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Flashcards in Pancreatic Disease Deck (77)
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1

Endocrine part of the pancreas

Islet of Langerhans
Produces and secretes hormone (insulin when increased blood glucose and glucagon when low blood glucose)

2

Exocrine part of the pancreas

Acinar cells to synthesize and secrete digestive enzymes into duodenum)
Pancreatic juice (electrolytes, bicarb and digestive enzymes to neutralize gastric acid and create basic environment)

3

What are the digestive enzymes from the pancreas?

Amylase: breakdown starch
Lipase: breakdown fat
Protease: breakdown protein

4

When do you see acute pancreatitis more?

In developed countries due to diet
Male is alcohol induced while female is gallstone induced
Usually only one episode (not much recurrence)

5

Causes of acute pancreatitis

Gallstones
Chronic alcohol abuse
Idiopathic (less)
Others: smoking, hypertriglyceridemia, hypercalcemia, meds, abd trauma or blunt trauma, infection, vascular disease, tumor, genetics or toxins

6

Pneumonic for causes of acute pancreatitis

I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion/snakes
Hyperlipidemia/hypercalcemia
ERCP
Drugs

7

How does acute pancreatitis happen?

High levels of activated trypsin--pancreatic auto-digestion, injury and inflammation--increased inflammation--leads to remote organ injury, systemic inflamm response, multi organ failure and death

8

Abd pain associated with acute pancreatitis

Acute, after eating
Midepigastric and radiates to back
Constant
Steady and boring
Worse when lying supine, food or alcohol
Better when sitting and leaning forward
Associated with anorexia, n/v, abd distension, jaundice , pallor or diaphoresis

9

PE for acute pancreatitis

Tachycardia, tachypnea, fever, hypotension
Guarding and decreased bowel sounds

10

Cause of acute pancreatitis based on finding: abd distension and hypoactive bowel sounds

Ileus

11

Cause of acute pancreatitis based on finding: scleral icterus

Choledocholithiasis or edema of pancreatic head

12

Cause of acute pancreatitis based on finding: hepatomegaly

Alcoholic abuse

13

Cause of acute pancreatitis based on finding: xanthomas

Hyperlipidemia

14

Cause of acute pancreatitis based on finding: parotid swelling

Mumps

15

What signs are seen with severe necrotizing pancreatitis?

Cullens: ecchymosis in periumbilical region
Grey turner: ecchymosis of flanks
Panniculitis: erythematous nodules

16

Labs in acute pancreatitis

Elevated WBC
Hyper or hypoglycemia
Hypercalcemia
Elevated bilirubin
ALT elevated
Elevated amylase and lipase
CRP >150 mg/dL at 48 hrs is severe

17

Amylase in acute pancreatitis

Rises in 6-12 hrs, pks in 48 hrs and normalizes in 3-5 days
Not as sensitive (some have normal)

18

Lipase in acute pancreatitis

Rises in 4-8 hrs, pks at 24 hrs and normalizes in 8-14 days
More sensitive to pancreatic injury

19

Urine trypsinogen-2 dipstick test for acute pancreatitis

Rapid and noninvasive
High sensitivity and specificity

20

Alanine aminotransferase (ALT) with acute pancreatitis

>150 U/L in first 48 hrs of sx onset has a high predictinf value for gallstone pancreatitis

21

When should you consider genetic testing with acute pancreatitis?

Strong family hx
<35 YO when onset
*should have genetic counseling before and after

22

Imaging done for acute pancreatitis

Abd x-ray: gall stones and sentinel loop
Abd us: gallstones
Abd CT: inflammation, calcification, pseudocyst, necrosis, abscess
MRCP
ERCP
Endoscopic US

23

What is a sentinel loop?

Small bowel inflammation and air from ileus formation

24

First diagnostic done with suspected pancreatitis

U/s

25

Diagnostics done with unexpained acute pancreatitis

Risk of malignancy so:
Abd CT with IV contrast (pancreas protocol)
MRI with MRCP
EUS

26

Diagnostics for recurrent pancreatitis

Consider EUS and/or ERCP (neoplasm or stricture)

27

Use of abdominal CT with acute pancreatitis

Diagnoses enlargment of the pancreas
IDs severity
IDs complications

28

What complications of acute pancreatitis can be seen on CT?

Necrosis
Pseudocyst
Abscess
Hemorrhage

29

What is done next when pt meets clinical and lab criteria for acute pancreatitis?

Nothing! (early CT is not recommended)

30

Why not use CT for most cases of acute pancreatitis?

Most are uncomplicated
No evidence that improves clinical outcomes
Complications really only appreciated 3 days after onset
IV contrast may worsen it