Term
| What are the anatomy components of the pancreas? |
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Definition
- The gall bladder stores bile, joins the pancreas at the common bile duct
- Islets of Langerhaans - Endocrine fxns. Secretion of insulin, glucagon, and somatostatin
- Acinar cells - exocrine, secrete 2.5L/day of isotonic fluid containing water and enzymes |
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Term
| What digestive enzymes are secreted from the pancreas? |
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Definition
- Amylase - breaks down carbs
- Lipase - breaks down TGs into FFA
- Trypsinogen - breaks down AAs |
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Term
| What is acute pancreatitis? |
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Definition
| Acute inflammation that may also involve surrounding tissues |
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Term
| What are the major causes of acute pancreatitis? |
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Definition
- Gallstones - Main cause, obesity a risk
- Alcohol consumption |
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Term
| What medications are Class 1 for pancreatitis? |
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Definition
M - Mercaptopurine, metronidazole, metformin
V - Valproic acid
P - Pentamidine
T - Tetracyclines
A - AZA
B - birth control
L - Lasix, lipids
E - Estrogens
T - Thiazides
S - Sulfonamides, steroids |
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Term
| What are the 3 phases of pathophys of pancreatitis? |
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Definition
- Phase 1 - premature activation of trypsinogen --> trypsin. Activates other enzymes
- Phase 2 - Inflammatory mediators such as TNF, IL-1, and IL-8
- Phase 3 - Inflammation can spread to other organs. Abcess or necrosis. |
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Term
| How does acute pancreatitis present? |
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Definition
- Characteristic epigastric pain that radiates to the back and worsens with eating
- N/V
- Fever |
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Term
| What is the gold standard for acute pancreatitis diagnosis? |
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Definition
Contrast-enhanced computed tomography (CECT
**Ultrasound and Xray will see a gallstone and rule out pneumonia |
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Term
| What are the criteria for diagnosis? |
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Definition
2 out of 3:
- Elevated serum amylase AND/OR lipase
- Characteristic epigastric pain
- CT scan imaging |
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Term
| What are the different types of acute pancreatitis? |
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Definition
- Mild - usually minimal intervention
- Severe - either interstitial (confined to pancreas) or necrotizing
- Necrotizing - either sterile (no bacteria present) or infected |
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Term
| What criteria is used to assess severity? |
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Definition
Ranson criteria upon admission:
- Glucose > 200
- Age > 55
- LDH (lactate dehydrogenase) > 350
- AST > 250
- WBC > 16
3-4 criteria: 16% mortality, 5-6: 40% |
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Term
| What complications can result from acute pancreatitis? |
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Definition
- Fluid loss can lead to hypovolemia and shock
- Acute respiratory distress syndrome
- DIC - abnormal clotting
- Infection
- Ascites |
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Term
| What are the treatment goals for mild acute pancreatitis? |
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Definition
- Aggressive IV fluids
- NPO 3-7 days - appropriate nutrition. NJ tube is preferred
- N/V TX prn
- IV narcotics w/ morphine, dilaudid, fentanyl. Does NOT affect sphincter of Oddi |
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Term
| What are the treatment goals for severe acute pancreatitis? |
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Definition
- Start EN ASAP, PN if 1 week without EN
- Octreotide theoretically allows pancreas to rest, but no good studies
Necrotizing:
- Do not use prophylactic antibiotics!!
- Empiric antibiotics - suspect an infections, start broad spectrum antibiotics: Imipenem or Flagyl + FQN |
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Term
| What is chronic pancreatitis? |
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Definition
Irreversible scarring due to prolonged inflammation. Rarely if ever caused by acute pancreatitis
Caused by: Alcohol, nicotine, high fat meals |
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Term
| What are the stages of chronic pancreatitis? |
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Definition
- Inflammatory - may have no symptoms
- Acute attack- may resolve back to inflammatory stage
- Intermittent/Constant pain
- Burnout - malabsorption, DM |
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Term
| How does chronic pancreatitis present? |
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Definition
- abdominal pain at night and with eating
- Fatty stools and diarrhea
- Diabetes
- Weight loss, pain
- Dyspepsia |
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Term
| What is the gold standard for chronic pancreatitis diagnosis? |
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Definition
| Endoscopy, but very invasive. Goes all the way through GI tract to sphincter of Oddi |
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Term
| What is non-pharmacologic tx for chronic pancreatitis? |
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Definition
Stop Smoking!
Avoid alcohol
Reduction of dietary fat
Surgical stent or transplant |
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Term
| How is chronic pancreatitis treated with drugs? |
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Definition
Pain is debilitating
- Opioids - addictive, monitor constipation
- NSAIDs, APAP, tramadol are options
- Pancreatic enzymes - Breaks down CCK, improves pain. Take w/ meals. Can add a PPI, more enzyme makes it through. |
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