Patho of Exocrine Pancreas [2] Flashcards Preview

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Flashcards in Patho of Exocrine Pancreas [2] Deck (18):
1

Exocrine fxn of pancreas

synth of enzymes needed for digestion of fats, proteins, and carbs

neutralizes gastric acid and chyme

2

What enzyme is released by the duodenum in response to drop in pH?

secretin: most imp for stimulus of NaHCO3 + CCK

Secretin and CCK both inhibit gastric acid/fluid production and delay gastric emptying until the intestine is ready for more

3

Acute pancreatitis
-Pathophys

acute inflammation with acute abdominal pain (often goes to the back) + elevated pancreatic enzymes in serum
- self limited

Trypsinogen+proenzymes are prematurely activated within the pancrease → autodigestion of gland → leakage of enzymes, complications, inflammatory cascade, death

4

#1 cause of acute pancreatitis world wide, and in america

alcohol abuse

US: Gallstones - Obstruction of duct

5

Presentation of acute pancreatitis

sudden abdominal/epigastric pain (radiating to back)
nause/vomiting
tachycardia
low grade fever
abdominal guarding
loss of bowel sounds (ileus: gut paralysis)
jaundice

6

Pancreatic pseudocyst
what is it
tx?

Can follow acute or chronic pancreatitis

Collection of pancreatic fluid/necrotic debris around wall of granulation tissue but lack epithelial lining
- majority will resolve with time

If it persists → chronic pain, infxn, obstruction → drain it

7

Testing for acute pancreatitis

Serum enzymes (amylase and lipase)
- should be elevated 3x (enzyme leaks out into blood)
- high sensitivity

US for GB stones
CT for edema, calcifications, fluid collection

8

Tx for acute pancreatitis

Basic management
admit to hospital → NPO
IV narcs for pain
Surgery consult if GS (ERCP)
If severe → feeding tube, IV nutrition, pancreatic debridement, pseudocyst drainage
Avoid alcohol

9

Chronic pancreatitis
-Pathophys

Permanent loss of pancreatic fxn → chronic inflammation, ductal obstruction, chronic pain, malabsorption

Permanent destruction of pancreatic parenchyma
(can b due to acute pancreatitis → fibrosis) → ductal strictures, ductal/parenchymal calcifications or stones

10

#1 cause of chronic pancreatitis

alcohol
(#2 is idiopathic)

11

Chronic pancreatitis presentation

abdominal pain
- chronic epigastric pain radiates to back
- worse after meals

Steatorrhea

Hypo or Hyperglycemia
- brittle diabetes from loss of islets

12

Chronic pancreatitis: below is the pathophys, describe the features
Ductal strictures/stones -
Pancreatic pseudocysts -
Acinar destruction -

Ductal strictures/stones - chronic pain, exocrine failure
Pancreatic pseudocysts - pain, nausea/vomiting, jaundice, feber
Acinar destruction - exocrine failure

13

Most common type of pancreatic cancer

ADENOCARCINOMA (dx very late, very hard to tx)
- must do CT to find
- 4th leading cause of cancer death in US

5yr survival is 5%

14

Presentation of pancreatic cancer

early:
jaundice
dark urine
pruritus

Late:
abdominal/back pain
weight loss
n/v
hormonal excess

15

Pancreatic Neuroendocrine tumor (NET)

slow growing
favorable prognosis
islet cell origin
sx: of hormone excess
- insulin, glucagon, somatostatin, gastrin, VIP

Dx and tx same as adenocarcinoma

16

autoimmune pancreatitis (AIP)

diffuse or focal enlargement of pancreatic parenchyma by infiltration of IgG-4 → narrowing of pancreatic duct and/or bile duct, plasma cells and lymphocytes

(mimics pancreatic cancer -
males 40-70 w/
- alcohol, hyperlipidemia, pancreatitis hx
Assoc. w/ other Autoimmune disorders

17

AIP presentation

chronic abdominal pain
jaundice [cholestasis]
weight loss
pancreatitis

(mimics panc cancer)

18

Dx of AIP

CT/MRI
Serum IgG-4
EUS
ERCP