Pancreas Flashcards
What are products of the exocrine pancreas?
- trypsinogen
- chymotrypsinogen
- procarboxypeptidase
- proelastase
- kallikreinogen
- prophospholipase
**are all zymogens**
What is the most common congenital anomaly of the pancreas?
(associations)
pancreas divisum:
- failure of the ventral and dorsal buds to fuse -> two pancreatic ductal systems (one independent of ampula of Vater)
- associated with chronic pancreatitis
What is annular pancreas?
abnormal rotation of a bilobed, ventral pancreatic bud:
-one wraps around each direction encircling duodenum -> obstruction
Where is ectopic pancreatic tissue most commonly seen?
What symptoms are associated with it?
- stomach
- duodenum
- Meckel diverticulum
Complications:
- pain
- mucosal bleeding
Which is more specific for pancreatitis, amylase or lipase?
Why?
Lipase more specific
Amylase is more likely to be elevated for other causes:
- intestinal obstruction
- gastroenteritis
- mumps
- ectopic pregnancy
- surgery
- opoids
What causes the damage to the pancreas in acute and chronic pancreatitis?
autodigestion by prematurely activated pancreatic enzymes
What normally prevents autodigestion of the pancreas?
- pancreatic enzymes are secreted as inactive zymogens
- most of the zymogens are activated by trypsin, which is activated by an enzyme in the duodenum
- ductal cells secrete trypsin inhibitos (SPINK1)
What are major (nongenetic) causes of acute pancreatitis?
- alcohol (male predominant)
- gallstones (female predominant)
- surgery
- trauma
- ERCP/MRCP
- medications
- infections (mumps, CMV, MAC)
What are genetic causes of pancreatitis?
- cystic fibrosis (CFTR)
- tyrpsin GoF (PRSS1)
- trypsin inhibitor LoF (SPINK1)
What factors are protective against acute pancreatitis?
- never smoker
- active lifestyle
How does acute pancreatitis present?
- constant epigastric pain radiating to back
- N/V
- hypotension
- tachycardia
Rare:
- Cullen sign (periumbilical ecchymosis)
- Gery Turner sign (flank ecchymosis)
What are the morphologic features of acute panreatitis?
- microvascular leak -> edema
- fat necrosis
- inflammation
- autodigestion
- vessel destruction -> hemorrhage
What are the diagnostic criteria for acute pancreatitis?
2 of 3:
- epigastric pain
- lipase 3x ULN
- CT changes
What labs should be orderd for acute pancreatitis and what is abnormal?
- amylase/lipase
- CBC (leukocytosis, HCT elevated = fluid loss, decreased = hemorrhage)
- CMP -> hypocalcemia, hyperglycemia, elevated BUN/creatinine, elevated ALP
lipid panel
- PT/INR - increased
- UA -> proteinuria
- elevated CRP
What are radiolgic features of acute panreatitis?
CT:
-enlarged pancreas with edema
XR:
- sentinal loop: segement of dilated, air-filled intestine in RUQ
- colon cutoff sign: air-filled, distended colon ending at pancreas
What are prognostic indicators for acute pancreatitis?
- Ranson criteria
- BISAP
- APACHE II
What is Ranson criteria?
prognostic predictor of acute pancreatitis
At admission (GA-LAW)
- glucose >200
- age >55
- LDH >350
- AST >250
- WBC >16,000
48 hours after admission (C & HOBBS):
- calcium <8
- hematocrit drop >10%
- oxygen <60 mmHg
- base deficit >4
- BUN increase >5
- sequestration of >6L of fluid
What is BISAP score?
prognostic indicator of acute pancreatitis:
- BUN >25
- Impaired (mental status)
- SIRS criteria >=2/4
- Age >60
- Pleural effusion
What is APACHE II?
prognostic indicator of all severly ill patients (not just pancreatitis)
-highly mutltivariable
What signs present in acute pancreatitis due to hypocalcemia?
Chvostek sign:
-twitching muscles innervated by facial nerve
Trousseau sign:
-hand posturing with inflation of BP cuff over systolic pressure for >3 mins
How is acute pancreatitis treated?
- FLUID RESUSCITATION
- NPO (pancreatic rest)
- bed rest
- pain control
- surgical consult
What are systemic manifestations of acute pancreatitis?
- ARDS
- acute renal failure
- shock
- sepsis
- DIC
What are complicaitons of acute pancreatitis?
- voume depletion (3rd spacing)
- pleural effusion
- necrosis
- pseudocysts
- ARDS
- ascites
- chronic pancreatitis
What is chronic pancreatitis?
prolonged inflammation of pancreas leading to destruction and fibrosis -> loss of function
