Pancreas Flashcards
Exocrine Pancreas
80% of function
Makes bicarb and H2O in response to SECRETIN from duodenum
Synthesizes digestive zymogens in reposne to CCK form duodenum
Zymogens are later activated via enterokinase in duodenum
Endocrine Pancreas
20% of function
Islet cells that produce insulin, somatostatin, VIP, glucagons etc.
ERCP
endoscopic retrograde cholangio-pancreatography
Acute Pancreatitis
info/cause
Digestive enzymes (esp. trypsinogen) are prematurely activated in pancreas thus digesting pancreas Causes: EtOH (premature zymogen release) & gallstones (blockage or bile reflux) Gallstones #1 cause in US
Acute Pancreatitis
pres
Sudden onset
Acute abd pain (epigastric +/- radiating to back)
Pseudocysts: leakage of enzyme, collection of fluid surrounded by granulation tissue
Necrosis - much worse prognosis
Acute Pancreatitis
diagnx
Elevated serum enzymes (amylase/lipase, elev 3x above normal)
Lipase more specific (both sesnitive)
US –> best for gallstones
Acute Pancreatitis
treat
Hospital admission NPO, IV fluid, IV analgesia
Surgery if gallstones
ERCP for bile duct stones
Full recover is common
Chronic Pancreatitis
info/cause
Permanent destruction of pancreas, replacement with fibrosis
Atrophy, DUCT obstruction, poss pseudocysts
EtOH!! also CF etc.
Acute Pancreatitis
non EtOH and gallstone causes
LOOK AT SLIDE
Chronic Pancreatitis
pres
Chronic pain and/or malabsorption
Prior acute episodes (not neccesarily though)
Pain post-prandial, (epigastic radiating to back)
Jaundice (bile duct obstruction)
Macrocytic anemia
Nausea/vomiting
Steatorrhea - oily stools, foul smelling, large volume so LOSE LOTS OF WEIGHT
Diabetes (at end stage)
Chronic Pancreatitis
diagnx
Usually have NORMAL serum enzymes Secretin test (rarely used anymore but is gold standard) - shod see a bicarb increase 40 mEg/L or more with release of secretin Vitamin K insufficiency Steatorrhea (Sudan fat stain) Xray/CT
Chronic Pancreatitis
treat
Stop ETOH!! pancreatic enzyme replacement for steatorrhea ERCP to treat duct obstruction Celiac nerve block for pain Resection
Pancreatic Cancer
(info/causes)
common mutation?
common tumor?
Diagnosed late because no good screening 5 year survival is 5% >90% have K-ras mutation ADENOCARCINOMA most common Islet cell tumors less common MEN1 and VHL link
Pancreatic Cancer
pres
Jaundice, Abd or back pain, weight loss
Dark urine, may become HYPERCOAGULABLE (Trousseau’s syndrome)
Pancreatic Cancer
diagnx
CT/MRI (contrast CT used for 80-90%)
Biopsy (via endoscope US) and staging
