Term
| What is the basic function of the pancreas? |
|
Definition
| excretion of hormones or enzymes that deal with digestion/absorption of nutrients from food intake |
|
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Term
| What are the 2 distinct components of pancreatic exocrine secretion? |
|
Definition
enzyme secretion
water + electrolyte secretion |
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Term
|
Definition
| endogenous hormone which stimulates enzyme secretion |
|
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Term
|
Definition
| endogenous stimulant of pancreatic electrolyte secretion |
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Term
|
Definition
an acute inflammatory process of the pancreas that
1. is assc w/ abdominal pain and elevations in serum levels of pancreatic enzymes
2. disrupts normal pancreatic architecture and function only until the illness resolves |
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Term
|
Definition
assc w/ permanent and irreversible damage to the gland deadly!!! |
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|
Term
| severe acute pancreatitis |
|
Definition
the presence of organ failure or pancreatic or peripancreatic complications or both along with unfavorable early prognostic signs |
|
|
Term
| what are the causes of acute pancreatitis? |
|
Definition
1. gallstones and microlithiasis/alcohol abuse 2. obstruction of pancreatic duct 3. trauma 4. toxins 5. drugs |
|
|
Term
| what is the clinical presentation of acute pancreatitis? |
|
Definition
- steady, dull or boring midepigastric to LUQ pain - N/V - progressive severity - radiates midline to back - worse in supine position |
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|
Term
| what do you see on your PE of an acute pancreatitis patient? |
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Definition
fever, tachycardia, hypotension marked tenderness w/ no peritoneal irritation signs masses, fluid collection, abscesses, palpable later jaundice, pulmonary sxs grey turners sign, cullens sign |
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Term
| with an acute pancreatitis pt, they are going into _______ bc they are in so much pain |
|
Definition
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Term
|
Definition
ecchymoses of the flank rare |
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Term
|
Definition
umbilicus ecchymoses rare |
|
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Term
| how can acute pancreatitis effect the eyes? |
|
Definition
xanthomas in pts with hyperlipidemic pancreatitis |
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Term
| if you see xanthomas, what test do you want to do? |
|
Definition
|
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Term
| what lab tests do you want to do for a pt w/ suspected acute pancreatitis? |
|
Definition
serum amylase (increased levels will be seen in about 75% of acute pancreatitis pts) serum lipase (often used as an adjunct to serum amylase) |
|
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Term
| what imaging tests do you want to do on a pt with acute pancreatitis? |
|
Definition
KUB US CT, w/ a bolus of contrast MRI cholangiopancreatography (tests for presence of bile duct stones) |
|
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Term
| what are some differential diagnoses for acute pancreatitis? |
|
Definition
acute appendicitis acute cholecystitis perforated duodenal ulcer (free air) alcoholic hepatitis intestinal obstruction diabetic ketoacidosis renal colic |
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Term
|
Definition
for determining acute pancreatitis upon admission: 1. age, 2. blood glucose > 200, 3. WBC >16,000, serum LDH >350, 5. AST >250 during initial 48 hours: 1. HCT falls >10%, 2. Serum calcium <8, 3. BUN rise >5, 4. est. fluid retention > 6 liters, 5. arterial PO2 < 60 < 3 signs - better prognosis, < 1% mortality > 3 signs - serious acute prognosis - may be 25% mortality |
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|
Term
| local complications of acute pancreatitis |
|
Definition
peripancreatic fluid collection pseudocyst pancreatic necrosis abscess duodenal obstruction biliary obstruction |
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|
Term
| cardiovascular complications of acute pancreatitis |
|
Definition
hypotension and shock pericardial effusion and tamponade ECG changes |
|
|
Term
| pulmonary complications of acute pancreatitis |
|
Definition
hypoxia atelectasis pneumonia pleural effusion ARDS |
|
|
Term
| metabolic complications of acute pancreatitis |
|
Definition
hypocalcemia hypertriglyceridemia hyperglycemia (can go down too) |
|
|
Term
| renal complications of acute pancreatitis |
|
Definition
oliguria and azotemia acute tubular necrosis |
|
|
Term
| hematologic complications of acute pancreatitis |
|
Definition
DIC vascular thrombosis GI bleeding |
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|
Term
| treatment of acute pancreatitis |
|
Definition
85-90% self limiting fluid and electrolyte replacement essential keep strictly NPO, NG suction pain control - demerol, toradol monitor for complications - can be deadly |
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Term
| what percentage of acute pancreatitis will progress into chronic? |
|
Definition
|
|
Term
| what causes 70% of non-obstructive chronic pancreatitis? |
|
Definition
|
|
Term
| chronic pancreatitis presentations |
|
Definition
persistent/recurring pain weight loss steatorrhea (stool with fat in it) jaundice ascites |
|
|
Term
| what's the classic triad for chronic pancreatitis? |
|
Definition
calcifications steatorrhea diabetes |
|
|
Term
| what are the risk factors for pancreatic cancer? |
|
Definition
age male obesity hx of diabetes smoking chronic pancreatitis most none |
|
|
Term
| pancreatic cancer presentation |
|
Definition
jaundice wt loss anorexia unrelenting abd pain/new onset w/o obvious cause |
|
|
Term
|
Definition
rare, name according to the hormone they produce generally malignant young to middle aged females nonfunctional: absence of sxs functional: named for major hormone |
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|
Term
| insulinomas of the pancreas |
|
Definition
most common endocrine tumor elevated plasma insulin and hypoglycemia SXS of hypoglycemia age 40-50 10-15% malignant 75-95% benign are cured with surgery |
|
|
Term
| gastrinomas of the pancreas |
|
Definition
2nd most common endocrine tumor ZOLLINGER-ELLISON SYNDROME (treated w/ PPIs) GERD x10 clinical sxs are due to gastric acid hyper secretion abd pain |
|
|
Term
|
Definition
chronic watery diarrhea hypercalcemia, elevated gastrin, low gastric pH therapy directed at controlling gastric acid and tumor growth |
|
|
Term
| in the US ____% of gallstones are of the cholesterol or mixed type |
|
Definition
|
|
Term
| what are the 2 functions of the gall bladder |
|
Definition
| storage and concentration |
|
|
Term
| risk factors for cholesterol gallstones |
|
Definition
increasing age female obesity rapid wt loss native american elevated trigs some meds: estrogen, fibric acid deriv |
|
|
Term
| risk factors for pigmented gallstones |
|
Definition
increasing age chronic hemolysis etoh liver disease biliary infection duodenal diverticulum truncal vagotomy primary biliary cirrhosis |
|
|
Term
| risk factors for cholelithiasis |
|
Definition
fair, fat, forty, fertile, flatulent rapid wt loss DM pregnancy ileal disease (Crohns) white>black sickle cell anemia cirrhosis |
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|
Term
| most sxs of GBD are __________ |
|
Definition
|
|
Term
|
Definition
biliary colic pain of acute cholecystitis GI (dyspepsia, heartburn, bloating, fatty food intolerance, repeated attacks are common) |
|
|
Term
| clinical manifestations of acute cholecystitis |
|
Definition
anorexia N/V fever abd pain RUQ tenderness pain can last up to 6 hours some pts have dark urine and jaundice |
|
|
Term
| PE for acute cholecystitis |
|
Definition
RUQ pain murphy's sign possibly a palpable GB tenderness, guarding and rebound secondary pancreatitis |
|
|
Term
| lab evaluation for acute cholecystitis |
|
Definition
leukocytosis elevated bilirubin and alk phos serum amylase may be elevated |
|
|
Term
| imaging test for acute cholecystitis |
|
Definition
US oral cholecystogram MR scan HIDA scan |
|
|
Term
| differential diagnosis for symptomatic cholelithiasis |
|
Definition
GERD PUD chronic relapsing pancreatitis IBS malignant neoplasm of GI tract |
|
|
Term
| complications of symptomatic cholelithiasis |
|
Definition
acute cholecystitis choledocholithiasis gallstone pancreatitis gallstone ileus rarely gallbladder carcinoma |
|
|
Term
| treatment of symptomatic cholelithiasis |
|
Definition
elective laparoscopic cholecystectomy diet: low fat, simple ursodeoxycholic acid (doesn't work well) |
|
|
Term
| what causes acute cholecystitis 90% of the time? |
|
Definition
|
|
Term
| acute cholecystitis differential diagnosis |
|
Definition
acute perforated peptic ulcer acute pancreatitis appendicitis perforated colon hepatitis liver abscess pneumonia with pleurisy |
|
|
Term
| acute cholecystitis: complications |
|
Definition
gallbladder perforation empyema of GB: bag of pus emphysematous cholecystitis (gas forming organisms - lethal) |
|
|
Term
| acute cholecystitis: treatment |
|
Definition
NPO antibiotics intravenous ailmentation cholecystectomy w/in 1-3 days |
|
|
Term
| chronic cholecystitis: symptoms |
|
Definition
flatulence heartburn postprandial distress pt may have had many episodes of acute disease |
|
|
Term
|
Definition
|
|
Term
| lab evaluation of cholangitis/choledocholithiasis |
|
Definition
elevated bilirubin alkaline phosphatase amminotransferase PT US may be + CT scan, limited usefulness MRI cholangiography ERCP |
|
|
Term
| treatment of gallstone pancreatitis |
|
Definition
bowel rest, support w/ resolution of pancreatitis cholecystectomy |
|
|
Term
| carcinoma of the biliary tract |
|
Definition
rare 2% finding at cholecystectomy in-situ has a good prognosis otherwise the prognosis is poor always gallstones |
|
|
Term
| carcinoma of the extrahepatic bile ducts |
|
Definition
3% of all caner deaths 50-70 years of age M=F Klatskin tumor = at confluence of bile ducts |
|
|
Term
| common features of esophageal disorders |
|
Definition
dysphagia odynophagia heartburn - pyrosis |
|
|
Term
| which is worse: dysphagia occuring with solid food or liquids? |
|
Definition
|
|
Term
| what diagnositic studies are there for the esophagus? |
|
Definition
upper endoscopy barium swallow esophageal manometry (measurement of pressures) esophageal pH recording |
|
|
Term
| clinical features of GERD |
|
Definition
regurgitation heartburn dysphagia atypical chest pain bleeding/anemia am hoarseness/aspiration asymptomatic asthma exacerbation chronic cough |
|
|
Term
| about how much of the adult population does GERD effect? |
|
Definition
|
|
Term
| what are some differential diagnoses for GERD? |
|
Definition
PUD, can have both cholelithiasis esophageal motility disorders cardiac pain |
|
|
Term
|
Definition
obesity ETOH smoking caffeine meds foods chocolate spicy, tomato based foods |
|
|
Term
|
Definition
barium swallow EGD esophageal manometry |
|
|
Term
| when do you need to do an EGD? |
|
Definition
in a pt with: anemia weight loss progressive dysphagia vomiting >45 yoa sxs 4+ wks dysphagia w/ pain |
|
|
Term
|
Definition
prevent reflux lower acid secretion prevent complications of esophagitis |
|
|
Term
|
Definition
esophageal stricture esophageal ulceration hemorrhage barrett's esophagus |
|
|
Term
| barrett's esophagus can lead to... |
|
Definition
|
|
Term
|
Definition
lower esophageal sphincter has failed: too tight absence of peristalsis in lower 1/2 of esophagus, LES failure progessive dysphagia, regurg and spasm weight loss halitosis have to do balloon dilation |
|
|
Term
| how do you diagnosis achalasia? |
|
Definition
barium swallow - dilated tapering to bird's beak endoscopy esophageal manometry |
|
|
Term
| how do you treat achalasia? |
|
Definition
balloon dilation of LES Ca Channel blockers botox - bc of spasms and contracture myotomy |
|
|
Term
how do you treat esophageal spasm disorders? |
|
Definition
nitrates Ca channel blockers antidepressants |
|
|
Term
| are men or women more likely to get esophageal cancer? |
|
Definition
|
|
Term
which is more common: squamous or adenocarcinoma of the esophagus? |
|
Definition
|
|
Term
| is esophageal cancer common? |
|
Definition
|
|
Term
| what are some ther esophageal conditions? |
|
Definition
webs-plummer-vinson syndrome- thinning flap that will close down upon itself schatzki ring oropharyngeal dysphagia scleroderma esophageal rings esophageal diverticula infections esophageal tears - mallory weiss syndrome (occurs with chronic alcohol use) |
|
|
Term
|
Definition
injury of gastric mucosa not reflux related has short or long term serious effects |
|
|
Term
|
Definition
irritation of esophageal mucosa reflux related long term serious effects nonulcer dyspepsia |
|
|
Term
|
Definition
hemorrhagic (stress ulcer) reflux (rxn to defective pylorus) erosive (rxn to chemical agents) |
|
|
Term
|
Definition
NSAIDS H. Pylori ICU stress ulcers acid hypersecretion worsened by smoking |
|
|
Term
| signs and symptoms of gastritis |
|
Definition
epigastric pain, gnawing improved w/ antacids, H2 blockers improved w/ eating, worse w/ empty stomach perforation/hemorrhage risk |
|
|
Term
| alarming signs/sxs of gastritis |
|
Definition
onset at >45 yoa wt loss recurrent vomiting dysphagia heme-pos stools anemia strong FH of GI cancers epigastric mass |
|
|
Term
| if a pt w/ gastritis has alarming signs/sxs what do you need to do? |
|
Definition
urgent endoscopy to rule out perforation, gastric cancer or obstruction |
|
|
Term
| what is required for a definitive diagnosis of gastritis? |
|
Definition
|
|
Term
| what would a EGD show you in a pt with gastritis? |
|
Definition
assess bleeding, reflux, dysphagia diagnosis esophagitis, strictures, tumors, barrett's campylobacter-like organism (CLO test) |
|
|
Term
what would you see in a pt w/ NSAID caused gastritis? |
|
Definition
|
|
Term
|
Definition
sudden, severe epigastric pain, peritoneal signs, N/V FREE AIR UNDER DIAPHRAGM |
|
|
Term
|
Definition
treat H. pylori H2 blockers PPIs avoidance of NSAIDS and ETOH surgery, if its a bad ulcer |
|
|
Term
| H. pylori infection is assc with... |
|
Definition
gastric and duodenal ulcers gastric carcinomas |
|
|
Term
| what is the standard treatment for H. Pylori? |
|
Definition
2 antibiotics 1 PPI prevac: prevacid, amoxicillin, clarithromycin |
|
|
Term
|
Definition
H2 blockers: 90-95% PUD healing w/ 8 wk txt PPIs: more expensive irreversibly inhibit H+/K+ pumps 90%+ PUD healing w/ 4 wk txt |
|
|
Term
| what test should you not do if you suspect a perforation? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
COX-2 inhibitors (celebrex, vioxx, mobiq) cytotec acetaminophen |
|
|
Term
|
Definition
may be ETOH or H. pylori related atrophic mucosa vit B12 def, secondary dec in intrinsic factor pernicious anemia may progress to adenocarcinoma |
|
|
Term
| atrophic gastritis has been seen in pts who have had what kind of surgery? |
|
Definition
|
|
Term
| you have a _______ increase in getting ZES if you have H. pylori |
|
Definition
|
|
Term
| you can do surgery for ZES if there are no: |
|
Definition
metatases MEN I short life expectancy |
|
|
Term
| which gastric problem is assc with DM? |
|
Definition
|
|
Term
| nonulcer dyspepsia is a _______________ |
|
Definition
|
|
Term
| what are some treatments for nonulcer dyspepsia? |
|
Definition
H. pylori txt long term PPIs |
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