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GI lectures > Inflammation and Tumours of Pancreas > Flashcards

Inflammation and Tumours of Pancreas Flashcards

1
Q

what does the pancreas form from?

A

dorsal and ventral bud fuse together (if they don’t fuse them together can cause pancreatitis in later life)

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2
Q

what arteries supply the pancreas?

A

gastroduodenal gives off abranch (ant. and post. superior pancreatiduodenal)
Superior mesenteric gives off ant. and post. inferior pancreatiduodenal
branches off splenic

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3
Q

what islet cells secrete what products?

A

alpha = glucagon
beta = insulin
delta = somatostatin
….

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4
Q

what regulates secretion of pancreatic fluid?

A

vagus nerve and gastrin levels

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5
Q

what do acinar cells secrete?

A

protease (trypsin and chymotrypsin)
pancreatic lipase
pancreatic amylase
other enzymes

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6
Q

how are 80% of acute pancreatitis cases managed?

A

analgesia and IV fluids

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7
Q

what drugs can cause pancreatits?

A

azathoprin

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8
Q

what are the 4 stages of pancreatitis due to autodigestion of pancreas by enzymes?

A

oedema and fluid shifts - hypovolaemic shock
autodigestion of blood vessels - retroperitoneal haemorrhage
infarction due to compromised blood supply - pancreatic necrosis
………

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9
Q

how does pancreatitis present?

A

acute epigastric pain radiating to back
very severe
nausea and vomiting
jaundice maybe is gallstone obstruction or chronic pancreatitis

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10
Q

pancreatitis on examination?

A

diffuse upper abdominal tenderness
soft
normal Bowel sounds
fullness in epiastrium due to pseudocyst

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11
Q

what arethe classic signs of pancreatitis?

A 
cullens sign (umbilical)
Grey turner's sign (flanks)
Erythema abigne (hot water bottle rash)
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12
Q

what are the initial investigations for pancreatitis?

A 
IV access
bloods: FBC, coagulation, U&Es, Ca, glucose, amylase/lipase, CRP, lactate
ABGs: hypoxia and ARDS
Imaging (AXR, AXR, US) can show:
- pleural effusion
- sentinel loop (buzz word)
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13
Q

what might be seen on US in apncreatitis?

A 
gallstones
thickened gallbladder
larger CBD
cholecystitis
free fluid
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14
Q

when is CT used in pancreatitis?

A

only to stage it or assess complications etc

5 days after onset

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15
Q

what are some possible complications of pancreatitis?

A 
fluid collection (cysts, pseudocysts)
necrosis
ascites
bleeding
abscess
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16
Q

what is the Glasgow prognostic criteria (IMREY SCORE)?

A 
PANCREAS
PaO2 < 8kPa
Age >55
Neutrophils (WBC >15)
Calcium < 2
Renal function (urea >16)
Enzymes (AST/ALT >....................)
ALbumin < 32
Sugar (glucose >10)
Score > 3 = sever pancreatitis
17
Q

what are the principles of aoncreatitis management?

A 
fluid resuscitation
correct electrolytes
careful fluid balance
oxygen
antibiotics if sure its an infective cause
Nutrition
Cholecystectomy
18
Q

what are pancreatic pseudocysts?

A

collection of fluid without a lining due to acute/chronic pancreatitis
pain, nausea, vomiting, jaundice, weight loss
can cause obstruction
no real treatment but can drain them
- endoscopic
- radiological
- surgical is chronic (drains into stomach)

19
Q

how can a cyst cause a haemorrhage?

A

cyst gets so large that it erodes an artery and artery then bleeds into the cyst

20
Q

how is pancreatic necrosis managed?

A

CT for assessment

drain or necrosectomy and lavage

21
Q

what is chronic pancreatitis?

A

progressive and irreversible
loss of endocrine and exocrine function
can cause diabetes

22
Q

how does chronic pancreatitis present?

A

similar to acute
alcoholic, smoker, medications etc
masses/ascites/jaundice on examination

23
Q

what diseases can predispose to chronic pancreeatitis?

A

CF
apha 1 antitrypsin
Autoimmune diseases

24
Q

how might chronic pancreatitis look on imaging?

A

stones

calcification

25
Q

what is Pustow procedure?

A

encourages drainage of pancreatic fluid from pancreas into ….
Freys procedure is similar

26
Q

what are some possible complications of chronic pancreatitis?

A 
splenic vein thrombosis
pseudoaneurysm
Pleural effusion
pancreatic cancer
ascites
pseudocyst
biliary obstruction
duodenal obstruction
27
Q

what is the most common pancreatic cancer?

A

adenocarcinoma (exocrine)

28
Q

symptoms of pancreatic cancer?

A 
painless jaundice
loose pale stools
dark urine
weight loss
back pain
29
Q

pancreatic tumour risk factors?

A

diabetes
smoking
obesity
charred meat

30
Q

inoperable pancreatic tumour?

A

stent

decompression…..

GI lectures (75 decks)

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