Chapter 37, Alternations in Function of the Gallbladder and Exocrine Pancreas

Which patients may be at risk for development of cholesterol gallstones?

High Spinal Cord Injuries, Receiving Total PArenteral Nutrition Had Rapid Weight Loss Pregnant women

Lipase preferred test for pancreatitis

Increase in amylase and lipase during first 12 hr(indictative) Elevated aminotransferases, alkaline phosphataseand bilirubin

Pancreatitis is associated with with quadrant of pain

LUQ and Epigastric Pain

Chronic Pancreatitis may lead to

Diabetes Mellitus

Which finding would indicate a critical complication of acute pancreatitis

Dropping blood pressure

Acute Pancreatitis Clinical manifestations

Steady, boring pain in epigastrium or LUQ• Increases in intensity• Severe tenderness on palpation• Radiates or penetrates to back• Nausea and vomiting Abdominal distention• Hypoactive bowel sounds Low-grade fever

Pancreatitis signs and symptoms

Steady, boring pain in epigastrium or LUQ• Increases in intensity• Severe tenderness on palpation• Radiates or penetrates to back• Nausea and vomiting Abdominal distention• Hypoactive bowel sounds Low-grade fever

Pancreatic cancer treatment

Surgery Chemotherapy

It is true that biliary cancer

Tends to be asymptomatic and progress insidiously

Chronic Pancreatitis is associated

with alcohol intake Can progress even if alcohol consumption is stopped

CT of abdomen for pancreatitis

• Gold standard: allows remarkable detail• Prognostic assessment: Ranson's criteria

Chronic Cholecystitis can lead to which problems

Biliary Sepsis, Calcified Gallbladder, Porcelain Gallbladder

chronic cholecystitis can lead to which problems

Biliary sepsis Calcified Gallbladder Cirrhosis

Acinar cell injury

Alcohol, drugs, ischemia, viruse

More than half of the initial cases of pancreatitis are associated with

Alcoholism

A biliary cause of acute pancreatitis is suggested by an elevation in which serum laboratory results

Alkaline Phosphatase

Chronic Pancreatitis clinical manifestations

Bouts of acute pancreatitis with progressive endocrine and exocrine pancreatic dysfunction • Diabetes: progressive loss of pancreatic islets • Malabsorption: fat and vitamins A, D, E, and K • Weight loss: poor intake related to pain Insidious onset of steady, boring epigastricpain radiating to back (first symptom Nausea After about 5 years of continual pain: decreasein symptoms (pain "burns out")

Which digestive enzymes are secreted from the intestinal mucosa during a meal?

Cholecystokinin, Secretin

Chronic Pancreatitis

Chronic inflammatory lesions in pancreas

Pseudocyst: collection of fluid within oradjacent to pancreas symptoms

Fever, tachycardia, abdominal mass, and tenderness• Management: endoscopic or surgical drainage

Defective intracellular transport

Metabolic Injury, Alcohol,

UNtreated acute cholecystitis may lead to gangrene of

the gallbladder wall.

Key ELement of pathogensis of chronic pacreatitis

Necrosis of exocrine parenchyma followed by fibrosis

3 pathways of pancreatitis

Obstruction of the pancreatic duct by a stone or other cause (usually unknown) Acinar cell injury Defective intracellular transport

Pancreatic cancer clincal manifestations

Pancreatic Head Tumors: Jaundice, Malabsorptions, and weight loss Pancreatic Tail: Ab pain and Nausea

Normal bile is composed of

water, electrolytes, and organic solutes.

Pathogenesis

Prescence of chronic inflammatory lesions in pancreas

Complications of chronic pancreatitis

Pseudocyst Pancreatic Ascites Obstruction of common bile duct: Surgical or endoscopic intervention Thrombosis of portal and splenic veins may lead to GI hemorrhage related to gastric varices Peptic Ulcer Disease

Acute Pancreatitis Complications

Pseudocyst: collection of fluid within oradjacent to pancreas

Narcotic administration should be administered carefully in patients with acute pancreatitis related to potential for

Sphincter of Oddi dysfunction

The definitive treatment for cholecystitis is

cholecystectomy

Most gallstones are composed of

cholesterol

Chronic pancreatitis may lead to

diabetes mellitus

Pancreatitis pathology

etiologic agent causes: -increase in pressure in the pancreatic ducts -allows pancreatic enzymes to escape from cells / ducts ---digest pancreas itself! ---digest surrounding adipose tissue this all leads to: -poor pancreatic function -necrosis and edema ---hemorrhaging ---perforation

A patient with pancreatitis may experience muscle cramps secondary to

hypocalcemia

Pancreatitis etiology

inflammation of the pancreas

Pancreatitis

inflammation of the pancreas Autodigestion of the pancreas from enzymeactivation

It is true that gall stones are

more common in women

Chronic Pancreatitis pathogensis leads to calcification

obstructed flow of pancreatic juices

the most challenging aspect of treatment for chronic pancreatitis is

pain control

Elevated Serum lipase and amylase levels are indicative of

pancreatitis

Elevated surum lipase and amylase levels are associated with

pancreatitis

Pancreatic ascites

persistent leak in pancreatic duct into pleural space and mediastinum Painless and massive• Detected by ultrasound or CT, fluid analysis obtainedby aspiration• Treatment: prolonged parenteral nutrition, stent

Patients with acute pancreatitis are generally made NPO and may require continuous gastric suctioning in order to

remove the usual stimuli for pancreatic secretion

The pain associated with chronic pancreatitis is generally described as

steady and boring in nature.