Pancreas Test

Front 1

What type of gland is the pancreas?

Back 1

Endocrine AND Exocrine

Front 2

Endocrine portion of the pancreas secretion

Back 2

hormones for regulation of carbohydrate metabolism

Front 3

Exocrine secretions of the pancreas

Back 3

enzymes aiding in digestion

Front 4

Why is it difficult to perform a physical examination of the pancreas?

Back 4

It is deeply located, under many organs

Front 5

Portion of pancreatic fluid that acts to neutralize HCL within the duodenum

Back 5

Bicarbonate

Front 6

Amylase

Back 6

exocrine secretions that breaks down carbohydrates

Front 7

Lipase

Back 7

exocrine secretions that breaks down fat

Front 8

Proteolytic enzyme precursors

Back 8

exocrine secretions that are activated in the duodenum and break down proteins

Front 9

Insulin

Back 9

endocrine secretion that lowers blood glucose by promoting its uptake in to cells

Front 10

Glucagon

Back 10

endocrine secretion that raises blood glucose by promoting breakdown of liver stores

Front 11

How does the pancreas regulate auto-digestion by proteolytic enzymes that it creates?

Back 11

- They are stored as inactive precursors (zymogens)
- They are stored in membrane bound "sacks"
- They are only activated after being secreted into the duodenum
- There are inhibitors present to prevent premature activation

Front 12

Main causes (2) of pancreatitis

Back 12

alcohol, and duct obstruction

Front 13

two forms of pancreatitis

Back 13

acute, chronic

Front 14

how many new cases of acute pancreatitis in USA each year?

Back 14

5,000

Front 15

Mortality rate of acute pancreatitis

Back 15

10%

Front 16

Acute pancreatitis

Back 16

inflammation of the pancreas associated with edema, autodigestion, necrosis, and hemorrhage

Front 17

Biliary pancreatitis

Back 17

inflammation of pancreas after a stone becomes lodged int he sphincter of iddi, ampulla of vater

Front 18

risk factor of severe pancreatitis

Back 18

obesity, due to increased deposits of fats around the pancreas

Front 19

Symptoms of acute pancreatitis

Back 19

- abdominal pain that radiates to the back
- nausea and vomiting

Front 20

serum tests performed to detect acute pancreatitis

Back 20

- serum amylase
- serum lipase
- WBC levels
- Glucose levels (hyperglycemia)
- Calcium levels (hypocalcemia)

Front 21

What will acute pancreatitis look like with U/S?

Back 21

edema, dilated ducts, calcification, pseudocysts

Front 22

Differential diagnosis for acute pancreatitis

Back 22

perforated viscus, cholecystitis, biliary colic, intestinal obstruction, mesenteric occlusion, renal colic, myocardial infarction, aortic aneurysm, and connective tissue disorders

Front 23

(T/F), 80-90% of acute pancreatitis cases are self limited and subside within 3-7 days after treatment

Back 23

True

Front 24

Acute pancreatitis treatment

Back 24

supportive: IV fluids, pain relief, withholding food intake to reduce gastric contents entering duodenum (NPO), antibiotics to prevent secondary infection

Front 25

Complications of acute pancreatitis

Back 25

- Phlegmon (mucous mass)
- Pseudocyst (necrotic debris)
- Abscess
- Pancreatic ascites

Front 26

Complications of pseudocysts from acute pancreatitis

Back 26

Infection, bleeding, and rupture in to peritoneum

Front 27

Chronic pancreatitis

Back 27

progressive destruction of pancreatic acini from inflammation, fibrosis, and dilation of ducts

Front 28

Conditions associated with chronic pancreatitis

Back 28

Alcohol abuse, trauma, drugs

Front 29

Most common cause of chronic pancreatitis in USA (adult/children)

Back 29

Alcoholism in adults, CF in children

Front 30

Signs of chronic pancreatitis

Back 30

- Severe abdominal pain that lasts years before physically manifestation occurs
- "Fatty Poop"
- Pain is primarily in back, or radiates there
- Weight loss
- Obstructive jaundice
- Diabetes (after gland destruction)
- GI bleeding

Front 31

Why weight loss with chronic pancreatitis?

Back 31

Anorexia, and poor fat absorption

Front 32

Differential diagnoses for chronic pancreatitis

Back 32

- Abdominal malignancies (colon, stomach, pancreas cancer)
- Peptic ulcer disease
- Mesenteric ischemic disease

Front 33

(T/F) chronic pancreatitis causes elevated serum levels of amylase and lipase

Back 33

False, these levels are not effected by chronic pancreatitis unless it is associated with an acute attack

Front 34

What will imaging show in chronic pancreatitis

Back 34

Dilated ducts, and calcifications

Front 35

Treatment of chronic pancreatitis

Back 35

prevent further damage of pancreas, pain relief, replace loss of function, drainage of pseudocysts, partial resection of damaged duct

Front 36

Complications of chronic pancreatitis

Back 36

From destruction of gland:
- Pseudocysts
- Pancreatic ascites
- CBD obstruction
- Diabetes
- Peptic ulcer
- Insufficient exocrine function
- Splenic vein thrombosis

Front 37

Why must all tumors of the pancreas be removed?

Back 37

For differentiation from adenocarcinomas

Front 38

Percent of pancreatic neoplasms that are cystic tumors

Back 38

5%

Front 39

Where in pancreas are cystic tumors located?

Back 39

body or tail

Front 40

Prognosis for pancreatic carcinoma

Back 40

Very bad, 98% fatal, 5th most common cause of cancer related death

Front 41

Primary suspect for pancreatic carcinoma

Back 41

70 year olds, slightly more male than female, Africans more predisposed

Front 42

Risk factors for pancreatic carcinoma

Back 42

- Smoking!
- Industrial work
- Autoimmune pancreatitis
- Age >50
- Family Hx

Front 43

Will an alcoholic be at higher risk for contraction of pancreatic carcinoma?

Back 43

No, not related unless smoking is also involved.

Front 44

What is a worrisome sign that may lead to diagnosis of pancreatic carcinoma?

Back 44

Painless jaundice

Front 45

What causes painless jaundice?

Back 45

Cancer in pancreatic head that pushes on, and obstructs, the CBD

Front 46

Signs related to pancreatic carcinoma

Back 46

- Painless jaundice
- Very distended GB, can be palpated!!
- Weight loss (unintentional, anorexia due to mass effect)
- Pain in abdomen, radiating to back

Front 47

Percent of patients with pancreatic carcinoma that present with obstructive jaundice

Back 47

80%

Front 48

What does significant pain suggest in relation to pancreatic carcinoma?

Back 48

invasion of nerves supplying abdominal organs

Front 49

Most common portion of pancreas effected by pancreatic carcinoma

Back 49

Head, then body, then tail

Front 50

What type of carcinoma are 90% of pancreatic carcinoma?

Back 50

adenocarcinoma, from ducts or glands

Front 51

How does one quantify the level of pain?

Back 51

If pain is disrupting normal sleep patterns it is SEVERE!

Front 52

When a very enlarged GB is causing abdominal distention WITHOUT pain, what is it called?

Back 52

Courvoisier sign

Front 53

Whipple procedure

Back 53

Removal of some, or all, of the pancreas and duodenum. Very hard and long procedure with high mortality rate. "pancreatoduodenectomy"

Front 54

Where is the most common spot for pancreatic carcinoma to met. to?

Back 54

Liver

Front 55

What is the ONLY way to diagnose pancreatic carcinoma?

Back 55

Tissue biopsy

Front 56

Why is it difficult to detect pancreatic carcinoma early?

Back 56

- Nonspecific symptoms
- No way to screen
- Blood tests not sensitive enough

Front 57

Order of imaging modalities when it comes to pancreatic carcinoma

Back 57

Ultrasound first, then CT, ERCP

Front 58

Which modality detects pancreatic cancer 80% of the time?

Back 58

CT

Front 59

What is the least invasive way to diagnose pancreatic carcinoma?

Back 59

FNA with u/s or CT guidance

Front 60

Percent of pancreatic carcinomas located in each portion of the pancreas

Back 60

- Head: 70%
- Body: 20%
- Tail: 10%

Front 61

Which area of the pancreas will provide the best prognosis (after resection) when effected with pancreatic carcinoma?

Back 61

The head

Front 62

Percent of pancreatic carcinomas arising from endocrine cells

Back 62

5-10%

Front 63

5-year survival rate for patients that undergo surgical resection of the body/tail of pancreas

Back 63

10%

Front 64

How are symptoms of pancreatic cancer treated through surgery?

Back 64

- Surgical decompression of biliary tract to stop jaundice
- Destruction of celiac plexus (nerves) to stop pain

Front 65

Does the risk of cancer recurrence change based on type of operative procedure? (removal of pancreas vs. pancreas and duodenum0

Back 65

No

Front 66

What is the survival length of a patient who has un-resectable pancreatic carcinoma?

Back 66

6 months

Front 67

Most common endocrine tumor of the pancreas

Back 67

Insulinoma

Front 68

2nd most common endocrine tumor of the pancreas

Back 68

Gastrinoma

Front 69

Clusters of endocrine cells that secrete hormonal products

Back 69

Islets of Langerhans

Front 70

Classes of islets and their respective secretions

Back 70

A cells: glucagon to raise glucose levels
B cells: (beta) insulin, lower glucose levels
D cells: somatostatin, slows body functions
PP cells: pancreatic polypeptide

Front 71

Symptom related to multiple gastrinomas

Back 71

Ellison syndrome

Front 72

Complication from gastrinomas

Back 72

peptic ulcers due to increased HCL

Front 73

Test for gastrinoma

Back 73

serum gastrin

Front 74

Hallmark of insulinoma

Back 74

symptomatic hypoglycemia (low glucose) from hyper secretion of insulin

Front 75

Test for insulinoma

Back 75

taking unsulin levels during fasting hypoglycemia (they will stay elevated when its not necessary)

Front 76

Symptoms of insulinoma

Back 76

- Headache
- Slurred speech
- Psych. alterations
- Confusion
- Visual disturbance

can also cause coma or death.....

Front 77

Secondary effects of hypoglycemia from insulinoma

Back 77

- Tremors
- Sweating
- Pallor
- Palpitations

Front 78

Therapy for insulinoma

Back 78

Surgical removal, which is then monitored by blood glucose levels