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Flashcards in Pancreatic Disease Deck (47):
1

what is the pancreatic duct?

duct of wirsung
empties into SB at ampulla of vater

2

what is the accessory duct?

duct of santorini
empties into SB superior to pancreatic duct

3

what makes up 99% of the pancreas?

acini (responsible for exocrine functions)

4

how much fluid does pancreas make?

1.5L

5

what is consistency of pancreatic juices?

clear, colorless, water, has salts, is alkaline and contains digestive enzymes (7.1-8.2-bicarb)

6

what does amylase do?

digests carbs

7

what does lipase do?

digests triglycerides

8

what do trypsin and chymotrypsin do?

protein digestion

9

what does the pancreatic polypeptide do?

inhibits secretion of somatostatin

10

what does somatostatin do?

inhibits secretion of insulin and slows absorption of nutrients

11

why is pancreas exocrine function important?

alteration can lead to malabsorption
-diarrhea, fat soluble vitamin loss

12

what is auto-digestion?

early activation of inactive pro-enzymes (caused by injury)

13

what is the MCC of acute pancreatitis?

gallstones
alcohol (2nd)
together account for 65%

14

what is MCC of metabolic pancreatitis?

hyperlipidemia (>2000 triglycerides)

15

what are hereditary causes of acute pancreatitis?

cystic fibrosis (plugs pancreas ducts)
hereditary

16

what is post _ERCP pancreatitis?

manipulation during surgery causes problem, can be more severe

17

what is MC drug related to acute pancreatitis?

HCTZ

18

what are features of acute pancreatitis?

1. discrete episode
2. abd pain severe, epigastrium
3. n/v
4. elevated amylase, lipase (2-3 times upper limit)

19

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

20

what indicates poor prognosis with acute pancreatitis?

Cullens or Turners sign

21

which lab test is more specific for acute pancreatitis?

lipase-is elevated longer (single best marker for pancreatitis)

22

which enzyme level increases first?

amylase

23

what is a very bad sign for blood test in acute pancreatitis?

elevated Hgb, hematocrit

24

what is another bad sign for blood work in acute pancreatitis?

elevated CRP >150 at 48 hrs

25

why test the triglycerides?

if it is very high, you can correct and improve problem going forward

26

what is the purpose of a plain film?

r/o surgical emergency

27

what is a sentinel loop?

focal pocket of air caused by slowed motility

28

what is role of CT scan for pancreas?

evaluate staging and r/o pancreatic necrosis

29

what is the role of MRI scan for pancreas?

better at differentiating pseudocysts

30

what is the role of US for pancreas?

r/o GB stones and biliary dilation

31

when would you do ERCP?

limited use in acute phase, usually let all inflammation calm down first

32

which criteria do you use to assess pancreatitis?

Ranson's criteria, admit or not, complications or not
more points = more mortality

33

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)

34

what is an bad complication of pancreatitis?

renal failure
pancreatic necrosis

35

what differentiates pseudocysts from regular cysts?

pseudocyst is lined with granulation tissue (inflammatory) as opposed to true cysts that are lined with epithelium

36

when does it become a pseudocyst?

after 4 weeks of being there

37

when would you drain pseudocyst?

only if they are really big

38

what is chronic pancreatitis?

repeated injuries interrupt the pancreas's ability to function appropriately

39

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

40

how do you treat chronic pancreatitis?

low fat diet
pancreatic enzymes
NO ETOH-inc cancer risk
NO SMOKING-inc cancer risk
screen for cancer

41

what is MC type of pancreatic cancer?

ductal epithelium

42

how do pancreatic cancer pts present?

wt loss**
Obstructive jaundice (painless)**
new onset DM
epigastric pain
n/v

43

when is jaundice a/w cancer?

painless
with pain is a/w stones and other causes

44

what tells you about resectability of pancreas tumor?

CT w/thin slice
Endoscopic ultrasound (EUS)-determines blood vessel involvement

45

what is the pancreatic tumor marker?

CA19-9
levels >1000 mean its unresectable

46

which arteries determine resectability of pancreatic tumor?

SMA, ?

47

what is surgery for pancreatic cancer called?

whipple

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