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28 Cards in this Set
- Front
- Back
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2 major cell types in pancreatic anatomy
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exocrine (ductal and acinar) & endocrine
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Main role of duct cells in pancreas
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alkalinization
bicarbonate secretion depends on secretin |
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Acinar cell function
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produces pancreatic enzymes
stim by CCK activated in duodenum by brush border enzyme |
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4 most common etiologies of acute pancreatitis
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alcohol, biliary causes, medications, idiopathic
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congenital cause of acute pancreatitis
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pancreas divisum
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What leads to tissue destruction in biliary pancreatitis?
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trypsinogen activation to trypsin while in pancreatic tissue
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3 genetic mutations for hereditary pancreatitis
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CFTR
Cationic trypsinogen (PRSS1) Pancreatic secretory trypsinogen inhibitor (PSTI, SPINK1) |
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2 most common causes of edematous pancreatitis
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gallstones, alcohol most common
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Dx of edematous pancreatitis
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elevated amylase and/or lipase
Check LFTs to rule out obstruction Imaging (ultrasound) |
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Management of edematous pancreatitis
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IV fluids
pain control antiemetics nutrition cholecystectomy (before leaving hospital) |
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Where does disease affect in acute necrotizing pancreatitis?
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extensive peripancreatic and pancreatic tissue destructon
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Most common cause of acute necrotizing pancreas
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gallstones
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Concurrent organ system failure with acute necrotizing pancreatitis
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pulmonary
renal liver GI tract |
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Presentation of acute necrotizing pancreatitis
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severe ab pain
N/V hypotension tachycardia Flank (grey-Turner's sign) & periumbilical (Cullen's sign) ecchymosis |
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Difference between acute necrotizing pancreatitis and edematous pancreatitis
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other organ damage
(LFTs, hypoxia, hypocalcemia, renal failure) |
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Purpose of CT scan in acute necrotizing pancreatitis
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confirm necrosis
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Complications of acute necrotizing pancreatitis
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pseudocysts (lack of epithelium)
bleeding infection fistulae pancreatic duct rupture & ascites pleural effusion |
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Management of acute necrotizing pancreatitis
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pain control
IV fluid/support (KEY) nutrition therapeutic ERCP Sx for infected necrosis or sterile w/ progressive organ failure |
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Chronic pancreatitis etiologies
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TIGAR-O
-alcohol -idiopathic |
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Presentation of chronic pancreatitis
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severe unremitting epigastric pain
-radiates to back -narcotic requirement Steatorrhea Malnutrition (A,D,E,K) Diabetes |
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Main way to diagnose chronic pancreatitis
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H&P
-poor nutritional status can support |
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commonly seen on chronic pancreatitis
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pancreatic calcifications
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Complications of chronic pancreatitis
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pseudocyts
mesenteric thrombosis biliary obstruction duodenal obstruction pancreatic ascites & pleural effusion |
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Medical management of CP
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pancreatic enzyme replacement
pain control w/ narcotics dec gastric acid secretion nutrition, low fat diet |
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risk factors for pancreatic adenocarcinoma
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CP
Hereditary pancreatitis tobacco! fat,meat |
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Palpable gallbladder known as...
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Courvoisier's sign
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Items removed during Whipple procedure
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head of pancreas, duodenal area, gall bladder
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Double-duct sign indicates what?
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ampullary neoplasms
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