Pancreatitis & Pancreatic Cancer for the NP Exam
Pancreatitis & Pancreatic Cancer for the Nurse Practitioner Licensing Exam
Overview
- Pancreatitis is inflammation of the pancreas, classified into acute and chronic forms.
- Acute pancreatitis: Reversible inflammation.
- Chronic pancreatitis: Irreversible fibrosis and loss of pancreatic function.
Acute Pancreatitis
Etiology
- Most common causes:
- Gallstones: Biliary obstruction.
- Alcohol abuse: Direct toxicity to the pancreas.
- Other causes: Hypertriglyceridemia, hypercalcemia, and medications.
Clinical Presentation
- Epigastric pain: Severe, radiates to the back.
- Nausea and vomiting.
- Signs of severe disease: Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (flank bruising).
Diagnosis
- Serum lipase or amylase >3 times normal (lipase is more specific).
- CT scan: Identifies complications like necrosis or pseudocysts.
Management
- Supportive care: IV fluids, NPO (nothing by mouth), and pain management.
- ERCP: For gallstone-related pancreatitis.
Chronic Pancreatitis
Etiology
- Most common cause: Chronic alcohol use.
Clinical Presentation
- Chronic epigastric pain, worsened by eating.
- Pancreatic insufficiency: Steatorrhea (fat malabsorption) and diabetes.
Management
- Pancreatic enzyme replacement for malabsorption.
- Pain control with NSAIDs or opioids.
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Pancreatic Cancer
Overview
- Pancreatic adenocarcinoma is the most common type, typically diagnosed at an advanced stage.
Risk Factors
- Smoking, chronic pancreatitis, and genetic mutations (e.g., BRCA1, BRCA2).
Clinical Presentation
- Painless jaundice, weight loss, and abdominal pain (often radiating to the back).
- New-onset diabetes in older adults.
Diagnosis
- CT scan with contrast: First-line imaging to detect masses.
- CA 19-9: Tumor marker used for monitoring.
Management
- Whipple procedure (pancreaticoduodenectomy): For resectable tumors.
- Chemotherapy: Used for unresectable or metastatic disease (e.g., gemcitabine).
Key Points
- Acute pancreatitis is most commonly caused by gallstones and alcohol, with treatment focused on supportive care.
- Chronic pancreatitis results from long-term alcohol use and leads to malabsorption and diabetes.
- Pancreatic cancer presents with painless jaundice and weight loss, with a poor prognosis due to late diagnosis.
- CT scan is essential for diagnosing both pancreatitis and pancreatic cancer.