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GI - Year 2 > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas?

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2
Q

What is the incidence of acute pancreatitis?

A

20-300 cases/million

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3
Q

What is the mortality rate for acute pancreatitis?

A

6-12 /million

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4
Q

What are the causes of acute pancreatitis?

A 
Alcohol abuse (60-75%)
Gallstones (25-40%)
Trauma (blunt/post-op/post-ERCP)
Drugs (steroids, azathioprine, diuretics)
Viruses (mumps, coxsackie B4, HIV, CMV)
Pancreatic carcinoma
Metabolic (increased Ca/triglycerides, decreased temp)
Autoimmune
Idiopathic (~10%)
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5
Q

What are the clinical features of acute pancreatitis?

A 
Abdominal pain
Vomiting
Pyrexia
Tachycardia, hypovolaemic shock
Oliguria, acute renal failure
Jaundice
Paralytic ileus
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hyperglycaemia
Effusions (ascitic + pleural)
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6
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangio- Pancreatography

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7
Q

What does EUS stand for?

A

Endoscopic UltraSound

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8
Q

What type of blood tests are done for acute pancreatitis?

A 
Amylase/lipase
FBC
U&Es 
LFTs
Ca2+
Glucose
Arterial blood gases
Lipids
Coagulation screen
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9
Q

Aside from blood tests what other investigations are done for acute pancreatitis?

A

AXR (ileus)
CXR (pleural effusion)
Abdominal ultrasound
CT scan

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10
Q

What score on the glasgow criteria indicates severe pancreatitis within 48 hours of admission?

A

> 3

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11
Q

What CRP level indicates severe pancreatitis?

A

> 150mg/l

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12
Q

How is acute pancreatitis managed?

A 
Analgesia
IV fluids
Blood transfusion
Monitor urine output (catheter)
Naso-gastric tube
Oxygen
May need insulin
Rarely require Ca supplements
Nutrition (enteral or parenteral) in severe cases
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13
Q

How is pancreatic necrosis managed?

A

CT guided aspiration

Antibiotics + surgery

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14
Q

How are gallstones managed?

A

EUS/MRCP/ERCP

Cholecystectomy

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15
Q

What are the complications of acute pancreatitis that can occur during management?

A

Abscess

Pseudocyst

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16
Q

How is an abscess managed?

A

Antibiotics + drainage

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17
Q

What is a pseudocyst?

A

Fluid collection without an epithelial lining

Persistent hyperamylasaemia/pain

18
Q

How is a pseudocyst diagnosed?

A

By ultrasound or CT scan

19
Q

What are the complications of a pseudocyst?

A

Jaundice
Infection
Haemorrhage
Rupture

20
Q

How is a pseudocyst managed?

A

If < 6cm diameter = resolves spontaneously

Endoscopic drainage or surgery if persistent pain/complications

21
Q

What is the mortality rate of acute pancreatitis?

A

Mild AP = <2%

Severe = 15%

22
Q

What is the incidence of chronic pancreatitis?

A

3.5/100,000 pop./year

23
Q

What are the causes of chronic pancreatitis?

A

Alcohol (80%)
Cystic fibrosis (CP in 2%)
Congenital anatomical abnormalities (e.g. annular pancreas/pancreas divisum)
Hereditary pancreatitis (rare - auto. dom)
Hypercalcaemia
Diet

24
Q

What are some of the genes associated with pancreatitis?

A

PRSS1 (cationic trypsinogen)
SPINK1 (pancreatic secretory trypsin inhibitor)
CFTR (cystic fibrosis transmembrane conductance regulator)

25
What happens in chronic pancreatitis?
Duct obstruction due to calculi, inflammation, protein plugs Abnormal sphincter of Oddi function - spasm/relaxation Genetic polymorphisms - abnormal trypsin activation
26
What is the pathology of chronic pancreatitis?
Glandular atrophy + replacement by fibrous tissue Ducts become dilated, tortous, strictured Inspissated secretions may calcify Exposed nerves due to loss of perineural cells Splenic, SMV + portal veins may thrombose -> portal hypertension
27
What are the clinical features of chronic pancreatitis?
``` Asymptomatic Abdominal pain Weight loss Exocrine insufficiency Endocrine insufficiency Jaundice, portal hypertension, GI haemorrhage, pseudocysts, pancreatic carcinoma ```
28
What are the investigations for chronic pancreatitis?
``` Plain AXR Ultrasound EUS CT scan Blood tests (serum amylase, albumin, LFTs, glucose, vit K) Pancreatic function tests ```
29
How is chronic pancreatitis pain controlled?
``` Avoid alcohol Pancreatic enzyme supplements Opiate analgesia Coeliac plexus block Referral to pain clinic/psychologist Endoscopic treatment (pancreatic duct stones and strictures) Surgery ```
30
How is the exocrine and endocrine insufficiencies managed in chronic pancreatitis?
Low fat diet Pancreatic enzyme supplements Vitamin supplements Insulin for diabetes mellitus
31
What is the prognosis of chronic pancreatitis?
Death from complications of acute-on chronic attacks, CV complications from diabetes, cirrhosis, drug dependence, suicide Continued alcohol intake = 50% 10 year survival Abstinence = 80% 10 year survival
32
What is the incidence of carcinoma of the pancreas?
11/ 100,000 pop/year
33
What are the types of carcinoma in the pancreas?
Duct cell mucinous adenocarcinoma (75%) - head 60%, body 13%, tail 5%, multiple 22% Carcinosarcoma Cystadenocarcinoma Acinar cell
34
What are the clinical features of pancreatic carcinoma?
``` Upper abdominal pain Painless obstructive jaundice Weight loss Anorexia, fatigue, diarrhoea, vomiting Tender subcutaneous fat nodules Thrombophlebitis migrans Ascites, portal hypertension ```
35
What are the physical signs of pancreatic carcinoma?
``` Hepatomegaly Jaundice Abdominal mass Abdominal tenderness Ascites, splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder ```
36
What imaging is used for pancreatic carcinoma?
USS CT MRI EUS
37
What is the investigation process for pancreatic carcinoma?
1. Suspicion 2. Abdominal USS/CT scan/EUS 3. Jaundice with/without mass --> ERCP Mass without jaundice --> EUS/biopsy 4. Carcinoma detected 5. CT scan/EUS/Laparoscopy/Laparotomy to determine if carcinoma is operable or inoperable
38
How is pancreatic carcinoma managed?
Majority of patients inoperable Radical surgery if patient is fit, tumour <3cm, no metastases Palliation of jaundice (stent, cholechoduoenostomy) Pain control Chemotherapy
39
What is the prognosis in inoperable cases of pancreatic carcinoma?
survival ~6 months | 1% 5 year survival
40
What is the prognosis in operable cases of pancreatic carcinoma?
15% 5 year survival | Ampullary tumours 30-50% 5 year survival

GI - Year 2 (39 decks)

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