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year 5 - GIT Internal medicine > pancreatic disorders > Flashcards

pancreatic disorders Flashcards

(48 cards)

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1
Q

where is CKK secreted from ?

A

duodenal andd jejunal I cells

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2
Q

what is the stimulus for the secretion of CKK ?

A

products of protein digestion
fat and fatty acids

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3
Q

what is the acttion of CKK ?

A

stimulates pancreatic enzyme secretion
stimulates bile secretion from the liver
gallbladder contraction
reduces gastric emptying

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4
Q

what suppresses CKK ?

A

trypsin

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5
Q

how is the exocrine function of the pancreas regulated ?

A

regulated by vagal efferent

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6
Q

what are the causes of acute pancreatitis ?

A

GETSMASSSHED

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7
Q

what drugs are commonly associated with acute pancreatitis ?

A

azathioprine oestrogens
valproic acid
furosemide
sulphonamides

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8
Q

what trauma is highly associated with acutee pancreatitis ?

A

bicycle handlebar
steering wheel
surgery

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9
Q

most common etiologies of acute pancreatitis ?

A

gallstones and alcohol

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10
Q

what is the typical presentation of mild acute pancreatitis ?

A

epigastric pain that may radiate to the back
relieved by leaning forward
associated with nausea and vomiting

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11
Q

what is the presentation of severe acute pancreatitis ?

A

same as mild but with tachycardia hypotension and oliguria
reduced or absent bowel sounds

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12
Q

what speciific sifgns are associatwd with pancreatitis ?

A

cullen’s sign -periumbilical
grey turner’s sign - flank bruising

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13
Q

what are the differentials of epigastric pain ?

A

MI
acute/chronic pancreatitis
GERD
functional dyspepsia

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14
Q

how is a diagnosis of AP made ?

A

abdominal pain consistent with AP
elevation of amylase and lipase more than 3 times of the upper limit
characteristic findings found on abdominal imaging

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15
Q

what are the other causes of elevated amylase levels ?

A

diabetic ketoacidosis
gastroduodenal perforation
renal failure
mumps
macroamylasemia

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16
Q

what type of imaging must be performed ?

A

erect X ray must first be performed to exclude gastroduodenal perforation
abdominal X ray for gallstones or pancreatic calcifications
abdominal US

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17
Q

how can the severity of acute pancreatitis be measured ?

A

atlanta revision :

mild : absence of organ failure
absence of local symptoms
Moderately severe :
local complications or transient organ failure
severe :
persistent organ failure

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18
Q

which scoring system can be used as early as 24h and is higher in sensitivity ?

A

APACHE

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19
Q

what are the blood tests done for a patient with suspected AP ?

A

Serum Lipase
Serum Amylase
Urinary amylase
CRP level
repeated at 24 then 48h

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20
Q

if we needed to differentiate between fluid and solid masses of the pancreas what imaging modality should be used ?

21
Q

what is the preferred route for nutrition for acute pancreatitis ?

Study These Flashcards
A

in moderate and severe - enteral nutrition
nasogastric tube or nasojejunal tube

22
Q

what are the ccomplications of acute pancreatittis ?

Study These Flashcards
A

infected necrosis
pseudocyst
pancreatic ascites and pleural effusion

23
Q

what is the management for pseudocyst ?

Study These Flashcards
A

EEUS guided drainage
ERCP
if endoscopic treatment failed then surgery

24
Q

what is the best imaging modality for gallstones ?

Study These Flashcards
A

RUQ ultrasound

25
when is an abdominal CT indicated ?
with acute severe pancreatitis or worsening pancreatitis within 48-72 hours after admission
26
when is it appropriate to start antibiotics ?
if signs of systemic affection begin to appear such as systemic inflammatory response syndrome
27
when is cholecystectomy indicated with acute pancreatitis ?
acute biliary pancreatitis
28
at what age should pancreatic tumors be considered as an etiology for acute pancreatitis ?
above 40
29
when can hypertriglyceridemia be considered the etiology for pancreatitis ?
if the levels are above 1000
30
if choledocholithiasis iis highly suspected what is the next best step in management ?
MRCP
31
what makes chronic pancreatitis different from acute pancreatitis ?
chronic - irreversible damage and may present with malabsorption due to EPI
32
what are the different types of pancreatic secretory function tests ?
direct - CCk and secretin stimulated pancreatic function test ( double tube test ) indirect - Lundh test meal , fecal fat , fecal elastase , NBT-PABA
33
what is the most sensitive test for exocrine pancreatic function ?
secretin and CCK stimulated pancreatic function test
34
what lab test should be done for suspected autoimmune pancreatitis ?
serum IgG4 levels
35
what is the best investigation for initial assessment for AP ?
ultrasound
36
what is the management of chronic pancreatitis ?
prevent further pancreatic destruction treatment of clinical symptoms
37
what are the association with pancreatic adenocarcinoma ?
associated with increasing agee smoking chronic pancreatitis
38
what is the picture of the pain associated with pancreatic adenocarcinoma ?
central abdominal pain (invasion from the coeliac plexus )
39
what special sign is associatedd with cancer head of pancreas ?
courvoisier's sign palpable non tender gallbladder in a jaundiced patient
40
what imaging modality is usually used for thee diagnosis of cancer head of pancreas ?
ultrasound and contrast enhanced CT
41
what are the etiologies for chronic pancreatitis ?
TIGAR-O toxic/metabolic idiopathic genetic autoimmune recurrent and severe pancreatitis obstructive
42
what is the cornerstone for treatment of autoimmune pancreatitis ?
corticosteroids
43
most common hereditary disease associated with exocrine pancreatic insufficiency ?
cystic fibrosis
44
what is the new born screening procedure for cystic fibrosis ?
trypsinogen - heel prick test sweat test - measure chloride concentration
45
what is pancreatic divisum ?
failure of the primitive dorsal and ventral duct to fuse during embryonic development
46
what is c annular pancreas ?
pancreas encircles the second part of the duodenum causing gastric outlet obstruction
47
what are the associations of c annular pancreas ?
malrotation of the intestinal atresia cardiac anomalies
48
what is the problem with true cystic lesions of the pancreas ?
can turn malignant so resection is required

year 5 - GIT Internal medicine (25 decks)

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