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68wm6 p2 Dis Panc

Disorders of the Pancreas

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