Pancreatic Disorders Flashcards
(33 cards)
What are the 3 endocrine hormones that are released by the pancreas?
Insulin
Glucagon
Somatostatin
Which cells release the digestive enzymes?
Acinar cells
Are the digestive enzymes released by the pancreas active or inactive?
Inactive
How much enzyme-rich fluid is released every day from the pancreas?
1.5 liters
What hormones are released to control pancreatic secretion?
Secretin
Cholecystokinin (CCK)
Secretin
Released by S-cells
Stimulates the release of bicarbonate & water
Cholecystokinin (CCK)
Released by SI cells
Stimulates acing cells to release digestive proenzymes
Define Acute Pancreatitis
Acute inflammatory process of the pancrease
Etiologies of Acute Pancreatitis
Mechanical: gallstones, stenosis Toxic: alcohol, scorpion bites Trauma: blunt, surgery Metabolic: hyperlipidemia, hypercalcium Infection: Hep B, HIV Misc: pregnancy, renal failure, genetic mutations, transplant
What is the most common cause of acute pancreatitis in women?
Gallstones
What is the most common cause of acute pancreatitis in men?
Alcohol
Classifications of Acute Pancreatitis
Mild: absence of organ failure
Moderately severe: transit organ failure, resolves in 48 hours
Severe: persistent organ failure, evolve to multiple organ failure
Clinical Manifestations of Acute Pancreatitis
Persistent, severe epigastric pain RUQ pain N/V Band like radiation of pain to back Dyspnea: diaphragm becomes inflamed Shock/Coma: loss of fluid surrounding pancreas
PE Findings of Acute Pancreatitis
Fever, tachycardia Epigastric/RUQ tenderness Shallow respirations Dyspnea Epigastric mass Cullen's sign Grey-Turner's sign Hypoactive Jaundice
Lab Tests for Acute Pancreatitis
Amylase: rises quickly, elevated 3-5 days
Lipase: more specific, elevations occur earlier & last longer
C-RP: use to differentiate severe from mild disease
Imaging for Acute Pancreatitis
Abdominal plain film
CXR: pleural effusions, pulmonary infiltrates, basal atelectasis, elevation of hemidiaphragm
US: hypoechoic pancreas
C: need oral/IV contrast
MRI: higher sensitivity, lack of nephrotoxicity, detect fluid, necrosis, hemorrhage, & pseudocyst
Treatment of Pancreatitis
Admit NPO IV hydration UO >30 ml/hr Pain control: meperidine Nausea control \+/- antibiotics, surgery Labs: CBC lipase, amylase, CMP, bilirubin, C-RP in 48 hours
Treatment of Severe Pancreatitis
Complications with pulmonary, renal, circulatory, & hepatobiliary dysfunction ICU monitoring Supplemental O2 Prevent infection TPN
Risk Factors for Acute Pancreatitis Disease Severity
Age >55 years Obesity: BMI >30 Organ failure at admission Pleural effusion Elevated C-RP
Define Chronic Pancreatitis
Progressive inflammatory changes result in permanent structural damage to the pancreas, leading to impairment of exocrine & endocrine function
Etiologies of Chronic Pancreatitis
Alcohol abuse Genetic: CF, hereditary Ductal obstruction: trauma, pseudocysts, stones, tumors Systemic: SLE, hypertriglyceridemia Idiopathic
Features of Chronic Pancreatitis
Aymptomatic over long periods of time
Fibrotic mass in abdomen
Serum amylase & lipase is normal
Clinical Manifestations of Chronic Pancreatitis
Chronic abdominal pain
Pancreatic insufficiency
Fat malabsorption
Pancreatic DM
Diagnostics for Chronic Pancreatitis
Labs: amylase & lipase normal Steatorrhea Imaging: Calcifications CT/MRI/US ERCP: duct changes
