Pancreas

Question 1

Acute pancreatitis

Answer 1

inflammation of the pancreas that is mild and often spontaneously resolves

Question 2

What percentage of acute pancreatitis ends patients in the hospital?

Answer 2

20%

Question 3

Acute pancreatitis patho

Answer 3

obstruction of outflow of pancreatic enzymes often related to pancreatic and common bile duct obstruction (often gallstones)

Question 4

Causes of acute pancreatitis

Answer 4

Alcohol, drugs, viral infection

Question 5

What does build up of enzymes cause?

Answer 5

Autodigestion of pancreatic cells which causes inflammation

Question 6

Complications of autodigestion of the pancreatic cells

Answer 6

Necrosis, fat necrosis, coagulopathy, vascular damage

Question 7

What does elevated trypsin cause

Answer 7

edema, hemorrhage, necrosis

Question 8

What does elevated elastase cause

Answer 8

hemorrhage

Question 9

What does elevated phospholipase A cause

Answer 9

Fat necrosis

Question 10

What does elevated kallikrein cause

Answer 10

edema, vascular permeability, shock, smooth muscle contractions

Question 11

What does vascular permeability cause

Answer 11

Fluid seeps into the pancreas which can cause ascites

Question 12

What does smooth muscle contractions cause

Answer 12

pain

Question 13

What is the cause of shock with acute pancreatitis

Answer 13

vascular permeability

Question 14

What does elevated lipase cause

Answer 14

fat necrosis

Question 15

Necrosis

Answer 15

Death and breakdown of tissues

Question 16

s/s acute pancreatitis

Answer 16

severe epigastric pain, N/V, hypoactive bowel sounds, ab distension, fever, hypotension, tachycardia, jaundice, ecchymosis

Question 17

Characteristics of acute pancreatitis pain

Answer 17

• sudden onset
• tender abdomen
• guarding
• may radiate to back

Question 18

What causes acute pancreatitis pain

Answer 18

edema - distention of pancreatic ducts and capsules and irritation of peritoneum and biliary tract

Question 19

Elevated labs with acute pancreatitis

Answer 19

amylase, lipase, WBCs

Question 20

How does acute pancreatitis affect glucose

Answer 20

Glucose can be high or low (depends which cells are autodigested)

Question 21

Ecchymosis

Answer 21

Cyanosis or green-yellow/brown color on abdomen

Question 22

Grey Turners

Answer 22

ecchymosis on the flanks

Question 23

Cullen sign

Answer 23

ecchymosis in the periumbilical area

Question 24

What kind of pancreatitis causes ecchymosis

Answer 24

Hemorrhagic pancreatitis

Question 25

Complications of acute pancreatitis

Answer 25

abscess, pseudocyst, pulmonary compromise, tetany, hypotension (shock)

Question 26

Pseudocyst

Answer 26

- Fluid filled cavity SURROUNDING the outside pancreas that are made of necrotic products and secretions, cause more inflam and scarring - visible on a CT - may be palpable epigastric mass that can cause peritonitis if it perforates - may need surgery to prevent

Question 27

Abscess

Answer 27

- Large fluid filled cavity in pancreas that can cause infection or perforation - Abdominal mass, inc fever, inc leukocytosis - cause is often necrotic pancreatic hemorrhage

Question 28

Why does tetany happen with acute pancreatitis?

Answer 28

Lipase causes fat necrosis which releases FFA that binds to calcium deposits in the peritoneum and causes dec calcium

Question 29

Chronic pancreatitis

Answer 29

Progressive fibrotic disease of the pancreas

Question 30

Most often cause of chronic pancreatitis

Answer 30

Alcohol

Question 31

Patho of alc chronic hepatitis

Answer 31

Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of langerhans

Question 32

Risk factors for chronic pancreatitis

Answer 32

Genetics, SMOKE, gallstone obstruction, Alcohol

Question 33

CM for chronic pancreatitis

Answer 33

- attacks of acute pancreatitis with progressive signs of dysfunction after attacks subside - abdominal pain and weight loss - diabetes r/t loss of islet of Langerhans - issues with nutrition, especially fat abs--wt loss - pancreatic psuedocysts

Question 34

Pharm for pancreatitis

Answer 34

Opioids, Antispasmodics, antacids, H2 receptor antagonists, pancrelipase, insulin or glucagon

Question 35

Dicyclamine

Answer 35

Antispasmodic (anti-ACh agent) that decreases spasming bile ducts

Question 36

Antacids

Answer 36

Neutralize Hcl secretion in stomach which dec secretion of pancreatic enzymes

Question 37

H2 receptor antagonists

Answer 37

basically antacids

Question 38

Pancrelipase

Answer 38

Replaces panc enzymes (chronic only)