Term
| the ? is a gland in the abdomen lying in the curvature of the stomach as it empties into the duodenum; the pancreas functions primarily as an ? gland although it also has ? function; the exocrine cells of the pancreas are called ? cells that produce ? fluid known as pancreatic juic that contains various digestive enzymes; the pancreatic juice is released through the ampulla of Vater into the ? to aid in the digestive process as well as buffer acidic fluid released from the stomach |
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Definition
| pancreas; exorine; endocrine; acinar; alkaline; duodenum |
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Term
| the digestive enzymes are produced and stored as inactive ? with ? granules to prevent autolysis and digestion of the pancreas; the zymogen granules are also responsible for enzyme transport to the ? duct; ? and ? are released from the zymogen granules in their active form, whereas the ? enzymes are activated in the duodenum by ?; enterokinase triggers conversion of ? to the active protease ?; trypsin then activates the other proenzymes to their active enzymes; the pancrease contains a ? inhibitor to prevent autolysis |
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Definition
| proenzymes; zymogen; pancreatic; amylase and lipase; proteolytic; enterokinase; typsinogen; trypsin; typsin |
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Term
| in the western hemisphere, acute pancreatitis is caused mainly by ? use/abuse and ? (cholelithiasis); other common causes of acute pancreatits include ?, endoscopic retrograde cholangiopancreatography, ?, and autodigestion due to early activation of pancreatic enzymes as well as numerous ? |
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Definition
| ethanol; gallstones; hypertriglyceridemia; pregnancy; medications |
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Term
| ethanol abuse may cause precipitation of ? enzymes in the ducts of the pancreas, leading to chronic ? and ? reulting in loss of exocrine function; ? may obstruct the ampulla of Vater causing pancreatic enzymes or bile to move in a ? fashion into the pancreas and this may be responsible for pancreatic ?; autolysis in the pancreas can occur when ? are activated in the pancreas before being relased into the duodenum; acute pancreatits can result from the initial injury to the ? producing cells which is followed by ? invasion of the pancreas and further activation of enzymes within the pancreas; this cascade of events is harmful and destructive to patient |
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Definition
| pancreatic; inflammation; fibrosis; gallstones; retrograde; autolysis; zymogen; zymogen; neutrophil |
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Term
| a ? fluid collection (or pancreatic pseudocyst) is a collection of tissue, pancreatic enzymes, and blood that froms weeks after acute pancreatits; many of these resolve spontaneously, but some require ? drainage; rupture of these associated with erosion and hemorrhage of major abdominal blood vessels can have a mortality approaching 60%; pancreatic ? is a diffuse inflammation of the pancreas; pancreatic necrosis occurs within the first ? weeks of acute pancreatits and develops in 10-30% of patients with acute pancreatits; the necrotic pancreas can become secondarily infected with enteric gram ? bacteria such as ? |
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Definition
| pancreatic; surgical; necrosis; 2; negative; E. coli |
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Term
| pancreatic ? is a collection of pus that forms in the pancreas 4 to 6 weeks after acute pancreatitis; pancreatic abscess is usually ? life threatening than pancreatic necrosis or pancreatic pseudocyst and can be managed with percutatneous ?; pancreatic ? can occur when pancreatic abscesses become secondarily infected and this infection is usually due to bacteria that are ? found in the GI tract |
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Definition
| abscess; less; drainage; necrosis; normally |
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Term
| a patient with acute pancreatits may develop many severe ? and ? complications; ? pain and distention may be due to local complications such as fluid collection, necrosis, or abcess in the pancreas; ?, ? and ? may result from systemic complications, which can affect virtualy any organ system but tend to target the ? and ? systems and the ?; ? ? (ARDS) is a life threating syndrome of acute lung injury with resulting hypoxia; patients at greatest risk for mortality from acute pancreatits are those who have multiorgan failure such as ?, ? failure, or ? failure or those with pancreatic ?, obesity, volume depletion, above ? years of age and elevated APACHE II score |
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Definition
| local; systemic; abdominal; hypotension, tachycardia, fever; pulmonary, cardiovascular, kidney; Acute Respiratory Distress Syndrome; hypotension; renal; respiratory; necrosis; 70 |
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Term
| diagnosis of acute pancreatits is based on the patient's ? and presenting ? and ?; evaluation of laboratory results, specifically the serum ?, aids in diagnosis; serum ? is elevated early in the disease process but may return to normal within ? hours; although an elevated serum amylase had been the diagnostic standard, its utility is now limited by lack of specificity; serum ? and ? are now the gold standards for laboratory testing; serum lipase will remain elevated for ? after the acute event; ? is more complicated than abdominal radiography or ultrasound, but it is the most useful tool for diagnosis and staging of acute pancreatitis |
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Definition
| history; signs and symptoms; lipase; amylase; 12 hours; lipase; colipase; days; CT scan |
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Term
| the goals of treatment for acute pancreatitis include: resolution of ?, ?, ? pain, and ?; ability to tolerate ? intake; normalization of serum ?, ?, ? count; resoultion of abcess, pseudocyst, or fluid collection as measured by ? scan |
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Definition
| nausea, vomiting, abdominal, fever; oral; lipase, amylase, white blood cell; CT scan |
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Term
| if a medication is determined to be the cause of acute pancreatitis, it should be ? and an ? therapy should be considered; therapy of acute pancreatitis is primarily ? unless a specific etiology is identified; supportive therapy involves ? repletion, ? support, and ? |
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Definition
| discontinued; alternative; supportive; fluid; nutrition; analgesia |
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Term
| patients with acute pancreatitis are administered ? fluids to maintain hydration and blood pressure in the form of ? or ?; ? at a rate of 50 to 100 ml/h is reasonable for patients with mild to moderate fluid depletion; however, as much as 200 ml/h may be required for patients with severe fluid losses; electrolytes such as ? and ? may be added to the infusions if necessary; hyperglycemia can be managed with ? |
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Definition
| IV; crystalloids; colloids; normal; potassium; magnesium; IV insulin |
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Term
| it is common practice to discontinue oral ? during an attack of acute pancreatitis; in theory, discontinuation of oral intake will decrease ? functions of the pancreas and minimize further complications from the disease; ? feeding delivered via a ? tube will feed the patient beyound the ampulla of Vater, minimizing the stimulation of the pancrease; if oral intake is discontinued for a protracted period, ? nutrition must be used to maintain adequate nutrition |
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Definition
| feedings; secretory; tube; nasojejunal; parenteral |
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Term
| if pancreatic necrosis has been identified, ? debridement is necessary because mortality approaches ?% without drainage or surgical intervention; ? has historically been the most popular analgesic in acute pancreatitis because it is purported to cause less ? and resulting in pain in the sphincter of ? than other analgesics however the clinical importance of this phenomenon is unclear and as a result patients should be given the most effective analgesic; ? and ? are reasonable alternatives to meperidine and may be more desirable due to other adverse effects associated with meperidine |
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Definition
| surgical; 100%; meperidine; spasm; Oddi; hydromorphone; fentanyl |
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Term
| empiric ? are not necessary if the patient has mild disease or a noninfectious etiology of acute pancreatitis; antibiotics have not been shown to prevent the formaation of pancreatic abscess or necrosis when given early in the course of acute pancreatitis |
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Definition
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Term
| antibiotics may be appropriate for pancreatic ?, which can be infected initially or be susceptible to a secondary infection; however, published data yield conflicting results regarding mortality and infection rate in this setting and as such the decision to use antibiotics is highly individualized; if necrosis is confirmed, antibiotics are insufficient as sole therapy and ? debridement is necessary for cure |
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Definition
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Term
| ? antibiotics with activity against enteric gram ? bacilli are appropriate; patients may receive ? courses of broad spectrum antibiotics such as ? and may develop superinfections due to more resistant bacteria or bacteria not susceptible to meropenem; antifungal drugs such as ? may be considered if peritonitis or GI perofration develops due to the presence of such fungi as ? in the GI tract |
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Definition
| broad spectrum; negative; long; meropenem; fluconazole; candida albicans |
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Term
| several pharmacologic therapies have been proven to be ineffective in reducing morbidity and mortality from the disease such as reducing pancreatic secretions by reducing ? or ?, reducing gastric acidity and decreasing pancreatic secretion with ?, inhibition of pancreatic enzymes usine ? inhibitors such as aprotinin, probiotics, and immunomodulation |
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Definition
| somatostatin; atropine; H2 antagonists; protease |
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Term
| the incidence of chronic pancreatitis is approximately one in ? people; the most common cause of chronic pancreatits in adults in Western countries is ? abuse; the most common cause in children is ? due to pre existing pancreatic insufficiency inherent in the disease; ? can occur at the same time as chronic pancreatitis but are not often implicated as the cause; unlike acute pancreatits, chronic pancreatits has an ? etiology in a significant number of cases |
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Definition
| 10,000; ethanol; cystic fibrosis; gallstones; unknown |
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Term
| the amount of ethanol consumed does not correlate with the incidence or progression of ? pancreatitis; the inflammation damages the ? producing cells in the pancrease and can also disrupt or destroy the ? function of the pancrease by causing diffuse scarring and fibrosis; long term sequalae of chronic pancreatits include dietary ?, impaired ? tolerance, cholangitis, and potential addiction to ? analgesics |
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Definition
| chronic; enzyme; endocrine; malabsorption; glucose; opioid |
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Term
| as patients lose ? function of the pancreas, they have decreased ability to absorb ? and ? ingested with normal dietary intake; ? loss from nutritional malabsorption is a common symptom of chronic pancreatitis not often seen in acute pancreatitis; ? or ? containing stools are also common; ? absorption is usually unaffected; no incidence of fat soluble ? deficieny in patients with chornic pancreatitis |
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Definition
| exocrine; lipids; proteins; weight; fat; protein; carbohydrate; vitamin |
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Term
| differentiating an episode of acute from chronic pancreatitis may be difficult because clinical presentations can be similar; the diagnosis of chornic pancreatitis is made by looking for the effects of chronic pancreatic inflammation and ? on the pancreas and the patient as a whole; ? or ECRP will allow visualization of chronic calcified lesions in the pancreas when present |
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Definition
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Term
| the goals of pharmacotherapy for chronic pancreatits are prevention and resolution of chronic ? pain and correction of dietary malabsorption with exogenous ? enzymes; ? modifications are an important part of the therapy for chornic pancreatitis; patients should be advised to completely avoid ? and ? meals which will help decrease the pain; most ? procedures in the treatment of chronic pancreatitis have not been proven to be effective (including nerve blocks) |
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Definition
| abdominal; pancreatic; lifestyle; ethanol; fatty; surgical |
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Term
| ? management is an important component of therapy and is similar to that of acute pancreatitis; nonopioid analgesics such as ? are preferred, but the severe and persistent nature of the pain often requires ? therapy; patients can require chronic doses of opioid therapy with a resulting risk of ? |
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Definition
| pain; tramadol; opioid; addiction |
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Term
| the goal of pancreatic ? supplementation is to deliver exogenous enzymes to the ? without causing further GI side effects from the medication; supplementation with pancreatic enzymes may reduce the ? and ? diarrhea associated with chronic pancreatitis; common pancreatic enzyme produces contain ?, ? and ? in varying proportions thus the dose can be tailored to the patient |
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Definition
| enzyme; duodenum; pain; fatty; lipase, amylase, protease |
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Term
| ? coated pancreatic enzyme supplements require ? doses to compensate for loss of enzyme due to destruction by the low pH stomach; this effect can be minimized by administering ? or ?; these non enteric coated pancreatic enzyme supplements may have an advantage in minimizing ? early in the disease state through regulation of proteases in the duodenum; these can be used for initial therapy and the relative dose of amylase, lipase, and protease may be increased until control of ? and ? diarrhea are achieved; if pain and diarrhea control are achieved, the patient may be transitioned to an ? coated supplement to maximize compliance |
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Definition
| nonenteric; high; H2 antagonists; PPIs; pain; pain; fatty; enteric |
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Term
| most pancreatic enzyme supplements are ? coated to release enzymes in the alkaline environment of the intestine; this minimizes ? destruction in the stomach; enteric coated pancreatic enzyme supplements require ? daily dosage units, but delivery of the drug to the site of action and effectiveness may be delayed by gastric emptying time; pancreatic enzymes should be taken immediately prior to ? to aid in the digestion and absorption of food; alternately, patients can supplement their diet with medium chain ? (MCTs) since they do not require pancreatic enzymes for absorption; once the patient is switched from the nonenteric coated to the enteric coated the H2 receptor antagonist or PPI can be ? |
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Definition
| enteric; enzymatic; lower; meals; triglycerides; discontinued |
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