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DU PA Pancreas
Duke PA Diseases of the Pancreas
| Question | Answer |
|---|---|
| the pancreas lies in the __ space | retroperitoneal |
| functional unit of the pancreas | pancreatic acinus |
| duct cells make | bicarbonate |
| acinar cells make | pancreatic enzymes that are active and inactive |
| amylase digests | carbohydrates |
| lipase digests | triglycerides |
| peptidase digests | proteins |
| nuclease digests | nucleic |
| toxins that may cause pancreatitis | alcohol, methyl alcohol, scorpion sting |
| edocrine cells of the pancreas | alpha, beta cells |
| alpha cells secrete | glucagon |
| beta cells secrete | insulin |
| clinical syndrome defined by enzymatic damage to the pancreas resulting in discrete episodes of abdominal pain and elevation in serum amylase and lipase | acute pancreatitis |
| key even in acute pancreatitis | inappropriate activation of trypsinogen to trypsin within the pancreas |
| sever pancreatitis with necrosis of parenchyma and blood vessels | acute necrotizing pancreatitis |
| elevated amylase or lipase in the absence of clinical signs of pancreatitis is | not pancreatitis |
| most common cause of pancreatitis, occurs more often in females | gallstones |
| medication causes of pancreatitis | furosemide/thiazides, azathioprine, 6-mercaptopurine, sulfa drugs, ACE inhibitors, HIV meds |
| infectious causes of pancreatitis | mumps, rubella, coxsackie virus, echovirus, EBV, HIV |
| classic symptoms of pancreatitis | constant, epigastric pain radiating to back, usually associated with n/v |
| flank ecchymosis from retroperitoneal hemorrhage, seen in acute necrotizing pancreatitis | Gray Turner's sign |
| periumbilical ecchymosis, seen in acute necrotizing pancreatitis | Cullen's sign |
| 45% from pancreas, 55% salivary, not specific | elevated amylase |
| more specific for pancreas, stays elevated longer | elevated lipase |
| imaging modality of choice for complicated disease | CT scan |
| endoscopically evaluate biliary tree and pancreatic duct. can intervene with stents, ductal dilation, do brushings | ERCP (edoscopic retrograde cholangiopancreatogram) |
| treatment for pancreatitis | pancreatic rest (NPO), IVF, pain meds |
| treatment fo fluid collection in pancreatic capsule | no treatment needed |
| treatment for pancreatic necrosis (sterile) | prophylactic antibiotics (imipenem)X14 days |
| treatment for pancreatic necrosis (infected) | antiobiotics and surgical debridement |
| collection of pancreatic juice ecased by granulation tissue that persists at least 4 weeks after episode of acute pancreatitis | pseudocyst |
| most common cause of chronic pancreatitis | alcohol use |
| genetic pancreatitis comes from which genes | PRSS1(hereditary), SPINK1, CFTR |
| steatorrhea is due to | pancreatic exocrine insufficiency resulting in fat malabsorption |
| test which can detect onset of chronic pancreatitis | there is no such test |
| treatment for chronic pancreatitis | abstinence from alcohol, pain (enzyme replacement , narcotics, ERCP, sphlanchnic nerve block), insulin for diabetes |
| lateral pancreatojejunostomy, option if duct is dilated >6mm | peustow procedure |
| patients who undergo total pancreatectomy usually become | very brittle diabetics |
| pancreatic adenocarcinoma is the __ leading cause of cancer related deaths | fourth |
| mean age of onset of pancreatic adenocarcinoma | 70-80 |
| screeing tool for pancreatic adenocarcinoma | non available |
| is associated with migratory thrombophlebitis | Trousseau's sign |
| palpable GB due to head mass compressing CBD | Courvoisier's sign |
| labs for diagnosis of pancreatic adenocarcinoma | alkaline phosphatase, bilirubin, CA 19-9 |
| pancreatic imaging protocol | CT |
| tissue diagnosis ofr pancreatic adenocarcinoma, in a good surgical candidate | not always needed if imaging is convincing |
| procedure used for resection of pancreatic adenocarcinoma in the head of the pancreas | Whipple |
| median survival time for patients with metastatic pancreatic adenocarcinoma | 3-6 months |
| median survival time for patients with resectable pancreatic adenocarcinoma | 15-17 months |
| the overall incidence of pancreatitis in the general population is 1:__ | 4000 |
| gallstones account for __% of all cases of acute pancreatitis | 45 |
| alcohol accounts for __% of all cases of acute pancreatitis | 35 |
| pancreatitis is probably caused by premature activation of __ which activates the other digestive zymogens, leading to acinar cell injury | trypsinogen to trypsin |
| __ is virtualy always present with pancreatitis | abdominal pain |
| abdominal pain associated with pancreatitis is usually __ | refractory to analgesics |
| abdominal pain associated with pancreatitis often radiates to __ and is worse when supine | the back |
| other manifestations of acute pancreatitis | nausea, vomiting, and fever |
| in acute pancreatitis a wide variety of toxic materials including pancreatic enzymes, vasoactive materials, are __ which leads to third space losses of protein rich fluid, hypovolemia, and hypotension | liberated by the pancreas and extravasate along fascial planes in the retroperitoneal space, lesser sac, and the peritoneal cavity |
| toxic materials from an inflammed pancreas may also reach the systemic ciruculation by way of lymphatics and venous pathways, which can lead to __ | subcutaneous fat necrosis, and end organ damage, including shock, renal failure, and respiratory insufficiency |
| ecchymosis of the flank | Grey Turner's sign |
| ecchymosis in the periumbilical region | Cullen's sign |
| Grey Turner's sign and Cullen's sign are associated with | hemorrhagic pancreatitis |
| metabolic problems are common in severe pancreatitis and include | hypocalcemia, hyperglycemia, and acidosis |
| hypocalcemia associate with pancreatitis is usually due to a concomitant __ | hypoalbuminemia |
| circumscribed intra-abdominal collection of pus, usually in proximity to the pancreas, which contains little or no pancreatic necrosis | pancreatic abscess |
| defined as encapsulated nonepithelial lined collections of pancreatic juice formed a minimum of four weeks after the onset of acute pancreatitis and located in or adjacent to the pancreas | pancreatic pseudcyst |
| treatment of pancreatic pseudocysts and abscesses requires __ | radiographic, endoscopic, or surgical drainage |
| the diagnosis of acute pancreatitis is based on __ | the presence of abdominal pain |
| the diagnosis of acute pancreatitis is supported by __ | elevations in serum amylase and lipase in excess of three times the upper limit of normal |
| elevated serum pancreatic enzymes may occur in a wide variety of other conditions such as | bowel perforation, intestinal obstruction, mesenteric ischemia, tuboovarian disease, and renal failure |
| __ can be used to confirm a diagnosis of pancreatitis | CT |
| does not correlate with the severity of pancreatitis | serum pancreatic enzymes |
| most patients with pancreatitis can be treated with | supportive therapy |
| early deaths within the first 2 weeks from pancreatitis are the result of __ | multisystem organ failure by the release of inlfammatory mediators and cytokines |
| late deaths from pancreatitis result from __ | local or systemic infection |
| an APACHE-II score greater than __ has been shown to predict severe pancreatitis | eight |
| characterized by intact microcirculation and uniform enhancement of the gland on contrast enhanced CT scanning | interstitial pancreatitis |
| characterized by disruption of the pancreatic microcirculation so that large areas do not enhance on CT | necrotizing pancreatitis |
| is recommended in the setting of necrotizing pancreatitis to reduce the incidence of pancreatic infection | selective gut decontamination or systemic antibiotic prophylaxis |
| patients with infected necrosis of the pancreas require | surgical debridement |
| patients with sterile necrosis of the pancreas can be __ | followed with supportive therapy |
| the most common non-obstructive cause of chronic pancreatitis is | chronic alcoholism |
| gallstone pancreatitis almost never leads to | chronic pancreatitis |
| in chronic pancreatitis pain may be accompanied by __ | steatorrhea with symptoms of diarrhea and weight loss |
| __ does not occur until the output of lipase is decreased to less than 10% of normal | steatorrhea |
| the complications of chronic pancreatitis include | pseudocysts, pancreatic fistulas, biliary obstruction, pancreatic cancer, small bowel bacterial overgrowth, and gastric varices secondary to splenic-vein thrombosis |
| because direct biopsy of the pancreas is considered too risky, the diagnosis of chronic pancreatitis is typically based on __ | tests of pancreatic structure and function |
| gold standard functional test for diagnsosing chronic pancreatitis. | secretin stimulation test |
| this test involves the oral placement of a catheter into the duodenum for aspiration of pancreatic juice before and after stimulation with intravenous secretin | secretin stimulation test |
| the gold standard to document steatorrhea, however it is not specific for pancreatic exocrine insufficiency | 72 hour fecal fat |
| is not widely performed b/c it is labor intensive and is uncomfortable for the pateint | secretin stimulation test |
| correlates with functioning acinar parynchema | serum trypsinogen level |
| should be the first test performed when pancreatitis is suspected b/c it is both simple and inexpensive | plain film radiography |
| the most sensitive imaging studies to evaluate for structural abnormalities of the pancreatic parenchyma | ERCP, EUS |
| carcinoma of the pancreas is the __ leading cause of cancer in adults | fourth |
| <__% of all patients with carcinoma of the pancreas are alive after the first year of disease | 20 |
| __% of patients with carcinoma of the pancreas are alive beyond the fifth year of disease | 1-3 |
| contributing factors to carcinoma of the pancreas | age, male, carcinogens, cigarette smoke, hereditary pancreatitis, chronic pancreatitis, possibly a high fat diet. |
| occupational exposure to __ are clear risk factors for carcinoma of the pancreas | naphthylamine and benzidine |
| neither __ appear to be risk factors for carcinoma of the pancreas | coffee or alcohol consumption |
| by the time of diagnosis of pancreatic cancer the tumor | has reached an advanced stage |
| common presenting signs and symptoms of pancreatic cancer | jaundice, weight loss, and abdominal pain (constant and radiates to the back) |
| __ is the most common presentation in patients with a potentially resectable and curable lesion | painless jaundice |
| __ are the best imaging studies to define a pancreatic mass and assess for liver metastasis or vascular invasion | CT and MRI |
| __ should be considered if pancreatic cancer is suspected but a mass has not been found on other imaging studies | ERCP |
| __ has a sensitivity of 80-90% and a specificity of 85-95% in diagnosing pancreatic cancer in patients exhibiting signs and symptoms suggestive of pancreatic cancer | CA 19-9 |
| __ is the most accurate diagnostic and staging technique, providing information of tumor location, vascular invasion, and lymph node involvement | EUS |
| cancers of the body and tail that are resectable for cure | none |
| cancers of the pancreatic head that are resectable for cure | 10-20% |
| surgery for resectable carcinoma of the head of the pancreas usually involves a __ | Whipple's operation |
| __ offers the only chance for cure in pancreatic cancer | surgery |
| __ have met wit little sucess in the treatment of pancreatic cancer | radiation and chemotherapy |
| for patients with inoperable lesions __often become the focus of therapy | palliative interventions to alleviate jaundice, pain and intestinal obstruction |
Created by:
bwyche
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