Pancreatic Disorders

Table Of Contents
1 Acute Pancreatitis
2 Pancreatic Pseudocyst
3 Chronic Pancreatitis
4 Pancreatic Cancer

Acute Pancreatitis

  • Path:
    • High levels of activated trypsin
    • Pancreatic auto-digestion
    • INC inflammation
    • Organ injury & failure cycle
  • Types:
    • Interstitial edematous acute pancreatitis
    • Necrotizing acute pancreatitis
  • Presentation:
    • ACUTE boring pain –> epigastric/RUQ & radiates to the back
    • Worse w/ laying upine
    • Better w/ sitting/leaning forward
    • N/V
    • DEC satiety
  • Causes: I GET SMASHED
    • Idiopathic
    • Gallstone <– MOST COMMON
    • Ethanol <– Second most common
    • Trauma
    • Steroid
    • Mumps
    • Autoimmune
    • Scorpion/Snake
    • Hyperlipidemia
    • ERCP
    • Drugs
  • Physical Exam:
    • Cullen sign –> periumbilical bruise
    • Grey turner sign –> waist and flank bruising
    • Ileus –> abdominal distension
    • Guarding
  • Labs:
    • CBC –> INC WBC
    • CMP: HYPERCALCEMIA
    • Triglyceride –> >1000mg
    • Pancreatic enzymes –> 3x upper limits of normal
  • Imaging:
    • Abdominal U/S
    • CT scan be done within >72 hrs of onset of pancreatitis if:
      • Persistent/recurrent pain
      • INC pancreatic enzymes after initial DEC
      • Worsening dysfunction
      • Sepsis
  • Criteria:  Requires two of the following:
    • -CP –> acute pain
    • -Labs –> 3x INC of lipase/amylase
    • -Imaging –> consistent w/ inflammation
  • Treatment:
    • Admit & NPO
    • Meds:
    • -Pain meds –> opioids
    • -(+/-) Abx
    • -Antiemetic
    • IV fluid replacement & Monitor

Pancreatic Pseudocyst

  • Localized collection of fluid, pancreatic enzymes, blood and tissues
  • Causes sxs of pancreatitis
  • Self-limited or surgery

Chronic Pancreatitis

  • TIGAR-O:
    • -Toxic
    • -Idiopathic
    • -Genetic
    • -Autoimmune
    • -Recurrent acute pancreatitis
    • -Obstructive
  • Classic Triad:
    • Diabetes
    • Steatorrhea
    • Calcifications
  • Presentation:
    • Epigastric pain radiating to the back
    • Aggravated by alcohol & large/high fat meals
  • Labs:
    • Fecal fat testing –> Fecal elastase –> INC
    • INC glucose on CMP
  • Images:
    • Trans-abdominal U/S –> calcifications
    • ERCP –> “Chain of Lakes”

Pancreatic Cancer

  • Types:
    • Exocrine pancreatic CA –> most common –> Ductal adenocarcinoma @ the head of the pancreas
    • Endocrine pancreatic CA
  • Presentation:
    • Epigastric/RUQ pain/Back pain
    • Weight loss
    • N/V & steatorrhea
    • Courvoisier sign –> nontender palpable gallbladder
    • Jaundice/Icterus
  • Labs:
    • Cholestasis evaluation for jaundice and epigastric pain
    • Tumor marker –> CA 19-9
  • Imaging:
    • Abdominal U/S
  • Imaging dx for Pancreatic CA w/ Epigastric pain w/ weight loss w/ NO Jaundice:
    • Thin sliced Helical CT of abdomen
  • Imaging of choice for staging and ID of Pancreatic CA:
    • Contrast Enhanced Helical CT
  • Treatment:
    • Biliary Obstruction: Stent/decompress
    • Surgical resection –> only potential cure
  • Prognosis: 
    • Overal: <5%
    • 5 year resected: 20%
    • Median survival w/ un-resected lesion: 3-12 months