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67 Cards in this Set
- Front
- Back
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Where is the head of the pancreas located? What is inside of it?
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C loop of the duodenum
The common bile duct is inside of it - if you have masses, you're going to see cholestatic symptoms |
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What are the main functions of the pancreas?
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Exocrine: acinar cells, pancreatic enzymes
Endocrione: islets, hormones to blood (glucagon, insulin) |
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What is the effect of acid on the secretion of pancreatic juice?
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More acid, more secretion
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What is contained in pancreatic juice?
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Bicarbonate
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What are the phases of pancreatic secretion?
Which is most important |
Cephalic
Gastric Intestinal - most important |
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What are the stimulants cephalic pancreatic stimulation? What mediates it?
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Stimulantss: sight, smell, taste
Mediator: vagus |
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What are the stimulants of gastric pancreatic stimulation? What mediates it?
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Stimulant: distension
Mediator: vagal-cholinergic |
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What are the stimulants to intestinal pancreatic stimulation? What mediates it?
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Stimulants: AAs, FAs, Ca, H+, distension
Mediators: CCK, secretin, enteropancreatic reflexes |
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Practically, what is the impact of NPO on pancreatic disease?
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They're still going to have some problems due to cephalic and gastric stimulation of pancreatic secretion
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What is the most important mediator of pancreatic enzyme secretion?
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Cholecystokinin
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What regulates the release of CCK?
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Hydrolytic products of digestion: AAs, FAs
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What stimulates the release of pancreatic fluid and bicarb?
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Secretin
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What regulates secretin release?
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Duodenal pH
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What's the threshold for secretin release?
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pH < 4.5
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What are the classes of pancreatic enzymes?
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Proteolytic
Amylase Lipolytic Nucleases |
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How are pancreatic enzymes released?
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Proenzymes
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What occurs in pancreatitis?
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Improper activation of pancreatic enzymes resulting in inflammation and damage
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What are the clinical findings of acute pancreatitis?
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Abdominal pain
Increased pancreatic enzymes in the serum (amylase, lipase) Radiologic evidence At least 2/3 MUST be present!!! |
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What are the usual causes of pancreatitis?
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Alcoholic
Biliary Idiopathic |
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What is a biliary-related cause of pancreatitis?
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Gallstone pancreatitis: 30-40%
BUT 3-7% of patients with gallstones develop problems |
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What lab findings are associated with gallstone pancreatitis?
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Increased Alk Phos (>200)
Increased bilirubin |
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What decreases the risk of gallstone pancreatitis?
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Cholecystectomy
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What kinds of stones more commonly cause pancreatitis?
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Small stones!
They're more likely to get out, get caught |
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How does alcohol predispose someone to pancreatitis?
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Many ways: some direct, some indirect
Don't memorize! |
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What are some inherited causes of pancreatitis?
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Trypsinogen mutations
CF (just 1!) Familial hypertriglyceridemia |
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How do traumatic injuries to the pancreatic duct happen?
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Compression with the spine
Can take years to develop after an injury |
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What's the treatment for traumatic pancreatitis?
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Stent via ERCP
Surgery |
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What is pancreatic divisum?
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Failure of the pancreatic bud to fuse (6-7%)
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What's the treatment for pancreatment divisum?
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Minor ampullary sphincterotomy
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What's the treatment of autoimmune pancreatitis?
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Steroids
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What is the presentation of someone with autoimmune pancreatitis?
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Jaundice
Irregular, narrowed duct on ERCP |
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What are the markers for autoimmune pancreatitis?
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IgG4
AnA Sed rate |
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What are some common drugs that cause pancreatitis?
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Azathioprine
6-Mercaptopurine Didanosine Pentamidine Valproate |
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What are the presenting features of acute pancreatitis?
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Abdominal pain
Nausea/vomiting Tachycardia Fevers are low! |
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Where is the pain for pancreatitis?
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Midline
Epigastric Radiates to the back (epigastric) |
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What enzymes do you check in acute pancreatitis? What's their timecourse?
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Amylase
Lipase |
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What are the properties of amylase behavior in acute pancreatitis?
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Peaks, falls early
Degree of elevation DOESN'T correlate with severity Cleared by renal system |
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What can cause elevated amylase in the context of a healthy pancreas?
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Kidney disease
Amylase is cleared by the kidney |
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What does prolonged elevation of amylase suggest?
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Pseudocyst
Cancer.. |
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What are causes of elevated amylase alone?
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Parotitis
Tubo-ovarian disease Macroamylasemia |
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What are causes of dual amylase and lipase elevation?
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Biliary stone impaction
Intestinal injury Renal failure Intestinal ischemia |
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What is the gray turner sign?
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Blood on the flank draining down from hemorrhagic pancreatitis
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What is Cullin's sign?
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Ecchymosis surrounding umbilical area
Hemorrhage into peripancreatic tissues with tracking along tissue planes to umbilicus |
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What is the prognosis with Cullen's and Gray-Turner sign?
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Poor.
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What are some worrisome bedside findings in a patient with pancreatitis?
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Tachycardia, hypotension
Tachypnea, hypoxemia Hemoconcentration Oliguria Encephalopahy Ileus with tense abdomen |
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What are the BISAP indicators?
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BUN > 25
Impaired mental status SIRS Age > 60 Pulmonary abnormality |
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What are the SIRS criteria?
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HR>90
RR>20 or pCO2<38 Temperature>36 4>WBC>12 |
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What are the local complications of pancreatitis?
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Fluid collections
Necrosis Infection Ascites Erosion into adjacent structure GI obstruction Hemorrhage |
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What are some of the systemic complications of acute pancreatitis?
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Pulmonary
Renal CNS Multiorgan failure |
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What are the causes of death in early acute pancreatitis?
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SIRS
Multiorgan failure |
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What are the main causes of death in late acute pancreatitis?
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Sepsis/failure
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What is an atypical presentation of pancreatitis?
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NO ABDOMINAL PAIN (5%)
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What should you get on every single person who comes into the ER with a suspected abdominal complaint?
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Amylase and lipase
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What is the supportive management of acute pancreatitis?
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Aggressive fluid replacement
Aggressive electrolyte replacement Monitor |
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What are some other treatments to give to people with acute pancreatitis?
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Acid suppression
Antibiotics Nutritional support Urgent ERCP NO IV octraotide |
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How much fluid should you give people in acute pancreatitis? What type?
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3-4 liters in the first 24 hours
Lactated ringers (not saline) except for hypercalcemia induced AP |
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What are the indications for NG suction in acute pancreatitis?
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Persistent vomiting
Obstruction Basically, it's important for symptomatic relief |
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When is nutritional support indicated in AP?
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When there's likely a chronic course and they won't be able to eat in a while.
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How should you give nutritional support to someone with AP?
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Enteral
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What electrolytes and nutrients do you monitor in AP/
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Calcium
Triglycerides |
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What are indications for antibiotic use in AP?
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Infected necrosis (drain it!)
Pancreatic abscess (catheter drainage) Infected pseudocyst (drain it!) Basically, you've got to drain it!!! |
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What are some imaging studies you should do in acute pancreatitis?
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Plainfilms
Ultrasound CT (most common) |
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What are some findings in a plainfilm of acute pancreatitis?
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Sentinel loop: localized ileus in duodenum
Colon cut-off Pleural effusion |
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What is a pseudocyst in AP?
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Localized fluid collection
Lack of epithelial lining Exists for > 4 weeks |
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What are the compliations of a pseudocyst in AP?
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Hemorrhage
Infection of intestine, stomach Obstruction |
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What are indications for treatment of a pseudocyst in AP?
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Size > 6 cm
Duration > 6 weeks Drain em! |
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What are Ranson's criteria at admission?
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Admission:
Age > 55 WBC > 16k Glucose > 200 LDH > 350 AST > 250 After 48 hours Hct decrease > 10% BUN up > 5 mg/dl Ca2+ < 8 mg/dL PaO2 < 60 Base deficit> 4 mEq Negative fluid balance > 6L |
