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clin med III, exam 2 > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

vascular supply to pancreas

A
  • celiac axis
  • SMA
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2
Q

where does the head of the pancreas lie

A

next to duodenum

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3
Q

describe pancreatic ductal anatomy

A
  • main pancreatic duct -> major papilla
  • accessory pancreatic duct -> minor papilla
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4
Q

What is the Exocrine function of the pancreas

A
  • Amylase: breakdown starch
  • Lipase: breakdown fat
  • Proteases: breakdown proteins
    • pancreatic juice: electrolytes, bicarbonate, digestive enzymes
      • release stimulated by
        • gastric acid
        • CCK
        • vagal stimulation
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5
Q

What is the Endocrine function of the pancreas

A
  • Insulin -> increases permeability of cell membranes to glucose
  • Glucagon -> stimulates liver to convert glycogen to glucose and stimulates gluconeogenesis
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6
Q

define acute pancreatitis

A
  • acute inflammatory process of pancreas
    • characterized by autodigestion of pancreas by proteolytic enzymes prematurely activated within the pancreas
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7
Q

what are the two most common causes of acute pancreatitis

A
  • alcohol
  • gallstones
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8
Q

what level of triglycerides are related to acute pancreatitis

A

hypertriglyceridemia

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9
Q

clinical presentation

  • acute, may be after eating meal
  • severe, persistent midepigastric pain, radiates to back
  • worse lying supine
  • relieved by sitting and leaning forward
  • anorexia, N/V, abd distension
A

acute pancreatitis

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10
Q

what is cullen’s sign

A

periumbilical eccymosis

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11
Q

what is Grey-Turners sign

A

flank ecchymosis

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12
Q

What are labs you would expect to be elevated in acute pancreatitis

A
  • Amylase
  • Lipase
  • WBC
  • HCT : due to dehydration
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13
Q

a ALT > 150 with elevated biliruben is suggestive of

A

gallstone pancreatitis

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14
Q

what imaging modality is used for diagnosed of acute pancreatitis

A
  • CT scan of the abdomen
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15
Q

When would you order a MRI/MRCP in assesment of acute pancreatitis

A
  • helpful if CBD stone not visualized on CT or US and biliary pancreatitis expected
    • lower risk of nephrotoxicity than CT
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16
Q

function of ERCP in evaluation of acute pancreatitis

A
  • visualize biliary and pancreatic ductal anatomy
  • may obtain cytology or biopsy
  • may be therapeutic
    • stone removal
    • stent insertion
    • sphincterotomy
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17
Q

list 3 most common causes of extrahepatic biliary obstruction

A
  1. gallstones
  2. pancreatitis
  3. pancreatic cancer
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18
Q

what is this classification of acute pancreatitis: absence of organ failure and local or systemic complications

A

Mild acute

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19
Q

what is this classification of acute pancreatitis: transient organ failure and/or local or systemic complications without persistent organ failure (<48 hrs)

A

Moderately-severe

20
Q

what is this classification of acute pancreatitis: persistent organ failure involving one or more organs

A

severe

21
Q

what is this classification of acute pancreatitis: characterized by acute inflammation of the pancreatic parenchyma and peripancreatic tissues, w/o necrosis

A

interstitial edematous acute

22
Q

what is this classification of acute pancreatitis: characterized by inflammation associated with parenchymal necrosis and or peripancreatic necrosis

A

Necrotizing acute

23
Q

managment of acute pancreatitis

A
  • hydration: Iv fluids
  • diet: NPO
  • pain control
  • monitor glucose control
24
Q

what are some local complications associaton with acute pancreatitis

A
  • Psuedocyst
  • Pancreatic abscess
  • pancreatic necrosis
  • hemorrhage
  • ascites
25
Q

What are some systemic complications of acute pancreatitis

A
  • pulmonary edema, pleural effusion, respiratory failure
  • renal failure
  • hypotension, shock
  • ileus
  • hyperglycemia, hypocalcemia
26
Q

what are two assessments you can use to help determine prognosis of acute pancreatitis

A
  • Ranson’s criteria
  • Acute physiology and chronic health evaluation (APACHE)
27
Q

define chronic pancreatitis

A
  • repeated episodes of acute inflammation leading to permanent structural damage and ductal obstruction
  • gradual loss of pancreatic function -> endocrine and exocrine insufficiency
28
Q

what is the most common cause of chronic pancreatitis

A

alcohol

29
Q

What is the classic triad of chronic pancreatitis

A
  1. ​Diabetes: due to endocrine dysfunction
  2. Steatorhea: due to exocrine dysfunction
  3. Pancreatic calcifications
30
Q

what lab testing can be done to evaluate for chronic pancreatitis

A
  • normal amylase, lipase
  • elevated glucose
  • increase in fecal fat testing
    • 72 hr quantitative fecal fat
31
Q

gold standard imaging study for evaluation of chronic pancreatitis

A
  • ERCP
    • will show chain of lakes
32
Q

behavior modification in managment of chronic pancreatitis

A
  • abstinence from alcohol
  • small, low fat meals
  • smoking cessation
33
Q

medication managment of chronic pancreatitis

A
  • pancreatic enzyme supplements
  • amitriptyline or SSRI
  • narcotic pain meds
34
Q

most common form of pancreatic cancer (cancer of exocrine pancreas)

A
  • ductal adenocarcinoma
  • majority of tumors in the head of pancreas
35
Q

what percentage of pancreatic cysts are neoplastic

A

15%

36
Q

risk factors for pancreatic carcinoma

A
  • male
  • african american
  • > 45 yo
  • smoking, alcohol, chronic pancreatitis, DM, obesity, FHx
37
Q

clinical presentation

  • jaundice
  • hepatomegaly
  • mass
  • cachexia
  • courvoisier’s sign: non tender palpable distended gallbladder
  • paraneoplastic syndrome
A

pancreatic carcinoma

38
Q

Virchow’s node

A
  • left supraclavicular adenopathy
    • sign of metastatic abd disease
39
Q

sister mary josephs node

A
  • palpable periumbilical mass
  • sign of metastatic abd disease
40
Q

what is blumers shelf

A
  • palpable rectal shelf
  • sign of metastatic abd disease
41
Q

what is the lab marker for pancreatic carcinoma

A
  • CA 19-9
    • elevations relative to tumor size
42
Q

imaging modality used in diagnosis of pancreatic cancer

A

CT scan

  • stages disease and identifies eligibility for resection
43
Q

what sign on ERCP is consistent with pancreatic carcinoma

A
  • “double duct sign”
    • stricture of both CBD and pancreatic ducts
  • can also obtain tissue sample
44
Q

use of EUS (endoscopic US) in assesment of pancreatic carcinoma

A
  • evalutaes local tumor involvement, vascular involvement and best for tissue diagnosis with FNA biopsy
45
Q

If jaundice is present, evaluate using what imaging modalities

A
  • US
  • ERCP
  • MRCP
46
Q

If epigastric pain and/or weight loss is present, evaluate using what imaging modalities

A

abdominal CT

47
Q

surgical resection of pancreatic carcinoma is done via what

A

Whipple procedure

clin med III, exam 2 (6 decks)

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