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68wm6 p2 Dis Panc
Disorders of the Pancreas
| Question | Answer |
|---|---|
| When is pancreatitis often fatal? | If inflammation is acute. |
| How much pancreatic juice does the pancreas produce a day? | 1000mL - 1500mL |
| What in the pancreatic juice is a digestive enzyme for proteins? | Protease (Trypsin) |
| What in the pancreatic juice is a digestive enzyme for Fats? | Lipase (Steapsin) |
| What in the pancreatic juice is a digestive enzyme for carbohydrates? | Amylase (Amylopsin) |
| What connects to the common bile duct from the liver and gallbladder and empties through a small orifice in the duodenum | Pancreatic duct |
| The pancreatic duct empties into the duodenum through this orifice | major duodenal papilla or papilla of Vater. |
| What cells of the pancreas secrete insulin? | Beta cells of the Islets of Langerhans |
| What cells in the pancreas secrete glucagon? | Alpha cells |
| What is the purpose of glucagon? | To increase blood sugar |
| Another name for the pancreatic duct | Duct of Wirsung |
| What does the inflammation of pancreatitis cause? | enzymes cannot flow out of the pancreas because of occlusion of the pancreatic duct (duct of Wirsung), leading to pressure build up. |
| What happens if the pressure in the pancreatic duct increases too much? | the duct ruptures releasing enzymes and the pancreas begins to digest itself (autodigestion) with these enzymes (especially Trypsin) |
| Within how long after an acute attack of pancreatitis does normal function of the pancreas return? | within 6 months |
| What is the etiology/pathophysiology of pancreatitis? | Pancreas becomes inflamed when there is reflux of bile and duodenal contents into the pancreatic duct, causing swelling and obstruction |
| What can refeeding after prolongued fasting or anorexia cause? | Pancreatitis |
| Pancreatitis from alchohol consumption is most common in who? | Men |
| Pancreatitis from damage to the biliary tract is most common in who? | Women |
| What is the most common sympton of pancreatitis? | Severe mid upper abdominal pain, which may radiate to both sides and straight up the back |
| How is the pain of pancreatitis often relieved? | By assuming a forward position, taking the stomach weight off the pancreas, or fetal position |
| What increases the pain of pancreatitis? | Eating or lying down. |
| Vomiting is seen in what percentage of PTs with pancreatitis? | 70% - 90% |
| How do the stools appears in the PT with pancreatitis? | Frothy and foul smelling |
| What may be present if the common bile duct is obstructed with pancreatitis? | Jaundice |
| What signs are indicators of panreatic bleeding? | Cullens and Turners signs |
| What abnormal bowel sounds can appear with pancreatitis? | Diminished bowel sounds |
| How can the abdomen of the PT with pancreatitis appear? | Distended and tender |
| What is cullens sign? | Bleeding around the umbilicus |
| What is Turners sign? | Bruising of the flanks |
| How do you perform Chvosteks test? | Tap facial nerve anterior to the earlobe |
| What does a positive Chvosteks sign indicate? | Hypocalcemia |
| How do you perform a Carpopedal Spasm (Trousseau's Sign)test? | Occlusion of brachial artery with a BP cuff for 3 minutes, looking for flexion at the wrist and metacarpophalangeal |
| What lab value may be elevated with the obstruction of the common bile duct? | Billiruben |
| In acute pancreatitis, serum amylase may elevate when? | Early with 2 - 36 hours |
| Which pancreatic enzyme level is a SPECIFIC indicator for diagnosing acute pancreatitis? | Serum Lipase |
| When do lipase levels first rise, peak, and how long do they remain elevated? | Rise in 4-8 hours, peak in 24 hours, and can remain elevated for 14 days. |
| How much can amylase and lipase levels elevate in a PT with acute pancreatitis? | 5 - 40 times more. |
| Serum values of Lipase: | 3 to 73 units/L |
| Serum values of Amylase: | 25 to 160 U/L |
| What Pancreatic problems are Endoscopic and Ultrasound exams used to determine? | *Pancreatic cysts *Abscesses *Pseudocysts (fibrous capsules filled with fluid, blood, enzymes, pus and tissue debris) |
| What is the medication of choice for Tx of pancreatic pain and spasms? | Demerol via PCA |
| What is given to reduce activity of the vagus nerve (Vagus nerve controls stomach activity)? | Atropine or anticholinergics |
| What is the medical management of pancreatitis caused by gallstones? | Cholecystectomy |
| What pain medication should be avoided in a PT with pancreatitis due to the possiblility of it causing spasms of the Sphincter of Oddi, and what pain medication should be given instead? | Morphine, give Demerol instead |
| In the case of severe acute pancreatitis, what may need to be given to maintain adequate nutrition? | TPN |
| What happens to the pancreas in a PT with chronic pancreatitis? | The pancreas hardens and undergoes fibrotic scarring, and exocrine and endocrine functions are partly or completely lost as pancreatic tissue is destroyed |
| What is the most common cause of chronic pancreatitis? | Chronic alcoholism |
| In what position does the PT asusme to relieve pain from chronic pancreatitis? | Pain is sometimes relieved by assuming a forward position, taking the stomach weight off the pancreas |
| In a PT with chronic pancreatitis, what may be felt on palpation of the abdomen? | Firm mass may be felt in upper left quadrant |
| If present, what contributes to the severity of symptoms in pancreatitis? | Pseudocysts |
| What test shows impaired ability to metabolize carbohydrates due to endocrine dysfunction? | Glucose tolerance test |
| What is the medical management of chronic pancreatitis with no obstruction? | *Abstinence from alcohol *Clear liquid, advance to fat free diet *Correction of biliary tract disease and/or hyperparathyroidism *Demerol is ordered cautiously, but focus is on non-opioid pain management |
| What is a Pancreatojejunostomy (Whipple Procedure)? | *Removal of: Gallbladder, Bile duct, Part of the duodenum, Head of the pancreas *Anastomy of the remaining pancreas to the remaining duodenum and biliary ducts from liver/gallblader attached directly to remaining duedenum. |
| What is Pancreatic autotransplantation? | *Excision and relocation of the pancreas *Innervation is cut, relieving pain symptoms. *Exocrine function is lost, but endocrine function is retained *Will require lifelong supplements |
Created by:
Shanejqb
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