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DU PA Pancreas

Duke PA Diseases of the Pancreas

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