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clin med III, exam 2 > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

(47 cards)

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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)

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A

Moderately-severe

20
Q

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

21
Q

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

Study These Flashcards
A

interstitial edematous acute

22
Q

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

Study These Flashcards
A

Necrotizing acute

23
Q

managment of acute pancreatitis

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

what are some local complications associaton with acute pancreatitis

Study These Flashcards
A
  • Psuedocyst
  • Pancreatic abscess
  • pancreatic necrosis
  • hemorrhage
  • ascites
25
What are some systemic complications of acute pancreatitis
* pulmonary edema, pleural effusion, respiratory failure * renal failure * hypotension, shock * ileus * hyperglycemia, hypocalcemia
26
what are two assessments you can use to help determine prognosis of acute pancreatitis
* Ranson's criteria * Acute physiology and chronic health evaluation (APACHE)
27
define chronic pancreatitis
* repeated episodes of acute inflammation leading to permanent structural damage and ductal obstruction * gradual loss of pancreatic function -\> endocrine and exocrine insufficiency
28
what is the most common cause of chronic pancreatitis
alcohol
29
What is the classic triad of chronic pancreatitis
1. **​Diabetes**: due to endocrine dysfunction 2. **Steatorhea**: due to exocrine dysfunction 3. **Pancreatic calcifications**
30
what lab testing can be done to evaluate for chronic pancreatitis
* normal amylase, lipase * elevated glucose * increase in fecal fat testing * 72 hr quantitative fecal fat
31
gold standard imaging study for evaluation of chronic pancreatitis
* ERCP * will show **chain of lakes**
32
behavior modification in managment of chronic pancreatitis
* abstinence from alcohol * small, low fat meals * smoking cessation
33
medication managment of chronic pancreatitis
* pancreatic enzyme supplements * amitriptyline or SSRI * narcotic pain meds
34
most common form of pancreatic cancer (cancer of exocrine pancreas)
* **ductal adenocarcinoma** * majority of tumors in the head of pancreas
35
what percentage of pancreatic cysts are neoplastic
15%
36
risk factors for pancreatic carcinoma
* male * african american * \> 45 yo * smoking, alcohol, chronic pancreatitis, DM, obesity, FHx
37
clinical presentation * jaundice * hepatomegaly * mass * cachexia * courvoisier's sign: non tender palpable distended gallbladder * paraneoplastic syndrome
pancreatic carcinoma
38
Virchow's node
* left supraclavicular adenopathy * sign of metastatic abd disease
39
sister mary josephs node
* palpable periumbilical mass * sign of metastatic abd disease
40
what is blumers shelf
* palpable rectal shelf * sign of metastatic abd disease
41
what is the lab marker for pancreatic carcinoma
* **CA 19-9** * elevations relative to tumor size
42
imaging modality used in diagnosis of pancreatic cancer
CT scan * stages disease and identifies eligibility for resection
43
what sign on ERCP is consistent with pancreatic carcinoma
* "double duct sign" * stricture of both CBD and pancreatic ducts * can also obtain tissue sample
44
use of EUS (endoscopic US) in assesment of pancreatic carcinoma
* evalutaes local tumor involvement, vascular involvement and best for tissue diagnosis with **FNA biopsy**
45
If jaundice is present, evaluate using what imaging modalities
* US * ERCP * MRCP
46
If epigastric pain and/or weight loss is present, evaluate using what imaging modalities
abdominal CT
47
surgical resection of pancreatic carcinoma is done via what
Whipple procedure

clin med III, exam 2 (6 decks)

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