Pancreatic disorders

Question 1

What are the exocrine functions of the pancreas

Answer 1

digestion
-secrete bicarbonate and digestive enzymes into ducts connecting pancreas to duodenum

Question 2

what are the endocrine functions of the pancreas

Answer 2

glucose homeostasis
-alpha cells: glucagon
-beta cells: insulin

Question 3

what is acute pancreatitis

Answer 3

acute response to injury/insult
inflammation that resolves both clinically and histologically

Question 4

what is chronic pancreatitis

Answer 4

result in permanent damage to structure
irreversible and progressive histologic changes that result in loss of exocrine and endocrine function

Question 5

what is the most common triggers of acute pancreatitis

Answer 5

gallstones and alcohol intake

Question 6

how is acute ppancreatitis diagnosed

Answer 6

clinical presentation, serum amylase and lipase, imaging

Question 7

what is the clinical presentation of acute pancreatitis

Answer 7

severe, upper abdominal pain with radiation (“boring”) to back; frequently N/v
appear acutely ill and sweaty
pulse usu 100-140bpm, rapid and shallow respiration
AMS

Question 8

What is Grey Turner sign

Answer 8

ecchymosis of the flanks

Question 9

what is Cullen Sign

Answer 9

ecchymoses of the umbilical region

Question 10

according to UCG guidelines, diagnosis of acute pancreatitis includes 2 of the following:

Answer 10

abdominal pain: consistent with acute pancreatitis
Serum Lipase level >3x upper limit of normal range
findings of acute pancreatitis on abdominal imaging

Question 11

what bloodwork should be completed on admission of acute pancreatitis

Answer 11

CBC
CMP
serum lipase and amylase
lactate
TG
CRP
*best for evolution: rising BUN or rising Hct

Question 12

what lab work is more specific for pancreatitis

Answer 12

Lipase

Question 13

what does an elevated anion gap metabolic acidosis indicate

Answer 13

shock

Question 14

what is the imaging study of choice for acute pancreatitis

Answer 14

CT with IV contrast - makes diagnosis

Question 15

what are risk factors that predict a severe course

Answer 15

age >60
comorbid health problems
obesity with BMI >30
long-term, heavy alcohol use
presence of systemic inflammatory response syndrome (SIRS)

Question 16

what are the scoring systems used for pancreatitis

Answer 16

Ranson Criteria
BISAP (bedside index of severity in acute pancreatitis)

Question 17

what is ranson criteria

Answer 17

cumbersome, takes 48 hours to compute but good negative predictive valvue for pancreatitis

Question 18

what is BISAP

Answer 18

bedside index of severity in acute pancreatitis
simple and calculated during first 24 hours; good positive predictor of severe cases M&M

Question 19

what are the types of acute pancreatitis

Answer 19

Intersitital and necrotizing

Question 20

what is intersitial pancreatitis

Answer 20

presence of an enlarged pancreas on imaging; peripancreatic stranding and signs of inflammation; more common type, majority of cases are self-limited

Question 21

what is Necrotizing pancreatitis

Answer 21

presence of pancreatic and/or peripancreatic necrosis; best seen on contrast-enhanced cross-sectional imaging; occurs in 5-10% of acute pancreatitis and associated with prolonged, more severe disease course

Question 22

what is the more important stage in management of acute pancreatitis

Answer 22

first 12-24 hours is the most important
fluid resuscitation
analgesia/meds
nutritional support

Question 23

what is the foundation of management of acute pancreatitis

Answer 23

early aggressive fluid resuscitation
-lactated ringer’s solution

Question 24

what are pseudocysts

Answer 24

pancreatic and peripancreatic collections of enzyme-rich pancreatic fluid
- fluid or fluid and necrotic material
-most resolve spontaneous

Question 25

what are systemic complicatiosn of acute pancreatitis

Answer 25

single or multiple organ failure and shock
risk increased with underlying comorbidities and/or persistent SIRS

Question 26

what is persistent inflammation of the pancrease that leads to permanent structural damage with fibrosis

Answer 26

chronic pancreatitis

Question 27

what are two major risk factors for chronic pancreatitis

Answer 27

drinking alcohol and smoking cigarettes

Question 28

what is the hallmark of pancreatitis

Answer 28

fibrosis caused by inflammation and recurrent pancreatic injury

Question 29

what is the primary manifestation of chronic pancreatitis

Answer 29

abdominal pain and pancreatic insufficiency

Question 30

what is the best imaging for diagnosis of chronic pancreatitis

Answer 30

MRI - confirms diagnosis

Question 31

what are direct pancreatic function tests

Answer 31

monitor actual ssecertion of pancreatic exocrine products (bicarbonate and enzymes)
most useful in earlier stage when imaging studies are not diagnostic

IV cholecystokinin, IV secretin, duodenal secretion

Question 32

what are indirect pancreatic function tests

Answer 32

measure secondary effects resulting from lack of pancreatic enzymes (e.g. fat malabsorption)
less accurate in earlier stages; blood or stool samples
serum trypsinogen tests, steatorrhea

Question 33

what is the treatment of chronic pancreatitis

Answer 33

smoking cessation and alcohol abstinence
pain control**
pancreatic enzyme supplements
mgmt: diabetes and other complications

Question 34

what is pancreatic enzyme replacement

Answer 34

25,000 - 50,000IU lipase per meal, half dose with snacks

Question 35

what is the removal of the head of the pancreas due to extensive disease

Answer 35

whipple procedure

Question 36

what is EPI

Answer 36

exocrine pancreatic insufficiency
reduction in pancreatic enzyme activity (mainly lipase) in intestinal lumen below threshold for digestive functions

Question 37

what are clinical manifestations of EPI

Answer 37

steatorrhea, flatulence, weight loss, abdominal pain
maldigestion and malabsorption

Question 38

what are the primary causes of EPI

Answer 38

adults: chronic pancreatitis
children: cystic fibrosis

Question 39

what is the treatment/management of EPI

Answer 39

monitory body weight and BMI
screening for nurtritional deficiency
referral to dietician
adress causes

Question 40

What is the mainstay treatment of EPI

Answer 40

pancreatic enzyme replacement therapy (PERT)

Question 41

what are complications without treatment of EPI

Answer 41

fat malabsorption and malnutrition reduce QOL
osteoporosis and osteopenia
reduced ability to work
increased cardiovascular complicationss