Term
| What do islets of langerhans secrete? |
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Definition
Insulin, glucagon, somatostatin, and other polypeptide hormones
75% of islet cell mass is made up of beta-cells secreting insulin |
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Term
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Definition
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}Acini
◦Secrete 1-2 L/d of iso-osmotic alkaline (pH 8.3) fluid containing water, electrolytes, bicarbonate, and enzymes
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Term
| What are pancreatic enzymes? |
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Definition
Proteolytic: trypsinogen, chymorypsinogen, procarboxypeptidase, proelastase
Amylolytic: amylase
Lipolytic: lipase
Nucleolytic
All emptied into main pancreatic duct
the main pabcreatic duct & common bile duct empties into duodenum at the ampulla of Vater |
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Term
| What is acute pancreatitis? |
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Definition
Acute inflammation of the pancreas
Initial insult:
- Premature activation of pancreatic zymogens w/in the acinar cells
- Pancreatic ischemia
- Pancreatic duct obstruction
Secondary events
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Term
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Definition
Gallstone associated biliary tract dz (30-85%)
Ethanol use (45%)
Iodopathic
Medications |
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Term
| What are medications associated with acute pancreatitis? |
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Definition
| 5- amino salicylic acid, ACE inhibitors, Amiodarone, Asparaginase, Azothioprine, Didanosine, Estrogens, Furosemide, Mercaptopurine, MEthyldopa, Metronidazole, Pentamidine, Sulfonamides, Sulindac, Tetracycline, Thiazides, Valproic acid/salt |
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Term
| What is proposed mechanism of how medications cause pancreatitis? |
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Definition
- Immune mediated inflammatory response
- Direct cellular toxicity
- Pancreatic duct constriction
- Arteriolar thrombosis
- Metabolic effects |
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Term
| What are local complications with pancreatitis? |
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Definition
- Acute fluid collection
- Pancreatic necrosis
- Abscess
- Pseudocyst |
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Term
| What are systemic complications with pancreatitis? |
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Definition
- CV
- Renal
- Pulmonary
- Metabolic
- Hemorrhagic
- Central nervous system |
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Term
| How does pancreatitis present? |
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Definition
- Abdominal pain (95%)
- Radiation of pain to back (50%)
- Abd distension (75%)
- N/V (80%)
- Low-grade fever (75%)
- Hypotension (30%) |
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Term
| What are abnormal lab tests seen? |
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Definition
- Leukocytosis
- Hyperglycemia
- Hypoalbuminemia
- Mild hyperbilirubinemia
- Inc serum alkaline phos & liver transaminases
- Hypocalcemia
- Thrombocytopenia, serum amylase, serum lipase |
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Term
| What are Ranson's criteria of severity of dz that are present initially? |
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Definition
- Age >55yo
- WBC count>16000/ul
-BG>200 mg/dl
- Serum LDH>350 IU/l
- AST(SGOT)>250IU/dl |
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Term
| What are Ranson's criteria of severity of dz that develops within 48 hrs? |
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Definition
- Hematocrit fall >10%
- BUN rise >5mg/dl
- Serum calcium <8 mg/dl
- Arterial PO2<60 mmHg
- Base deficit >4meq/L
- Estimate fluid sequestration >6L |
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Term
Mortality rates: severe defined as 3 or more criteria
<3 criteria mortality <1%
6 criteria mortality is 100% |
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Definition
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Term
| What are treatment goals? |
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Definition
- Identify & correct factors that precipitated acute attack (drinking get them stop , worry about DT)
- Relieve abd pain
- Replace fluid
- Minimize systemic complications
- Manage pancreatic necrosis and infection |
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Term
| What are supportive care given? |
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Definition
- Withhold food/liquids to min exocrine stimulation
- Pain control
- Nasogastric aspiration in pt w/ severe pain, ileus, or intractable vomiting
- Fluid rescuscitation****
- Replace electrolytes, treat hyperglycemia, nutritional support |
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Term
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Definition
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}Opiates: Transient elevations in serum amylase & lipase following use should not stop administration
}Meperidine and the Sphincter of Oddi spasms: truth or myth? SE of neurotoxicity and seizure, however, Benefit does not outweigh the risk
}Morphine inc biliary pressure, but not contraindicated in acute pancreatitis.
}Pick one. PCA if dosing q 2-3 hrs
}no need for PPI or H2 antagonists
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Term
| When are prophylactic abx warranted? |
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Definition
In pts with:
- Biliary or pancreatic duct obstruction
- Necrotizing pancreatitis
- Suspected abscess |
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Term
| What are monitoring parameters? |
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Definition
- Pain control
- Signs of infection
- Electrolytes
- Fluid status and urine output
- Nutrition support (hold food for shorter period of time, not long b/c pt get malnourished) (restart food slowly or use NG tube(push into small intestine juvenile))
- BP, HR, urine output |
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Term
What is chronis pancreatitis? |
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Definition
Inflammation of pancreas leading to irreversible damage to pancreatic structure and function
all pts lose exocrine tissue and fibrosis
many lose endocrine function
70% case in US, 2nd to prolonged ethanol abuse |
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Term
| How does alcohol cause chronis pancreatitis? |
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Definition
Inflammation progresses to cellular necrosis--fibrosis
Formation of intraductal protein plugs that block small ductules producing progressive structural damage in the ducts and the acinar tissue
Calcium complexes to the protein plugs
Eventually destroys pancreatic tissue |
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Term
| How does chronic pancreatitis present? |
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Definition
Abd pain: consistent (alcoholics) or episodic, frequently nocturnal, deep seated, unresponsive to meds. Severe attacks may last days to wks aggravated by eating
Cause: inc intraductal pressure 2nd to continued pancreatic secretion, pancreatic inflammation, abnormal pancreatic nerves. Less pain over time |
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Term
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Definition
Malabsorption: of protein & fat when enzyme secretion dec by 90%. Steatorrhea (excessive loss of fat in feces) (diarrhea & bloating). Fat soluble vit & B12 malabsorption
- Wt loss: N/V, pain
- Diabetes: late manifestation, brittle b/c lose glucagon in addition to insulin |
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Term
| What are classic signs and symptoms? |
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Definition
- Pain
- Wt loss
- Steatorrhea
- Diabetes
- Calcification of pancreas |
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Term
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Definition
Amylase & lipase usually normal unless acute exacerbation or pancreatic duct is blocke or pseudocyst is present
Fluid & electrolytes usually normal unless a lot of v/diarrhea
72 hr quantitative measurement of fecal fat (>7g of fat in feces /24 hrs is abnormal should be on a diet of 100 g/d fat) |
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Term
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Definition
- Control chronic abd pain
- Correct malabsorption
- Tx diabetes |
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Term
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Definition
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}Stop alcohol
}Non-narcotic analgesics
◦Acetaminophen (>2 alcoholic bev/day give no more than 500 mg qid) (worry about liver)
◦NSAIDs (worry about GI bleeding and liver dz)
◦Tramadol
}Low fat diet (50-75 g/day)
}Narcotics as last resort, but do not withhold because of risk of addiction
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Term
| What are pancreatic enzyme supplement ADE? |
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Definition
- Hyperruricosuria
- Hyperuricemia
- Kidney stones
- Impaired folic acid absorption
- Dose related GI SE occur less with enteric coated products |
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Term
| What are patient monitoring parametes? |
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Definition
- Abd pain control
- Body weight
- Stool consistency/frequency
- 72-hr stool test
- Serum uric acid yearly
- Serum folic acid yearly
- BG |
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