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F3 E3 Shea > Pancreas > Flashcards

Pancreas Flashcards

(46 cards)

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1
Q

Exocrine function of pancreas:

What are the 3 pancreatic enzymes and what is their function?

A
  1. Amylase: breakdown starch
  2. Lipase: Breakdown fat
  3. Proteases: Breakdown proteins
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2
Q

Endocrine function of pancreas:

What is the role of insulin and glucagon?

A
  • Insulin: increases permeability of cell membranes (lowers BS)
  • Glucagon: Stimulates liver to convert glycogen–>glucose (increases BS)
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3
Q

Which pancreatic cells secrete amylase into the duodenum for the digestion of starch?

A

acinar cells

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4
Q

In pancreatitis, do you see elevation in amylase or lipase first?

A

Amylase

(A comes before L)

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5
Q

Is Amylase or Lipase more specific to pancreatic disease?

A

Lipase

(amylase is also found in saliva, ovaries, skeletal mm and GB)

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6
Q

T/F: pts w/ chronic pancreatitis might NOT have increase in amylase. Why?

A

TRUE.

Acinar cells destroyed–> no amylase

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7
Q

Although Lipase is more specific to pancreatic dz than amylase, what 2 othe rconditions is it seen in?

A
  1. renal failure
  2. intestinal infarction/obstruction
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8
Q

What is the definition of acute pancreatitis?

A

Inflammatory disease characterized by autodigestion of panc by proteolytic enzymes prematurely activated w/in the pancrease]

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9
Q

What are the 2 main etiologies of acute pancreatitis?

A
  1. Alcohol
  2. Gallstones
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10
Q

What is the MC mechanical cause of pancreatitis

A

gallstones

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11
Q

What is the MC metabolic cause of acute pancreatitis

A

alcohol

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12
Q

Other than alcohol, what is another metabolic etiology of pancreatitis

A

hypertriglyceridemia

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13
Q

Pt presents with constant, “boring” midepigastric pain radiating to the back—> what dx are you thinking

A

acute pancreatitis

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14
Q

what makes acute pancreatitis worse? better?

A

worse: lying supine
better: sitting and leaning forward

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15
Q

What is the tx for acute pancreatitis?

A
  1. Admit

2. keep NPO

  1. IV fluids​
  2. Strong pain meds
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16
Q

If a patient has signs of acute pancreatitis in addition to jaundice, what are you thinking is the cause?

A

biliary obstruction

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17
Q

What is heard on auscultation of the abdomen in acute pancreatitis

A

bowel sounds hypoactive or absent

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18
Q

What is Cullens sign and Grey Turners sign? what are they indicative of?

A

Cullens: Periumbilical ecchymosis (Cullens= around the Core)

Grey-Turner’s: Flank ecchymosis

****signs of hemorrhagic pancreatitis***

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19
Q

Amylase and lipase are >____x abnormal in acute pancreatitis

20
Q

What 2 lab findings suggest gallstone pancreatitis

Study These Flashcards
A

LFTs: transient elevations

  • ALT> 150
  • Increased bilirubin
21
Q

Will WBC be elevated in acute pancreatitis>

22
Q

Although abdominal x-ray has limited role in dx of acute pancreatitis, what might it show?

Study These Flashcards
A

sentinel loop of dilated bowel

+/- calcified gallstones in RUQ

23
Q

Why would you order a CXR if you are concerned for acute pancreatitis?

Study These Flashcards
A

r/o pulmonary infiltrates or pleural effusions

24
Q

What will be on CT in acute pancreatitis?

Study These Flashcards
A

enlargement of pancreas

blurring of fat planes/fat stranding

25
What are the 4 complicatiosn of acute pancreatitis
1. necrosis 2. Pseudocysts 3. Abscess 4. Hemorrhage ("He NAPs")
26
What are the 3 reasons to order a CT to eval for acute pancreatitis?
1. For diagnosis (but not always necessary) 2. Identify severity of disease 3. Identify complications (necrosis, pseudocysts, abscess, hemorrhage)
27
Which imaging has the following advantages over CT: * lower risk of hepatotoxicity * Better view of **_biliary and pancreatic ducts_**
MRI/MRCP
28
Which diagnostic study is newer, has increased sensitivity and can be diagnostic and therapeutic
**ERCP** (able to visualize biliary and pancreatic ductal anatomy, obtain cytology/biopsy and can be therapeutic- stone removal, stent insertion, sphincterotony)
29
What 3 things is extrahepatic biliary obstruction caused by
1. Gallstones 2. pancreatitis 3. pancreatic cancer
30
31
When are abx indicated in a patient w/ acute pancreatitis
when infected necrosis is a concern | (Imipenem)
32
What are 3 early identification signs of complications of acute pancreatitis?
1. decreased UOP/ rising SrCr 2. resp failure 3. Inc. pain, F, leukocytosis
33
What are 5 local complications of acute pancreatitis?
1. pseudocyst 2. Pancreatic abscess 3. pancreatic necrosis 4. Hemorrhage (signs= cullens and grey turners) 5. Ascites ("He NAPs because of his Ascites")
34
When would you suspect a pancreatic abscess? (3\_
suspect w/ fever, increased WBC, clinical deterioraion
35
Which condition? * Abd pain * **_Early satiety_** * N/V
Pancreatic pseudocyst
36
T/F: pancreatic pseudocysts can spontaneously resolve or continue to enlarge
true (so only intervene if signs of infection)
37
What are the 3 complications of pancreatic pseudocyst
1. Rupture 2. Hemorrhage 3. Infection
38
When is surgery or drainage indicated in pancreatic pseudocyst?
if symptomatic or infected
39
Complication of acute pancreatitis: ## Footnote **What is a pancreatic pseudocyst?**
collection of fluid and debri; no epithelial lining; fibrotic wall
40
Complications of acute pancreatitis: ## Footnote **What is a pancreatic abscess? You would suspect this when you see what 3 things?**
* infected pseudocyst or necrotic area * Suspect w/ F, increased WBC, clinical deterioration
41
What are the 5 systemic complications of Acute pancreatitis?
1. Pulmonary- resp failure/ARDS, pulm edema, pleural effusions, atelectasis 2. Renal failure 3. Hypotension/shock 4. Ileus 5. Hyperglycemia/hypocalcemia
42
What are 2 metabolic complications of acute pancreatitis?
hyperglycemia hypocalcemia
43
The following are all components of what criteria used to determine prognosis of Acute pancreatits? (see attached pic)
Ranson's criteria
45
Age \> _____ is part of Ransons criteria (used for prognosis of acute pancreatitis)
55
46
Mortality of Acute pancreatitis realted to number of Ranson's signs: 0-2= \_\_\_% 3-4= \_\_\_% 5-6= \_\_\_% 7-8= \_\_\_\_%
0-2= \<1% 3-4= 15% 5-6= 40% 7-8= 100%
47
How do you prevent recurrence of biliary pancreatitis?
ERCP if CBD stone Elective CCY

F3 E3 Shea (24 decks)

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