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