multiorgan failure and SIRS

Question 18

T/F: pancreatic pseudocysts can occur when onset of acute pancreatitis is happening

Answer 18

false. Occurs late >4 weeks after diseasse onset. this is due to ductal disruption. Not lined by epithelium.

Question 19

hallmarks of chronic pancreatitis

Answer 19

chronic abdominal pain, pancreatic insufficiency– less enzymes, shrunken.

pancreatic calcification.

this is not due to a cytokine storm.

Question 20

Is pain worse at the beginning of chronic pancreatitis or after 15 years of onset?

Answer 20

pain is prevalent at the beginning, but as one ages, pain subsides even though the physilogical symptoms are worsening – ex higher rates of calcification, malabsorption and diabetes.

Question 21

main causes of chronic pancreatitis.

Answer 21

Question 22

A person comes in with obstructive jaundice, abdominal pain, a high serum igG/igG4 and upon CT scan, a sausage like pancreas is seen. What could be happening? How would you treat?

Answer 22

autoimmune chronic pancreatitis. treat with steroids (retuximap)

Question 23

how to differentiate between pancreatic cancer and autoimmune pancreatitis on the CT scan

Answer 23

no dilation of pacnreatic ducts = autoimmune pacnreatitsi

dilation of the pancreatic ducts + mass visualization = cancer.

autoimmune pancreatitis can present with a mass as well, but it is not cancerous unless the ducts are dilated.

Question 24

change in stool in someone with chronic pancreatitis

Answer 24

steattorhea is seen in 90% of pancreatic patients.

Question 25

what type of abdominal pain is mostly associated with pancreatitis

Answer 25

epigastric pain radiating front to back.

Question 26

why is steattorhea a symptom of chornic pancreatitis

Answer 26

1. decreased concentratino of lipase
2. decreased duodenal pH (inactivation of pacnreatic lipase pH<4.5, there is a precipitation of bile salts.

the acidity of duodenal pH is because acinar cells in the pancreas are affected, causing less bicarbonate nutralization.

Question 27

what tests can we order in CP?

Answer 27

1. tests of pancreatic structure/diagnotic imaging/ CT
2. tests of pancreatic function: fecal fat, blood glucose (diabetes r/o), fecale elastase.

Question 29

treating chronic pancreatitis

Answer 29

treat the cuase. must stop drinking alcohol. Also treat the complications of chornic pancreatitis. manage exocrine insufficeincy with diet and exogenous enzumes. Modify fat intake, and REPLACE THE FAT SOLUBLE VITAMINS, B12 AND CALCIUM.

treat pain with narcotics or neuromodulators (TCAs)

Question 30

Why might malnutrition occur in someone with CP

Answer 30

because there is decreased FAT absorption and breakdown since lipase is decreased (it’s increasd in acute pancreatitis). without fat absorption, fat soluble nutrients will be less likely absorbed. therefore, you can see defieicnies in vitamins ADEK

Question 32

intervention strategies for chronic pancreatitis

Answer 32

EUS guided celiac plexus block

ERCP with pancreatic duct stenting (if you see strictures, stones etc).

pancreaticojejunoostomy.

Question 33

symptoms that chronic pancreatitis is turning into pancreatic cancer.

Answer 33

Question 34

Overall: