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Pancreas Flashcards

1
Q

Pancreatic insufficiency is a decrease in _ due to obstruction/atrophy/inflammation

A

Pancreatic insufficiency is a decrease in pancreatic digestive enzymes (exocrine) due to obstruction/atrophy/inflammation

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2
Q

Causes of pancreatic insufficiency include:

A

Causes of pancreatic insufficiency include:
* Chronic pancreatitis
* Cystic fibrosis
* Cancer

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3
Q

Pancreatic insufficiency involves a (increase/decrease) in duodenal pH

A

Pancreatic insufficiency involves a decrease in duodenal pH
* Decrease in bicarbonate (duct cells responsible for making bicarbonate)

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4
Q

Pancreatic insufficiency is associated with a decrease in pancreatic enzymes; fecal _ is specifically used to monitor pancreatic function

A

Pancreatic insufficiency is associated with a decrease in pancreatic enzymes; fecal elastase is specifically used to monitor pancreatic function

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5
Q

Pancreatic insufficiency is associated with a decrease in the absorption of fat-solube vitamins and _

A

Pancreatic insufficiency is associated with a decrease in the absorption of fat-solube vitamins and vitamin B12

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6
Q

Pancreatic insufficiency will show a _ D-xylose test

A

Pancreatic insufficiency will show a normal D-xylose test

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7
Q

What kind of pain is associated with pancreatitis?

A

Epigastric pain that radiates to the back is typical for pancreatitis
* Worse postprandial
* Better leaning forward

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8
Q

How does pancreatic insufficiency present?

A

Pancreatic insufficiency presents with:
* Diarrhea (steatorrhea)
* Weight loss, fatigue
* Symptoms of vitamin deficiencies
* Symptoms of insulin resistance

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9
Q

Pancreatic insufficiency is caused by _

A

Pancreatic insufficiency is caused by enzyme supplementation or obstruction removal

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10
Q

Acute pancreatitis is caused by _

A

Acute pancreatitis is caused by intrapancreatic activation of enzymes that lead to the autodigestion of the pancreas

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11
Q

Acute pancreatitis occurs due to activation of _ inside the pancreas

A

Acute pancreatitis occurs due to activation of trypsin inside the pancreas
* Increases lipolysis, proteolysis, tissue destruction –> inflammation

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12
Q

Acute pancreatitis is associated with an increase in enzymes _ and _

A

Acute pancreatitis is associated with an increase in enzymes lipase and amylase

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13
Q

The most specific marker of acute pancreatitis is an increase in _

A

The most specific marker of acute pancreatitis is an increase in lipase
* Can be up to 3x normal limit
* More specific to pancreas than amylase level

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14
Q

Acute pancreatitis will appear _ on imaging

A

Acute pancreatitis will present with (on imaging):
* Effusion/ fluid collections
* Pseudocysts
* Fistulas

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15
Q

_ sign is bruising around the umbilicus associated with acute pancreatitis

A

Cullen’s sign is bruising around the umbilicus associated with acute pancreatitis

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16
Q

_ sign is flank bruising associated with acute pancreatitis

A

Grey Turner’s sign is flank bruising associated with acute pancreatitis

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17
Q

Explain the pathogenesis of shock in acute pancreatitis

A

Vasodilation and capillary leakage –> third space fluid loss –> shock (tachycardia, hypotension, oliguria)

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18
Q

Explain how acute pancreatitis can cause peripancreatic fat development

A

Shock –> decreased organ perfusion –> pancreatic necrosis –> pancreatic lipolysis –> peripancreatic fat

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19
Q

How does peripancreatic fat lead to tetany?

A

Peripancreatic fat –> calcium chelation of fat –> hypocalcemia and tetany

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20
Q

The mcc of chronic pancreatitis is _

A

The mcc of chronic pancreatitis is alcohol use
* Other causes: CF, autoimmune, obstructive, idiopathic

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21
Q

What do you expect to see on imaging for chronic pancreatitis?

A
  • Calcification of pancreas
  • Change in size (atrophy or enlargement)
  • Fibrosis (hyperechoic)
  • Pseudoaneurysms, pseudocyts
  • Dilation of pancreatic duct
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22
Q

Chain of lakes sign is _

A

Chain of lakes sign is dilation of the pancreatic duct

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23
Q

Chronic inflammation of the pancreas activates _ cells which mediate the fibrosis in chronic pancreatitis

A

Chronic inflammation of the pancreas activates pancreatic stellate cells which mediate the fibrosis in chronic pancreatitis

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24
Q

Clinical presentation of chronic pancreatitis:

A

Clinical presentation of chronic pancreatitis:
* Epigastric pain
* Decreased biliary outflow (jaundice)
* Decreased exocrine function (malabsorption)
* Decreased endocrine function (new onset diabetes)
* Ascites

25
Q

Pancreatic adenocarcinoma arises from the _ cells

A

Pancreatic adenocarcinoma arises from the pancreatic ducts

26
Q

Pancreatic adenocarcinoma is most common in _ region of the pancreas

A

Pancreatic adenocarcinoma is most common in the pancreatic head

27
Q

On histology, pancreatic adenocarcinoma appears _

A

On histology, pancreatic adenocarcinoma appears as disorganized glandular structure with cellular infiltration

28
Q

Risk factors for pancreatic adenocarcinoma include:

A

Risk factors for pancreatic adenocarcinoma include:
* Chronic pancreatitis
* Smoking
* Diabetes
* Age > 50

29
Q

Pancreatic adenocarcinoma is associated with tumor markers _ and _

A

Pancreatic adenocarcinoma is associated with tumor markers CA 19-9 and CEA (CEA is less specific)

30
Q

Redness and tenderness on palpation of the extremities is a sign of _ ; which is associated with pancreatic adenocarcinoma

A

Redness and tenderness on palpation of the extremities is a sign of migratory thrombophlebitis ; which is associated with pancreatic adenocarcinoma
* Trousseau sign
* We can also get activation of clotting factors and DIC

31
Q

Courvoisier sign is _

A

Courvoisier sign is obstructive jaundice with painless, palpable gallbladder
* Dark urine, pale stools

32
Q

Acute pancreatitis can lead to severe critical illness including _

A

Acute pancreatitis can lead to severe critical illness including ARDS and death

33
Q

The classic clinical presentation of acute pancreatitis will include:

A

The classic clinical presentation of acute pancreatitis will include:
* Acute abdominal pain radiating to back
* Nausea and vomiting
* Fever/ chills
* Tachycardia, hypotension, volume depletion

34
Q

“Interstitial edematous pancreatitis” describes (chronic/acute) pancreatitis

A

“Interstitial edematous pancreatitis” describes acute pancreatitis
* Will most often be self-limiting

35
Q

Severe acute pancreatitis occurs when we progress from interstitial edematous to _

A

Severe acute pancreatitis occurs when we progress from interstitial edematous to necrotizing –> necrotizing pancreatitis
* Extensive pancreatic tissue destruction
* Surrounding organ damage
* Can get systemic inflammatory response and multi-organ failure

36
Q

Why does acute pancreatitis cause third spacing of fluid?

A

Activated enzymes damage the blood vessels –> leaky blood vessels –> third spacing of fluids –> hypotension

37
Q

Explain how acute pancreatitis can cause multi-organ failure

A

Activated enzymes get into the blood stream –> travel to other organs –> cause damage/destruction –> AKI, ARDS, shock

38
Q

Multiple recurrences of acute pancreatitis can lead to the development of _ and _

A

Multiple recurrences of acute pancreatitis can lead to the development of pancreatic insufficiency and chronic pancreatitis

39
Q
A

Pancreatic pseudocyst

40
Q
A

Necrotizing pancretitis

41
Q

Grossly, acute pancreatitis will present with _

A

Grossly, acute pancreatitis will present with swollen, edematous pancreas with fat necrosis and hemorrhage

42
Q

Explain the saponification of fat in acute pancreatitis

A

Inflammation mediated by neutrophils –> adipocytes get necrotic and release fatty acids –> fatty acids bind to calcium –> calcium soaps

43
Q
A
44
Q
A
45
Q

The majority of acute pancreatic cases are caused by either _ or _

A

The majority of acute pancreatic cases are caused by either gallstones or alcohol
* Hypertriglyceridemia
* Medication
* Autoimmune
* Genetic (PRSS, SPINK1)
* Post-ERCP
* Trauma
* Infection

46
Q

Diagnosis of acute pancreatitis requires 2/3 features:
1. Acute onset severe epigastric pain
2. Elevated amylase/lipase
3. CT imaging (or MRI)

A

Diagnosis of acute pancreatitis requires 2/3 features:
1. Acute onset severe epigastric pain
2. Elevated amylase/lipase
3. CT imaging (or MRI)

47
Q

Besides elevated amylase and lipase and abdominal pain, what are other common features of acute pancreatitis?

A
  • Hypocalcemia
  • High BUN, Cr
  • High WBC
  • Hypoxia
  • High LFTs (if gallstone)
  • Elevated glucose
48
Q

_ is the most important first intervention in acute pancreatitis

A

IV fluid resuscitation is the most important first intervention in acute pancreatitis

49
Q

What is chronic pancreatitis?

A

Chronic pancreatitis is a progressive fibroinflammatory disorder that is associated with a loss of pancreatic parenchyma (structure and function)

50
Q

Explain the structural damage associated with chronic pancreatitis

A
  • Loss of parenchyma
  • Atrophic pancreas
  • Pancreatic duct dilation/obstruction
  • Chronic pain
  • Calcifications on imaging
  • Pseudocysts
51
Q

Once we lose about 80-90% of pancreatic function we can end up with _

A

Once we lose about 80-90% of pancreatic function we can end up with significant pancreatic insufficiency
* Loss of exocrine function
* Malabsorption
* Low ADEK, protein/albumin
* Steatorrhea
* Weight loss

52
Q

Dilation of the main pancreatic duct is associated with (acute/chronic) pancreatitis

A

Dilation of the main pancreatic duct is associated with chronic pancreatitis

53
Q
A

Chronic pancreatitis

54
Q

Etiologies of chronic pancreatitis

A

Etiologies of chronic pancreatitis:
TIGAR-O
1. Toxin (alcohol)
2. Idiopathic
3. Genetic (SPINK1, PRSS)
4. Autoimmune
5. Recurrent
6. Obstructive

55
Q

Fecal elastase will be (high/low) in chronic pancreatitis

A

Fecal elastase will be low in chronic pancreatitis

56
Q

What labs do we expect with chronic pancreatitis?

A
  • Low fecal elastase
  • Fecal fat
  • Fat soluble vitamins (ADEK)
  • Low albumin
  • Low duodenal pH
  • Amylase and lipase are not helpful, often low or normal
57
Q
A

Chronic pancreatitis

58
Q

_ is a tumor maker for pancreatic adenocarcinoma

A

Ca19-9 is a tumor maker for pancreatic adenocarcinoma

GI (13 decks)

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