Pancreatic and Biliary Pathology​

Functions of the Pancreas

• Role in homeostasis by regulating: ​

• So…disorders of the pancreas will have

• Role in homeostasis by regulating: ​

  • Electrolytes​

  • Water​

  • Glucose ​

• So…disorders of the pancreas will have systemic impacts

Pancreatitis

• Inflammation of pancreas and surrounding organs​

• The digestive enzymes that the pancreas produces may start to auto-digest the pancreas

Pancreatitis

• Can be

• Causes include:​

• Can be acute or chronic​

• Causes include:​

  • ETOH abuse**​

  • Gallstones** (increase risk of gallstones with obesity)​

  • Cancer​

  • Infection ​

  • Cystic fibrosis ​

  • Toxins​

  • Can be idiopathic (unknown cause)

Acute Pancreatitis

• Considered an

• Pancreatic inflammation from

  • Enzyme activation →

• Progresses to a

• Considered an emergency​

• Pancreatic inflammation from inappropriate enzyme activation ​

  • Enzyme activation → inflammatory response​

• Progresses to a systemic response​

  • Multi-system organ failure

Acute Pancreatitis - Clinical Manifestations

• Abdominal

• Nausea,

• If associated with gallstones: pain worsened by

• Signs of progression:​

• Abdominal pain – upper quadrant (dullsharp)​

• Nausea, vomiting, anorexia​

• If associated with gallstones: pain worsened by eating fatty food/ETOH​

• Signs of progression:​

  • Fever​

  • Tachycardia​

  • Hypoxia​

  • Tachypnea​

  • Changes in mental status

Complications of acute pancreatitis- progressions

• Renal failure ​

• Malnutrition​

• Pancreatic cancer​

• Abscess​

• Chronic pancreatitis

acute pancreatitis diagnosis

• Clinical presentation ​

• Labs​

  • Amylase and lipase will increase early on ​

• Imaging​

  • Abdominal CT or MRI​

  • Transabdominal US(gallbladder)​

  • ERCP

acute pancreatitis Treatment

• Usually self-limiting​

• Pain management​

• NPO (nothing by mouth) to allow pancreas to rest​

  • Then clear liquids to soft low-fat​

• Severe cases​

  • ICU​

  • Hydration​

  • Enteral nutrition​

  • ERCP

Pancreatitis:​ PT Implications

• Early presentation may be

• Spinal extension may be

• Need to be aware of those with

• Patient may be most comfortable in

• In acute cases, need to carefully monitor

• Be aware of

• Early presentation may be back pain (T/L junction) ​

• Spinal extension may be lost ​

• Need to be aware of those with back pain and GI symptoms​

• Patient may be most comfortable in L S/L, leaning forward​

• In acute cases, need to carefully monitor vitals/lab values to assess for bleeding and infection​

• Be aware of food/drink restrictions

Chronic Pancreatitis

• Chronic inflammation →

• Most likely associated with

• Clinical manifestations​

• Chronic inflammation → permanent changes​

• Most likely associated with alcoholism​

• Clinical manifestations​

  • Abdominal pain (chronic pain) → opioid use​

  • Decreased appetite and weight loss​

  • Fluctuation of symptoms based on acute attacks​

  • Diabetes likely to develop

Treatment of Chronic Pancreatitis​

• Prevention of further injury​

• _____ relief​

• Replacement of lost

• Prevention of further injury​

  • ETOH cessation​

  • Smoking cessation​

  • Healthy diet ​

• Pain relief​

• Replacement of lost pancreatic function (exocrine and endocrine)​

  • May need insulin

Pancreatic Cancer

• Lowest 5-year survival rate

• Relationship to BRACA 1 and 2 genes​

• Risk factors​

  • Smoking​

  • H/o pancreatitis​

  • Obesity​

  • Diabetes

Pancreatic Cancer – Clinical Manifestations

• Vague symptoms​

• Later stages​

• Metastasis​

• Vague symptoms​

  • Anorexia, malaise, nausea, fatigue​

  • Abdominal pain​

  • Jaundice​

• Later stages​

  • Epigastric, back (T/L) pain​

• Metastasis​

  • Liver, peritoneum, lungs, bone adrenal glands

Pancreatic CA and PT Implications​

• Promotion of

• May palpate enlarged

• Treatment of

• Promotion of smoking cessation ​

• May palpate enlarged supraclavicular lymph node (L)​

• Treatment of intractable back pain

Terminology associated with biliary disease

• Cholelithiasis: ​

  • Presence of

• Cholecystitis: ​

  • inflammation of the

• Cholelithiasis: ​

  • Presence of one or more gallstones ​

  • Gallstones will block this flow of bile ​

• Cholecystitis: ​

  • inflammation of the gallbladder and can include biliary tract obstruction from gallstones

Cholelithiasis

• Common​

• Stones form → bile flow is decreased​

• Risk factors:​

  • Age​

  • Genetics​

  • Obesity OR rapid weight loss (ex. s/p weight loss surgery)​

  • Use of TPN​ (feeding tube)

  • Pregnancy​

  • High triglycerides/LDL​

  • Diet (high fat, high cholesterol, low fiber)

Clinical Manifestations of Gallstones​

• Most remain

• Abdominal

• pain referral pattern​

• Older adults may manifest with

• Jaundice when

• Can lead to

• Most remain asymptomatic​

  • Become symptomatic when they travel and get stuck in bile ducts​

• Abdominal pain (RUQ)​

• R shoulder pain/upper back pain​

• Older adults may manifest with mental status changes​

• Jaundice when common bile duct is blocked​

• Can lead to cholecystitis ​

  • inflammation

Acute cholecystitis

Occurs with prolonged obstruction to bile flow

Diagnosis and Treatment- gallstones

• History/physical exam​

• Transabdominal US​

• If infection, antibiotics can be used first​

• Cholecystectomy (laparoscopy vs. open)

PT Implications- gallstones

• Promote

• Aware of

• US may not always show

• Progression to

• Post-op​

• Promote physical activity to decrease risk of developing gallstones​

• Aware of referred pain pattern to R shoulder​

• US may not always show disease process so refer back if R shoulder pain not improving​

• Progression to sepsis if cholecystitis progresses ​

• Post-op​

  • Deep breathing to help with pain​

  • Mobility as tolerated​

  • Heat to abdomen (if surgeon approves)