Upgrade to remove ads
Disorders of the Pancreas
Terms in this set (79)
endocrine fxn of pancreas
blood sugar regulation
responsible for releasing insulin
A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues
responsible for releasing glucagon
delta cells release __________________ which inhibits release of insulin
A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.
T/F: endocrine products are released into the duedenum
false, they are released into the blood stream
exocrine fxn of the pancreas
digestive; alkaline fluid (everything released from pancreas has a high pH aka basic)
exocrine hormones release directly into the ______________
responsible for carbohydrate break down
responsible for fat break down
responsible for protein break down
where are amylase, lipase, and protease released from
why does acinar cell injury happen?
-duct obstruction (pancreatic or common bile) d/t gallstones or malignancy
-direct cellular damage (EToH, viruses, trauma)
-elevated triglycerides (free fatty acids damage pancreas and decrease blood flow)
what happens after acinar cells are injured?
intracellular activation of pancreatic enzymes -> autodigestion of pancreas;
RESULT -> edema, interstitial hemorrhage, cellular fat necrosis
Acute pancreatitis causes
gallstones (MCCs - 40%)
ethanol (MCCs - 35%)
mumps and other viruses
hypercalcemia, hyperlipidemia/triglyceridemia, hypothermia
drugs (steroids, sulfonamides, azathioprine, NSAIDS, diuretics)
Acute Pancreatitis S/Sx
•Epigastric pain: constant, boring, with radiation to the back
•Pain may be exacerbated if supine, eating, walking
•Pain may be relieved if leaning forward, sitting, fetal position
•N/V and fever are common
how does epigastric pain d/t pancreatitis differ if the etiology is gallstone vs metabolic
Acute onset with gallstones as cause
•Less abrupt if metabolic cause
Acute Pancreatitis Physical Exam Findings
•Distended abdomen with decreased BS secondary to adynamic ileus
•Tachycardia, hypotension, tachypnea
•Inspect...there may be other clues too
when fluid leaves the vasculature and enters tissue spaces; what does this cause?
third spacing; dehydration
ecchymosis in umbilical area, seen with pancreatitis
bruising in flank area (lower back area)
Grey Turner's Sign
yellowing of the sclera due to jaundice
if someone has scleral icterus and acute pancreatitis; what is the likely etiology?
accumulation of lipids underneath the skin; cholesterol deposits
ddx for acute pancreatitis (epigastric pain); how to r/o?
Peptic ulcer disease (no change in amylase and lipase)
Choledocholithiasis (AST/ALT levels inc.)
Cholecystitis (murphy's sign)
Intestinal obstruction (whoops comes back 30 min in)
Mesenteric ischemia (pain out of proportion to physical exam)
Hepatitis (inc. liver enzymes; no effect of amylase/lipase generally)
acute pancreatitis dx
Need 2 out of 3 of the following:
1. Acute onset of persistent severe epigastric pain
2. Increase in amylase and lipase to 3x Upper Limit of Normal (ULN)
3. Characteristic findings of edema on CT
T/F: diagnosis of acute pancreatitis require imaging
false; can be diagnosed clinically
acute pancreatitis labs
•*Amylase (3 times ULN is suggestive)
•ALT increased 3-fold -> gallstone the cause
between amylase and lipase, which is more sensitive in making the dx for acute pancreatitis?
What lab findings in acute pancreatitis indicate dehydration?
•Falsely elevated HCT
if we are concerned about necrosis of the pancreas, what is our imaging tool of choice?
acute pancreatitis severity w: Absence of organ failure and local or systemic complications
acute pancreatitis severity w: Transient organ failure (resolves in 48 hours) and/or local or systemic complications that do not result in end organ damage
acute pancreatitis severity w: Persistent organ failure of 1 or more organs
diagnostic imaging test of choice for acute pancreatitis
What can an U/S help us identify with acute pancreatitis?
Can assess for gallstones, bile duct dilation, ascites, pseudocyst
Abdominal xray is not the test of choice, but what can it pick up that would indicate pancreatitis?
•Might see "sentinel loop"
•Dilated small bowel in LUQ
•Colon cut-off sign
•Pancreatic calcifications (in chronic pancreatitis)
•+/- left sided exudative pleural effusion
localized ileus of duodenum due to acute pancreatitis seen on abd x ray
Colon cut-off sign
abrupt collapse of colon near pancreas
used to help understand how sick our patient w acute pancreatitis is and what their mortality is
high LDH indicates
high rate of cellular death
T/F: calcium binds to necrotic tissue, so an increase in calcium indicates necrosis
false; a DROP in calcium idicates necrosis
complications of acute pancreatitis
•Acute peripancreatic fluid collection (APFC)
•Develop early (in the first 4 weeks)
•Not walled off
•Encapsulated fluid collection (after 4 weeks)
necrotic complications from acute panc.
•Acute necrotic collections•Ill defined collection of necrotic fluid (first 4 weeks)
•Walled of Necrosis (WON)
•Walled off collection of necrotic fluid (> 4 weeks)
•Can become infected
acute panc tx
•90% recover without complications; supportive measures only
•Analgesia (careful with morphine)
•Antibiotics: NOT routinely used. If severe necrotizing -> broad spectrum
•ERCP if biliary sepsis suspected
Study of the bile ducts, pancreatic duct, and gallbladder
•Endoscope into duodenum
•Catheter placed in the ducts
•Injection of contrast material
Endoscopic Retrograde Cholangiopancreatography (ERCP)
•Long standing inflammation causing parenchymal destruction, fibrosis, and calcification.
•See loss of exocrine and sometimes endocrine function
etiology of Chronic Pancreatitis
•Cystic fibrosis is most common cause in kids
MCC of chronic pancreatitis
MCC of chronic pancreatitis in children
chronic pancreatitis triad
calcifications + steatorrhea + DM (hallmark - but only seen in 1/3 of pts)
chronic pancreatitis dx
X-ray w/ calcifications
US or CT w/ changes in pancreas
ERCP w/ changes in ducts.
amylase and lipase frequently nl
chronic pancreatitis tx
replace pancreatic enzymes; ETOH abstinence: pain control
Pancreatic CA incidence
•Estimated to see 60,430 cases this year
•Estimate 48,220 deaths
•Average 5 year survival rate -> 10%
•Rarely seen before 45
•Male to female 1.3:1
Pancreatic CA risk factors
•Smoking (2x more likely than non-smoker)
•Diabetes (Type 2)
•Family history - inherited syndromes
•Age (70% of pancreatic cancers occur >65 y/o)
T/F: BRCA1/BRCA2 gene increases risk for pancreatic CA
true; also Lynch syndrome!
pancreatic CA is 30% more common in men. WHY?
leading theory: more men are smoking than women
most common type of pancreatic CA; where are they usually found?
Ductal adenocarcinoma >80% of all primary pancreatic cancers
•65% in head
•20% in body or tail
•15% diffusely involve entire gland
pancreatic CA S/sx
•Weight loss (75%)
•Pain (back pain, epigastric pain)
•Recent onset of atypical DM
•Trousseau's syndrome (migratory phlebitis)
•Anorexia, acholic stools, dark urine
painless jaundice is indicative of a tumor in what location?
80% when the tumor is in the head of pancreas
why does pancreatic CA cause itching
pruritus secondary to increased bile salts in skin
why do pancreatic CA pts often present w Trousseau's syndrome?
pancreatic CA puts pts in a hypercoagulable state
Pancreatic CA physical exam findings:
•Palpable mass (usually not palpable unless v large)
•Ascites in late disease
•Sister Mary Joseph's node
nontender, palpable gallbladder with jaundice
Pancreatic CA dx
•CT scan - initial diagnostic test of choice if presenting with epigastric pain and weight loss
•U/S - used when pt has jaundice only.
T/F: CA19-9 is used for pancreatic CA screening
false; used for prognosis only
If tumor markers + and Imaging +, do we biopsy?
no, Unless Hx of pancreatitis
Workup of staging = assessing ability to resect
How does this work?
•CT -> local and regional disease extent
•Looking for arterial or venous involvement; metastasis
pancreatic CA tx
•Surgery - only curative option
•Chemo - may improve short term survival rates
pancreatic endocrine tumors
Gastrin hypersecretion -> PUD
Beta cell tumor -> hypoglycemia
Vasoactive intestinal peptide -> diarrhea, hypokalemia, achlorhydria
•Alpha cell tumor -> Diabetes
Delta cell tumor -> inhibits nutrient absorption (DM and steatorrhea)
THIS SET IS OFTEN IN FOLDERS WITH...
Diseases of the Gallbladder
IM II Exam 2 (GI): Lange Questions
OTHER SETS BY THIS CREATOR
Intro to Emergency Medicine
GI drugs part II