what is the pancreatic duct?
duct of wirsung
empties into SB at ampulla of vater
what is the accessory duct?
duct of santorini
empties into SB superior to pancreatic duct
what makes up 99% of the pancreas?
acini (responsible for exocrine functions)
how much fluid does pancreas make?
1.5L
what is consistency of pancreatic juices?
clear, colorless, water, has salts, is alkaline and contains digestive enzymes (7.1-8.2-bicarb)
what does amylase do?
digests carbs
what does lipase do?
digests triglycerides
what do trypsin and chymotrypsin do?
protein digestion
what does the pancreatic polypeptide do?
inhibits secretion of somatostatin
what does somatostatin do?
inhibits secretion of insulin and slows absorption of nutrients
why is pancreas exocrine function important?
alteration can lead to malabsorption
-diarrhea, fat soluble vitamin loss
what is auto-digestion?
early activation of inactive pro-enzymes (caused by injury)
what is the MCC of acute pancreatitis?
gallstones
alcohol (2nd)
together account for 65%
what is MCC of metabolic pancreatitis?
hyperlipidemia (>2000 triglycerides)
what are hereditary causes of acute pancreatitis?
cystic fibrosis (plugs pancreas ducts) hereditary
what is post _ERCP pancreatitis?
manipulation during surgery causes problem, can be more severe
what is MC drug related to acute pancreatitis?
HCTZ
what are features of acute pancreatitis?
- discrete episode
- abd pain severe, epigastrium
- n/v
- elevated amylase, lipase (2-3 times upper limit)
what is CC of pancreatitis pt?
abrupt onset severe, persistent epigastric radiating to the back lasts hours to days n/v but no relief made better by lying down
what indicates poor prognosis with acute pancreatitis?
Cullens or Turners sign
which lab test is more specific for acute pancreatitis?
lipase-is elevated longer (single best marker for pancreatitis)
which enzyme level increases first?
amylase
what is a very bad sign for blood test in acute pancreatitis?
elevated Hgb, hematocrit
what is another bad sign for blood work in acute pancreatitis?
elevated CRP >150 at 48 hrs
why test the triglycerides?
if it is very high, you can correct and improve problem going forward
what is the purpose of a plain film?
r/o surgical emergency
what is a sentinel loop?
focal pocket of air caused by slowed motility
what is role of CT scan for pancreas?
evaluate staging and r/o pancreatic necrosis
what is the role of MRI scan for pancreas?
better at differentiating pseudocysts
what is the role of US for pancreas?
r/o GB stones and biliary dilation
when would you do ERCP?
limited use in acute phase, usually let all inflammation calm down first
which criteria do you use to assess pancreatitis?
Ranson’s criteria, admit or not, complications or not
more points = more mortality
what is the txment approach for pancreatitis?
NPO, NPO Fluids, fluids, fluids anti-emetic analgesics (demerol, dilaudid) NG tube (in case of ileus) abx (no for mild)
what is an bad complication of pancreatitis?
renal failure
pancreatic necrosis
what differentiates pseudocysts from regular cysts?
pseudocyst is lined with granulation tissue (inflammatory) as opposed to true cysts that are lined with epithelium
when does it become a pseudocyst?
after 4 weeks of being there
when would you drain pseudocyst?
only if they are really big
what is chronic pancreatitis?
repeated injuries interrupt the pancreas’s ability to function appropriately
what are sxs of chronic pancreatitis?
chronic pain (worse with fatty, greasy food)
steatorrhea (yellowish, oily, floating stools)
malabsorption (loss of ADEK-fat soluble nutrients)
weight loss
how do you treat chronic pancreatitis?
low fat diet pancreatic enzymes NO ETOH-inc cancer risk NO SMOKING-inc cancer risk screen for cancer
what is MC type of pancreatic cancer?
ductal epithelium
how do pancreatic cancer pts present?
wt loss** Obstructive jaundice (painless)** new onset DM epigastric pain n/v
when is jaundice a/w cancer?
painless
with pain is a/w stones and other causes
what tells you about resectability of pancreas tumor?
CT w/thin slice Endoscopic ultrasound (EUS)-determines blood vessel involvement
what is the pancreatic tumor marker?
CA19-9
levels >1000 mean its unresectable
which arteries determine resectability of pancreatic tumor?
SMA, ?
what is surgery for pancreatic cancer called?
whipple
