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22 Cards in this Set
- Front
- Back
What do pancreatic duct cells secrete?
- what does this secretion depend on? |
bicarb
- secretin, produced in the small intestine in response to acid and nutrients |
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What do pancreatic acinar cells do?
- what stimulates this? - what activates this product? |
produced propeptide forms of pancreatic enzymes (zymogens)
- CCK (cholecystokinin) - i/ duodenum by brush border enzyme enterokinase |
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Even though there are many other possible causes of acute pancreatitis, what are the three most common causes of it?
- which other three causes will we "hear about on the boards?" |
Alcohol, medications, gallstones (inflammation/biliary)
- viral (mumps), scorpion bites, hypertriglyceridemia |
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What is one of the common (3-5%) side effects of ERCP?
- Can abdominal trauma (like a MVA) cause it as well? |
Acute Pancreatitis
- yes |
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If you see a pt in which you suspect pancreatitis, but they are also jaundiced.... v. good evidence that this is what?
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a gallstone problem
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what is the primary pathophysiology of gallstone pancreatitis?
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self-digestion (via trypsin)
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What is a pathonomic finding of alcoholic pancreatitis? Is this is most common reason that alcoholics get pancreatitis?
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calcification, and calcium dense stones.
- no. |
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What are the two classifications of acute pancreatitis presentations? Subgroups?
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edematous (acute interstitial)
Necrotizing - sterile - non-sterile |
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Confirming alcoholic edematous pancreatitis requires what? Which is more sensitive? More specific?
- anytime we suspect this, what else should we check? - imaging test? - tx? |
elevated amylase and/or lipase (3-5x normal)
- amylase = sensitive - lipase = more specific - LFTs to eval for cholestatic pattern of bile duct obstruction. + ^ Bili and alkphos. - US + don't need crosssectional imaging - IV fluids & pain control, + cholecystectomy before they leave the hospital, but it's not emergent. |
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What is the most common cause of acute necrotizing pancreatitis?
- can this induce multisystem organ failure? how? - how can you differentiate this from non-necrotizing dz? |
gallstone
- yes, systemic inflammatory response. - presence of hypotension / tachycardia. |
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What is Grey-Turner's sign, and what can it indicate? Cullen's sign?
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flank ecchymosis
periumbilical ecchymosis |
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How is necrotizing acute pancreatitis dx'ed?
- can US be used? - if the pt isn't getting better, or they're febrile, etc, what do you do? - ERCP? |
- US is only good for +/- stones, not for the pancreas itself
- CT - no, only if a stone is lodged there. |
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What is the tx for acute necrotizing pancreatitis?
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Aggressive fluid support
Pain control ERC if needed |
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What is the primary cause of chronic pancreatitis?
- sx? |
alcohol
- unremitting epigastric pain, often radiates to back, requires narcotics, etc. - **steatorrhea/malnutrition**... all the stuff we talked about with malabsorption - diabetes |
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What type of dx is Chronic Pancreatitis?
- if you see pancreatic calcification on plain films, is that helpful? |
Clinical
- yes, that can help dx. - on CT you might see dilated duct w/ atrophy |
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What is one of the only conditions in which you'd see isolated gastric varices (splenic vein thrombosis)?
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Chronic pancreatitis
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Are pseudocysts seen in chronic pancreatitis?
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yes, even though the dz is chronic it has acute flares.
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What is a puestow procedure?
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lateral pancreatic duct drainage
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How can you tx chronic pancreatitis? (4)
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enzyme replacement, pain control, decrease gastric acid secretion, low fat diet.
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What is the strongest environmental association with pancreatic adenocarcinoma?
- is chronic pancreatitis associated? - is there a hereditary component? |
tobacco
- yes - yes |
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Painless jaundice can be a sign of what, especially if it presents with pruritus, weight loss, malaise, early satiety, depression, and/or diabetes.
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Pancreatic adenocarcinoma.
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Do we often need to biopsy pancreatic adenocarcinomas?
- how do we make the dx? - how to we tx it? |
No
- CT/MRI - pancreatodudenectomy (Whipple procedure) when possible. |