Exam 2 PANCREATIC DZ Flashcards Preview

Q4 Clin Med III (GI) > Exam 2 PANCREATIC DZ > Flashcards

Flashcards in Exam 2 PANCREATIC DZ Deck (29):
1

Pancreas vascular supply?

Celiac axis
SMA

2

Pancreas innervation?

Autonomic

3

Pancreas fxn: Exocrine?

Other contents of juice? (2)

Juice release stim by? (3)

Breakdown of:
Starch (Amylase)
Fat (Lipase)
Protein (Protease)

Bicarb, e-

Gastric acid
Cholecystokinin
Vagal stim

4

Pancreas fxn: Endocrine?

Insulin release (response to high glucose)

Glucagon release (response to low glucose)

5

Acute Pancreatitis is?

Inflamm dz -> premature activation of protealytic enz -> autodigestion of pancreas

6

Acute Pancreatitis caused by? (6)

EtOH (Toxins)
Gallstones (Mechanical)
Hypertrigly (Metabolic)
Ischemia (Vascular)
Viral
Genetic

7

Acute Pancreatitis presentation: OLDCARS

Acute, P post meal
Midepigast -> back radiation
Constant
Steady, boring
Supine
Tripod
Anorexia, N/V, distention

8

Acute Pancreatitis presentation: exam findings

Vitals?

Skin?

Abd:

Other? (2)

Fever, tachy/tachy, +/- hypoTN

Jaundice if obstruction

hypoactive or no BS
tender w/ or w/o guarding/rebound

Cullen's Sign: periumbil ecchy
Grey-Turner's Sign: flank ecchy

9

Acute Pancreatitis labs? (9)

Amylase = ↑
Lipase = ↑
WBC = ↑
HCT = ↑
Cr = ↑
Glu = mild ↑
LFT = transient ↑
Ca2+ = ↓
ABG = P ↓

10

Acute Pancreatitis imaging? (5)

XRay = r/o obstruction/perf
US = stones
CT = edema, inflamm, calcif, necrosis, abscess
MRCP
EUS = newest/best

11

Acute Pancreatitis tx? (6)

Admit
Tx underlying dz
NPO
IV fluids!
Pain (Demerol)
P abx (Imipenem)

12

Acute Pancreatitis: signs of complications?

↓ urine/↑ Cr
Resp fail
↑pain, fever, leukocytosis

13

Acute Pancreatitis: Complications

Pseudocyst?

Abscess?

Ascites?

fluid/debris collection w/ fibrotic wall

infected pseudocyst or necrotic area

leaking duct or pseudocyst

14

Acute Pancreatitis: Systemic Complications

Pulmon?

Renal?

Card?

GI?

Metabolic?

Pulmonary fail, edema, effusion, atelectasis

Renal fail

hypoTN/shock

ileus

hypergly/hypoCa2+

15

Chronic Pancreatitis is?

Repeat episodes of acute inflamm ->
permanent structural damage/obstruction

16

Chronic Pancreatitis caused by? (4)

EtOH (80%)
Repeat acute pancr
Cystic fibrosis
Hereditary

17

Chronic Pancreatitis presentation?

Triad?

Epigastric pain aggravated by EtOH, fat

DM (endo dysf)
Steatorrhea (exo dysf)
Pancreatic calcification

18

Chronic Pancreatitis induced Exocrine Insuff causes?

Endocrine Insuff causes?

Malabsorp -> steatorrhea, wgt loss

Diabetes (damages α, β cells)

19

Chronic Pancreatitis labs? (4)

Amylase/Lipase = N or slight ↑
Bilirubin/Alk Phos = mild ↑
Glu = ↑
72hr Fecal Fat Test = ↑

20

Chronic Pancreatitis imaging? (4)

XRay = P scattered calcification
CT = calcif, ductal dilation, pseudocysts
MRCP = good view pancr/bili ducts
ERCP = chain-of-lakes DIAGNOSTIC

21

Chronic Pancreatitis tx? (3)

Behavior (EtOH, tobacco, fat)
Pancr enz supplements (Creon)
DM tx w/ insulin
Pain

22

Chronic Pancreatitis Pain tx? (6)

Pancreatic supplements 1st
Amitriptyline or SSRI
Long-act narcotics (MS Contin)
Endoscopic ductal dilation, stenting
Nerve block (celiac plexus)
Resection

23

Pancreatic CA U located?

U what type?

head of pancr

adenocarc
∴ 15% of cysts are CA

24

Pancreatic CA risk factors? (8)

M > F
Blacks
> 45yo
Smoke/EtOH
Chronic pancr
DM
Obese
FHX

25

Pancreatic CA presentation? (6)

U Abd pain: Gnawing epigast w/ radiation to back

Bloating
Early satiety/anorexia
Wgt loss
Jaundice
Steatorr

26

Pancreatic CA exam findings? (5)

Cachexia (wasting)
Jaundice/Icterus
L supraclavicular LN (Virchow's)
Ascites
Palp GB (Courvoisier's Sign)

27

Pancreatic CA labs? (5)

Amylase/Lipase = mild ↑
Bilirubin/Alk Phos = ↑
Glucose intolerance
Mild anemia
CA 19-9 (carbohydrate antigen) = 90% sen/spec for pancr CA

28

Pancreatic CA imaging? (3)

US = dilated CBD, head mass
ERCP = DIAGNOSTIC, Double-Duct Sign
CT = Dx and staging

29

Pancreatic CA tx?

Prognosis?

Resection is only cure

Poor