Pancreas - Exam 4 Flashcards by Johannah Crumpton

What cavity is the pancreas located in?

retroperitoneal

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_____ connects the main pancreatic duct to the duodenum

major duodenal papilla

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What are the exocrine functions of the pancreas? What the generic responsibilities of each?

Pancreatic protease-> protein digestion, lipase -> triglycerides and amylase -> carbohydrate digestion

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What are the endocrine functions of the pancreas?

Insulin and glucagon

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________ secrete pancreatic enzymes into the pancreatic duct while ______ lining the small pancreatic ducts secrete ______.

Acinar cells

epithelial cells

bicarbonate

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What are the two major pancreatic proteases?

trypsin and chymotrypsin

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Pancreatic _______ responsible for hydrolysis of triglyceride molecule into _______ and _______ which can be absorbed via intestinal mucosa

Lipase

monoglyceride

two free fatty acids

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Pancreatic ______ responsible for carbohydrate utilization via hydrolysis of _____ to _____

Amylase

starch

maltose

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________ multiple spherical groups of epithelial cells embedded as nodules in the endocrine pancreas which are surrounded by a rich capillary plexus. Most numerous in the ____ and make up 2% of the pancreas.

Islets of Langerhans

tail

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_______ (15-20% of the islets)secrete _______ which raises blood glucose levels by accelerating conversion of liver glycogen into glucose.

Alpha cells

glucagon

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______ (60-70% of the islets) secrete _____ which influences carbohydrate metabolism enabling glucose utilization

Beta cells

insulin

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______ (5-10% of the islets) secrete _______ which inhibits insulin and glucagon secretion

Delta cells

somatostatin

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Which cell type is the most abundant in the pancreas?

Beta cells 60-70%

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______ is the leading cause of gastrointestinal-related hospitalization in the United States

acute pancreatitis

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What are the top 2 causes of acute pancreatitis? Which one is the MC?

Gallstone is MC

heavy alcohol intake: NOT a single binge drink

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______ may reduce the risk of non biliary pancreatitis

Coffee drinking

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**What are the 10 causes of acute pancreatitis? What is the acronmyn to help remember them?

I GET SMASHED

Idiopathic causes
G = Obstruction by Gallstones
E = is Ethanol, or alcohol use, and it is not sure how it leads to pancreatitis.
T = Trauma

S = Steroids
M = infection with Mumps virus
A = Autoimmune diseases, like systemic lupus erythematosus and rheumatoid arthritis.
S = Scorpion sting, which also damages the pancreas directly.
H = Hypertriglyceridemia and Hypercalcemia.
E = Trauma from an ERCP
D = Drugs, like didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, and Diuretics

Drugs Causing A Violent Abdominal Distress

aka but mostly alcohol and gallstones

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What are the 3 pathophys causes behind acute pancreatitis?

Edema or obstruction at ampulla of Vater

premature or overactivation of pancreatic enzymes

autodigestions (when enzymes are activated in the pancreas acinar cell compartment rather than the intestinal lumen)

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What is the pathophys of gallstone induced acute pancreatitis? What does it lead to? What enzyme in particular?

Early event is blockade of secretion of pancreatic enzymes while the synthesis of them continues

leads to autodigestive injury to the gland

trypsin

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________ happens d/t pancreatic enzymes that damage the vascular endothelium. Name some changes seen. What do these changes lead to?

Microcirculatory injury, vasoconstriction, capillary stasis, decreased oxygen saturation, progressive ischemia

changes lead to increased vascular permeability and swelling of the gland

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In summary, activated ______, ________, and the release of ________ lead to a rapid worsening of pancreatic damage and necrosis

pancreatic enzymes
microcirculatory impairment
inflammatory mediators

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How does acute pancreatitis present? Describe the timing. What makes it better? What makes it worse?

Epigastric abdominal pain that radiates to the back

sudden onset, steady and severe

worse with activity and lying supine

improves with leaning forward

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What are 2 pt history points that would be consistent with acute pancreatitis?

Binge or heavy drinking just prior to symptoms, history of consuming a fatty meal just prior to symptom onset

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______ will be seen in acute pancreatitis if it is associated with ampulla of vater blockage

jaundice

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**What is the cullen’s sign?

ecchymotic discoloration observed in the periumbilical region

**What is the Grey Turner sign?

ecchymotic discoloration observed along the flank

What do the presence of Cullen’s sign and Grey Turner sign suggest?

Retroperitoneal bleeding

**What are the 2 ways to classify acute pancreatis?

According to morphology and according to severity

**According to the Atlanta classifications, what are the 2 options for acute pancreatitis?

Acute interstitial edematous pancreatitis : blood supply is maintained and Necrotizing acute pancreatitis : blood supply is not maintained

**What are the acute pancreatitis classifications according to severity?

** What are the 2 labs that you need to get if concerned about acute pancreatitis? Which one is more sensitive?

Serum amylase and serum lipase -> more sensitive

What are 2 findings on xray that would point towards acute pancreatitis? Give a brief interpretation of each

“Sentinel Loop” and “Colon Cut-Off Sign” “Sentinel Loop” - Dilated air filled small intestine near the pancreas “Colon Cut-Off Sign” - Gas filled segment of transverse colon abruptly ending near pancreas due to functional spasm of descending colon secondary to pancreatic inflammation

When would an US be helpful in acute pancreatitis?

Helpful if looking for stone in suspected biliary pancreatitis but otherwise NOT helpful

What would a CT scan show in acute pancreatitis?

Enlarged pancreas and signs of inflammation associated with acute pancreatitis.

What are the essentials of dx for acute pancreatitis?

What is needed to dx acute pancreatis? Do you need imaging?

In patients with characteristic abdominal pain and elevation in serum lipase/amylase to 3 times or greater than the upper limit of normal No imaging is required to establish the diagnosis

When would you order imaging if acute pancreatitis is suspected? What imaging would you order?

Abdominal pain is NOT characteristic, amylase/lipase levels are less than 3x ULN abdominal CT WITH contrast

______ is the criteria used in acute pancreatitis to assess severity and prognosis

Ranson's Criteria

**What are the parameters for Ranson’s criteria?

______ is the simplest criteria when determining the severity/prognosis of AP. What is the criteria?

BISAP

What is the tx for mild AP? What do you NOT want to give the pt? Why?

once s/s resolves plus clear liquids and slowly advancing diet DO NOT GIVE MORPHINE because Morphine may cause sphincter of Oddi spasm

What is the tx for severe AP?

What are 3 complications of AP?

Pancreatic abscess Acute peripancreatic fluid collection Pancreatic Pseudocyst

When does a pancreatic pseudocyst occur? Describe it.

Occur more than 4 weeks after onset Encapsulated collection of fluid with well defined inflammatory wall Fluid collections outside of the pancreas

What does chronic pancreatitis involve?

A syndrome involving inflammation, fibrosis, and loss of acinar and islet cells

What is the MC etiology in chronic pancreatitis?

Alcoholism +/- smoking

What is the MC eitology of chronic pancreatitis in children?

Cystic fibrosis

What is the pathophys behind chronic pancreatitis? What does the persistent inflammation cause?

Persistent inflammation of the pancreas resulting in permanent structural damage changes to structures including fibrosis atrophy and calcification that leads to IRREVERSIBLE damage

What is the clinical presentation of chronic pancreatitis?

Chronic, steady or intermittent epigastric, LUQ pain- radiates to back; worse 15-20 min after eating

65% of chronic pancreatitis pts either have ______ or ______.

Osteopenia or osteoporosis

______ is the MC reason for hospitalization in chronic pancreatitis. What would prompt a search for a complication of chronic pancreatitis?

PAIN A change in pattern or sudden worsening of pain

In CP, what is the cause of the pain due to?

The cause of pain is due to increased pressure, ischemia, and inflammation of the pancreas

What will serium amylase/lipase levels show in CP?

Slightly elevated but can also be NORMAL

What is the most frequently utilized imaging study in chronic pancreatitis? What will endoscopic US show?

CT because able to image entire pancreas and pancreatic ducts “honeycombing” of pancreas

What are 6 complications of chronic pancreatis? What is the main cause of death?

Pseduocysts DM malabsorption deficiency opioid addiction disability reduced life expectancy pancreatic carcinoma- main cause of death

What is the non-invasive tx for chronic pancreatitis?

Low fat diet, avoid alcohol, manage pain, pancreatic digestive enzymes, insulin as needed, tx any malabsorptive disorders

What are the invasive tx options for CP?

ERCP for stone extraction or decompression of pancreatic duct, Puestow procedure for dilated pancreatic duct, Whipple procedure, surgical drainage of pseudocysts, pain management

What is the Puestow Procedure?

“filet” open the pancreas and sew it to the jejunum

**Where is the major of pancreatic cancer located? Which location indicates a poorer prognosis?

75% in head, 25% in body and tail-> poorer prognosis

**What cell type is pancreatic carcinoma most likely?

85% are adenocarcinoma

What does an older pt with new onset DM make you think?

Possible pancreatic cancer

What is the MC presentation of pancreatic cancer?

Vague epigastric pain with radiation to back, typically gnawing, visceral with insidious onset. Can also be asymptomatic until metastasis has occurred

**What is Courvoisier sign? What is it due to?

Painless Jaundice and Enlarged palpable gallbladder, Due to tumor of pancreatic head causing obstruction of common bile duct

In advanced carcinoma of the pancreas, what node may be palpable?

hard periumbilical nodule called the Sister Mary Joseph node.

What cancer maker may or may not be positive in pancreatic cancer? What will amylase and lipase levels look like?

+ or - CA 19-9 tumor marker, Amylase, Lipase - normal to mildly elevated

What is the first line imaging in pancreatic cancer?

CT, can also do CT with FNA for cytologic studies

What is the “double duct?”

Simultaneous dilation of pancreatic and common bile duct that is confirmatory for pancreatic cancer on ERCP if CT was inconclusive

What is the tx for pancreatic cancer is dz is local and in the head? Give a brief description.

Whipple procedure then chemo/radiation, Removal pancreatic head, duodenum, first 15cm of jejunum, common bile duct, gallbladder, and a partial gastrectomy

What is the tx for pancreatic cancer if the cancer is in the tail? What do you need to do first?

Distal pancreatectomy with splenectomy, staging laparascopy first to visualize

What makes pancreatic cancer non-resectable?

Liver, peritoneum, and omentum mets, Encasement of superior mesenteric artery/vein, Extension into inferior vena cava

What is the screening recommendation for pancreatic cancer?

Patients with a family history (1st degree relative) with pancreatic cancer should have screening CT age 40-45 or 10 years before onest of cancer in the family member

________ and ______ are the keys in pancreatic cancer

Early recognition and prevention

What are the 4 pt education points for pancreatic cancer prevention?

Don’t smoke, limit alcohol, maintain a healthy weight, know your family hx, be familiar with common symptoms ( jaundice, unexplained weight loss, stomach pain that radiates to the back

What is the difference between ERCP and MRCP?

ERCP is more invasive, uses sedation but can visualize and treat the cause at the same time (stone removal) vs MRCP only visualizes but does NOT use sedation

Pancreas - Exam 4 Flashcards

(75 cards)