Inhibits secretion of many hormones, such as gastrin, CCK, glucagon, GH, insulin, secretin, pancreatic polypeptide, TSH, and vasoactive intestinal peptide.
Reduce secretion of fluids by the intestine and pancreas.
Reduce gastrointestinal motility and inhibit contraction of the gallbladder.
Inhibit the action of certain hormones from the anterior pituitary
Cause vasoconstriction in the blood vessels.
Reduce portal vessel pressures in bleeding varices
What is third spacing? #18
Fluid from the circulation into the abdominal cavity causing inadequate blood volume.
Fluid loss from vomiting, internal bleeding, or oozing of fluid from the circulation into the abdominal cavity in response to the pancreas inflammation.
Inadequate blood volume.
What is a pancreatic pseudocyst? #19
Pancreatic secretions walled off by scar and inflammatory tissue.
Late complication, pancreatic secretions walled off by scar and inflammatory tissue.
Painful & may become infected; may rupture and hemorrhage & pressing/occlucing on bile duct >jaundice
What is a pancreatic abscess? #20
Late complication of pancreatitis; collection of pus on surface of pancreas that can lead to infection.
A late complication of acute necrotizing pancreatitis 4 weeks after the initial attack.
collection of pus resulting from tissue necrosis, liquefaction, and infection. 3% of the patients will develop an abscess.
What is chronic pancreatitis (easy answer)? #21
Acute inflammation in a previously injured pancreas.
Recurring, alters pancreatic structure and functions.
What is acute pancreatitis? #22
Sudden inflammation of the pancreas can be mild or severe > death.
It is a sudden inflammation of the pancreas, depending on its severity, it can have severe complications and high mortality despite treatment. Severe pancreatitis will need ICU/surgery tx to deal with complications, whereas mild pancreatitis (treated NPO and IV fluid rehydration) can be treated on the common ward.
Why do gallstones cause pancreatitis? #23
Gallstones obstruct outflow of pancreatic juices from pancreas into the duodenum.
Gallstones lodged in the CBD obstruct outflow of pancreatic juices from pancreas into the duodenum. Backflow causes lysis (dissolving) of pancreatic cells and subsequent pancreatitis. Subsequent: occurring or coming later or after.
1) What is an ERCP? #24
2) What is 1 the indication for early ERCP?
3) What are disadvantages of ERCP?
4) What diagnostic modality is replacing ERCP?
Endoscopy and fluoroscopy to diagnose and treat problems of the biliary or pancreatic ductal systems. ERCP can treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars) & leaks (from trauma and surgery). View inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.
2) The indications for early ERCP are as follows :
a) Lack of improvement after 24 hours
b) ERCP if gallstones are present or
c) dilated ducts on CT abdomen
3)Disadvantages of ERCP are as follows :
ERCP precipitates pancreatitis, and can introduce infection to sterile pancreatitis
4) Safer and relatively non-invasive investigations: such as magnetic resonance
cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that
ERCP is now rarely performed without therapeutic intent
When is surgery indicated for chronic pancreatitis (3)? #25
Surgery is divided in which 2 areas?
1) Surgery is indicated for complications, diagnostic uncertainty, infection
2) Divided into two areas - resectional and drainage procedures
uncertainty: unsure if it is pancreatits causing the pain
Name (3) H2 antagonist drugs (brand name and chemical name)? #26
Block the action of histamine on parietal cells in the stomach decreasing the production of acid.
Are surpassed in popularity by the more effective proton pump inhibitors.
1)Give 3 examples of drugs plus trade names.
2) What are Proton pump inhibitors (PPIs) #27
2)Irreversibly, long-lasting reduction of gastric acid production
Pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today. Irreversibly blocking enzyme system on the gastric proton pump of the gastric parietal cell (enzymes are naturally destroyed then renewed).
Advanced s/s of pancreatits? #28
Impaired cardiac function:
Impaired cardiac function:
Hypovolemia: (low BP, ^HR, Low UO) Ascites;
High BP r/t pain yet low BP
SIRS (Systemic inflammatory response syndrome) &
DIC Disseminated intravascular coagulation
Decreased bowel sounds
ARDS: Acute resp distress syndrome
pleural effusions, hypoxemia atelectasis lungs may collapse as a result of the
shallow breathing which occurs because of the abdominal pain from Pneumonitis: may occur as a result of pancreatic enzymes directly damaging the lung, pancreatic exudate