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Flashcards in Pathophysiology of exocrine pancreas Deck (26)
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1
Q

the pancrease responds to what 2 molecules?

A

secretin -> stimulates bicarb sectrion

cholecystokinin -> pancreatic enzymes

2
Q

describe zymogen activation

A

zymogens are secreted into duodenum from pancreas -> trypsinogen is converted to trypsin by brush border enzyme enterokinase -> trypsin proteolytically cleaves zymogens, converting them to their active forms.

3
Q

classify acute pancreatitis

A

Acute inflammation
Acute abdominal pain
Elevated pancreatic enzymes in serum
Self-limited

4
Q

classify chronic pancreatitis

A

Chronic inflammation
Chronic pain or malabsorption
Fibrosis and ductal obstruction
Permanent loss of pancreatic function

5
Q

how does alcohol cause acute pancreatitis

A

Causes Premature release and activation of zymogens.

Causes Proteinacious plugs within pancreas duct

6
Q

what is the #1 cause of acute pancreatitis in America

A

Gallstone (biliary) pancreatitis

7
Q

what are Clues to diagnosis of gallstone (biliary) pancreatitis)

A

1) Risk factors for gallstones (age, female,
hypercholestremia)
2) Gallstones seen on imaging (in gallbladder or bile duct)
3) Elevated liver chemistries
4) Dilated bile duct
5) Absence of other risk factors

8
Q

what are complications of acute pancreatitis

A

Ileus (paralysis of gut)
Intra-abdom hemorrhage
Pseudocyst formation

9
Q

what is a pancreatic pseudocyst

A

Collection of pancreatic fluid, debris surrounded by wall of granulation tissue - lacks epithelial lining

10
Q

pancreatic pseudocyst can result from _______

A

ductal disruption, necrosis, or both

11
Q

what syndrome is Associated with pancreatic necrosis

A

Adult respiratory distress syndrome (ARDS)

12
Q

describe acute pancreatitis managment

A

Admit to hospital (usually)
Aggressive IV fluids
NPO, slow advancement in diet p 2-3 days
Intravenous narcotics for pain
Surgery consultation if gallstones present
Consider ERCP for bile duct stone removal

13
Q

what is the management for severe acute pancreatitis

A
feeding tube,
IV nutrition (TPN), 
surgical or endoscopic necrosectomy, 
pseudocyst drainage, etc
14
Q

what is the defining characteristic in chronic pancreatitis

A

Permanent destruction of pancreatic parenchyma with replacement by fibrosis (scar tissue)

15
Q

what are the causes of chronic pancreatitis

A
Alcohol (60-70%)
Idiopathic (20%)
other (20%)
      cystic fibrosis
      hereditary pancreatitis
      hyperlipidemia
16
Q

Describe the clinical presentation of Chronic pancreatitis

A

1)Abdominal pain
Chronic epigastric pain, radiates to back
Worse after meals
2)Steatorrhea
Oily stools
Large-volume, light- colored, foul-smelling
Gas, bloating
3)hypo- or hyperglycemia
Brittle diabetes from loss of islets

17
Q

what are the 2 mechanisms for steatorrhea

A

Decreased lipase and colipase in duodenum

Decreased duodenal pH
Inactivation of pancreas enzymes
Bile acid precipitation

18
Q

in Chronic pancreatitis what can be seen on plain x-ray and CT?

A

Plain x-ray → calcifications in pancreas

CT → dilated duct, atrophy, calcifications, pseudocysts

19
Q

what is considered a positive secretin test

A

Secretin 0.2mcg given IV, if Duodenal [HCO3] increase of less than 80 mEq/l suggests pancreatic obstruction or failure

20
Q

Pancreatic neurendocrine tumor (NET) are _____ growing, the Prognosis is ________ and are of ____
cell origin

A

slow,
favorable,
Islet

21
Q

what is autoimmune pancreatitis?

A

Diffuse or focal enlargement of pancreatic parenchyma,

Infiltration of pancreas/ampulla by IgG-4 + plasma cells and lymphocytes

22
Q

what population typically gets autoimmune pancreatitis

A

Males, typically ages 50-70

23
Q

what other autoimmune diseases is autoimmune pancreatitis associated with?

A

RA, Sjogren’s, IBD, SLE

24
Q

what symptoms can be seen in autoimmune pancreatitis

A

abdominal pain,
jaundice,
weight loss,
(rarely) acute pancreatitis

25
Q

What tests can diagnose autoimmune pancreatitis

A

CT/MRI,
serum IgG-4,
EUS,
ERCP

26
Q

what is the treatment for Autoimmune pacreatitis

A

PO corticosteroids x 6 weeks

Biliary stenting for symptom relief