Gi: Pancreatitis

Front 1

What do pancreatic duct cells secrete?
- what does this secretion depend on?

Back 1

bicarb
- secretin, produced in the small intestine in response to acid and nutrients

Front 2

What do pancreatic acinar cells do?
- what stimulates this?
- what activates this product?

Back 2

produced propeptide forms of pancreatic enzymes (zymogens)
- CCK (cholecystokinin)
- i/ duodenum by brush border enzyme enterokinase

Front 3

Even though there are many other possible causes of acute pancreatitis, what are the three most common causes of it?

- which other three causes will we "hear about on the boards?"

Back 3

Alcohol, medications, gallstones (inflammation/biliary)

- viral (mumps), scorpion bites, hypertriglyceridemia

Front 4

What is one of the common (3-5%) side effects of ERCP?
- Can abdominal trauma (like a MVA) cause it as well?

Back 4

Acute Pancreatitis
- yes

Front 5

If you see a pt in which you suspect pancreatitis, but they are also jaundiced.... v. good evidence that this is what?

Back 5

a gallstone problem

Front 6

what is the primary pathophysiology of gallstone pancreatitis?

Back 6

self-digestion (via trypsin)

Front 7

What is a pathonomic finding of alcoholic pancreatitis? Is this is most common reason that alcoholics get pancreatitis?

Back 7

calcification, and calcium dense stones.
- no.

Front 8

What are the two classifications of acute pancreatitis presentations? Subgroups?

Back 8

edematous (acute interstitial)

Necrotizing
- sterile
- non-sterile

Front 9

Confirming alcoholic edematous pancreatitis requires what? Which is more sensitive? More specific?
- anytime we suspect this, what else should we check?
- imaging test?
- tx?

Back 9

elevated amylase and/or lipase (3-5x normal)
- amylase = sensitive
- lipase = more specific
- LFTs to eval for cholestatic pattern of bile duct obstruction.
+ ^ Bili and alkphos.
- US
+ don't need crosssectional imaging
- IV fluids & pain control,
+ cholecystectomy before they leave the hospital, but it's not emergent.

Front 10

What is the most common cause of acute necrotizing pancreatitis?
- can this induce multisystem organ failure? how?
- how can you differentiate this from non-necrotizing dz?

Back 10

gallstone
- yes, systemic inflammatory response.
- presence of hypotension / tachycardia.

Front 11

What is Grey-Turner's sign, and what can it indicate? Cullen's sign?

Back 11

flank ecchymosis
periumbilical ecchymosis

Front 12

How is necrotizing acute pancreatitis dx'ed?
- can US be used?
- if the pt isn't getting better, or they're febrile, etc, what do you do?
- ERCP?

Back 12

- US is only good for +/- stones, not for the pancreas itself
- CT
- no, only if a stone is lodged there.

Front 13

What is the tx for acute necrotizing pancreatitis?

Back 13

Aggressive fluid support
Pain control
ERC if needed

Front 14

What is the primary cause of chronic pancreatitis?
- sx?

Back 14

alcohol
- unremitting epigastric pain, often radiates to back, requires narcotics, etc.
- **steatorrhea/malnutrition**... all the stuff we talked about with malabsorption
- diabetes

Front 15

What type of dx is Chronic Pancreatitis?

- if you see pancreatic calcification on plain films, is that helpful?

Back 15

Clinical
- yes, that can help dx.
- on CT you might see dilated duct w/ atrophy

Front 16

What is one of the only conditions in which you'd see isolated gastric varices (splenic vein thrombosis)?

Back 16

Chronic pancreatitis

Front 17

Are pseudocysts seen in chronic pancreatitis?

Back 17

yes, even though the dz is chronic it has acute flares.

Front 18

What is a puestow procedure?

Back 18

lateral pancreatic duct drainage

Front 19

How can you tx chronic pancreatitis? (4)

Back 19

enzyme replacement, pain control, decrease gastric acid secretion, low fat diet.

Front 20

What is the strongest environmental association with pancreatic adenocarcinoma?
- is chronic pancreatitis associated?
- is there a hereditary component?

Back 20

tobacco
- yes
- yes

Front 21

Painless jaundice can be a sign of what, especially if it presents with pruritus, weight loss, malaise, early satiety, depression, and/or diabetes.

Back 21

Pancreatic adenocarcinoma.

Front 22

Do we often need to biopsy pancreatic adenocarcinomas?
- how do we make the dx?
- how to we tx it?

Back 22

No
- CT/MRI
- pancreatodudenectomy (Whipple procedure) when possible.