PANCE REVIEW: Pancreas

Need to knows about the pancreas:

1. Acute pancreatitis

Notes:
Causes = ETOH abuse, cholelithiasis, hyperlipidemia, trauma, drugs, 2ndary to HIV meds
Clinical:

Classic presentation = epigastric pain radiates to back, N/V/F, pain alleviated by fetal position or leaning forward, leukocytosis, severe hypOvolemia

Labs/Tests:
-Increase serum amylase (not very helpful because it can be nl after 48-72hrs)
-Serum LIPASE = more sensitive/specific, but only with increases of 3x+
-Increase in liver enzymes if biliary obstruction
-Ranson's Criteria
Treatment:
-NPO
-IVF
-TPN
-pain management (MEPERIDINE (Demerol))
-consider antibx
-monitor for complications

2. Chronic pancreatitis

Notes:
-90% caused by ETOH abuse
- Triad only seen in 20% of pts [pancreatic calcification, steatorrhea, DM]

Clinical:
-same as Acute Pancreatitis +  steatorrhea (poor fat absorption)
Labs/Tests:
-serum lipase
-Abd film shows calcification in 20-30% of pts

Treatment: 
 -same as Acute Pancreatitis
-low fat diet at discharge
-NO ETOH

3. Pancreatic neoplasms

Notes:
-5th leading cause of CA related death in US
-Risks = incr age, obesity, tobacco, chronic pancreatitis, abd radiation, fam hx

Clinical:
-abdominal pain
-COURVIER'S SIGN (palpable gall bladder)

Labs/Tests:
-CT of abdomen
-angiography

Treatment: 
-surgical resection if no mets (Whipple procedure)
-POOR PROGNOSIS



Source: AAPA and PAEA Exam Review Book