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Flashcards in Pancreatic Disorders Deck (33)
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1

What are the 3 endocrine hormones that are released by the pancreas?

Insulin
Glucagon
Somatostatin

2

Which cells release the digestive enzymes?

Acinar cells

3

Are the digestive enzymes released by the pancreas active or inactive?

Inactive

4

How much enzyme-rich fluid is released every day from the pancreas?

1.5 liters

5

What hormones are released to control pancreatic secretion?

Secretin
Cholecystokinin (CCK)

6

Secretin

Released by S-cells
Stimulates the release of bicarbonate & water

7

Cholecystokinin (CCK)

Released by SI cells
Stimulates acing cells to release digestive proenzymes

8

Define Acute Pancreatitis

Acute inflammatory process of the pancrease

9

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

10

What is the most common cause of acute pancreatitis in women?

Gallstones

11

What is the most common cause of acute pancreatitis in men?

Alcohol

12

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

13

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

14

PE Findings of Acute Pancreatitis

Fever, tachycardia
Epigastric/RUQ tenderness
Shallow respirations
Dyspnea
Epigastric mass
Cullen's sign
Grey-Turner's sign
Hypoactive
Jaundice

15

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

16

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

17

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

18

Treatment of Severe Pancreatitis

Complications with pulmonary, renal, circulatory, & hepatobiliary dysfunction
ICU monitoring
Supplemental O2
Prevent infection
TPN

19

Risk Factors for Acute Pancreatitis Disease Severity

Age >55 years
Obesity: BMI >30
Organ failure at admission
Pleural effusion
Elevated C-RP

20

Define Chronic Pancreatitis

Progressive inflammatory changes result in permanent structural damage to the pancreas, leading to impairment of exocrine & endocrine function

21

Etiologies of Chronic Pancreatitis

Alcohol abuse
Genetic: CF, hereditary
Ductal obstruction: trauma, pseudocysts, stones, tumors
Systemic: SLE, hypertriglyceridemia
Idiopathic

22

Features of Chronic Pancreatitis

Aymptomatic over long periods of time
Fibrotic mass in abdomen
Serum amylase & lipase is normal

23

Clinical Manifestations of Chronic Pancreatitis

Chronic abdominal pain
Pancreatic insufficiency
Fat malabsorption
Pancreatic DM

24

Diagnostics for Chronic Pancreatitis

Labs: amylase & lipase normal
Steatorrhea
Imaging: Calcifications
CT/MRI/US
ERCP: duct changes

25

Treatment of Chronic Pancreatitis

Establish Dx
Pain management
Control N/V
Diet: no smoking or alcohol, low fat diet
Surgery: fail medical therapy, pain relief

26

Risk Factors for Pancreatic Cancer

Chronic pancreatitis
Smoking
Obesity
Male gender

27

Clinical Features of Pancreatic Cancer

+/- pain
Weight loss
Jaundice
Steatorrhea

28

PE Findings of Pancreatic Cancer

Abdominal mass
Ascites
L. supraclavicular node (Virchow's node)
Palpable periumbilical mass (Sister Mary Joseph's node)

29

Work-up of Pancreatic Cancer

Imaging: US/CT
Labs: LFT's
Serum tumor marker: CA 19-9
Biopsy: FNA, ERCP, Surgery

30

Treatment of Pancreatic Cancer

Surgery (resection or palliative)
+/- radiation
+/- chemotherapy
Pain control
Pancreatic enzyme replacement