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Gastrointestinal > Pancreatic Pathology > Flashcards

Pancreatic Pathology Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the exocrine pancreas resulting in reversible destruction/auto digestion by it’s own digestive enzymes

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2
Q

What causes acute pancreatitis?

A

I GET SMASHED

Idiopathic

Gallstones

Ethanol

Trauma

Scorpio stings

Mumps

Autoimmune

Steroids

Hypercalcaemia, hypothermia

ERCP

Drugs

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3
Q

What drugs can cause acute pancreatitis?

A

Sodium valproate

Azathioprine

Mesalazine

Fuorsemide/thiazide diuretics

Tetracycline

Co-trimoxazole

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4
Q

How does acute pancreatitis present?

A

Acute epigastric pain

  • Sitting forward relieves pain
  • Radiation to the back

N&V

Fever

Tachycardia

Cullen’s sign

Grey Turner’s Sign

Jaundice

Palpable mass if pseudocyst present

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5
Q

What is Cullen’s sign?

A

Bruising around umbilicus due to retroperitoneal haemorrhage

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6
Q

What is Grey Turner’s sign?

A

Bruising around flanks due to retroperitoneal haemorrhage

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7
Q

What investigations are used in acute pancreatitis diagnosis and monitoring?

A

>Amylase and lipase

LFT

  • Decreased albumin
  • AST>ALT suggesting alcohol use

FBC

  • >WCC

U&E

  • >Urea

Hyperglycaemia

Hypocalcamemia

>CRP

LDH

Coagulation

US

CT

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8
Q

Is amylase or lipase better to use in acute pancreatitis diagnosis and why?

A

Lipase is more sensitive and specific

Serum amylase may rise and fall quite quickly and lead to a false negative result

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9
Q

What CT signs are present in acute pancreatitis?

A

Pseudocysts

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10
Q

What are we looking for on an US in acute pancreatitis?

A

Gallstones

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11
Q

Why does hypocalcaemia occur in acute pancreatitis?

A

Lipase uses Ca2+ up

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12
Q

Why is LDH present in acute pancreatitis?

A

Tissue damage

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13
Q

Why is coagulation assessed in acute pancreatitis?

A

DIC is a complication

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14
Q

What is the management of acute pancreatitis?

A

IV fluids

Analgesia

Ca

Insulin

Urinary catheter

Naso-jejunal feeding, to avoid pancreatic stimulation

Treat cause

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15
Q

Name some complications of acute pancreatitis?

A

Pseudocyst/peripancreatic fluid collections

Pancreatic cancer

DIC

Acute Respiratory Distress Syndrome

Pancreatic abscess

Chronic pancreatitis

Pancreatic necrosis

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16
Q

What is a pseudocyst?

A

Fluid collection in lesser sac

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17
Q

What blood test is pseudocyst associated with?

A

Raised amylase

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18
Q

When do pseudocysts become present?

A

No earlier than 4 weeks after acute pancreatic attack

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19
Q

How are pseudocysts managed?

A

Symptomatic cases may be observed for 12 weeks as half resolve

Cystogastrostomy or aspiration

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20
Q

What criteria assesses the severity of acute pancreatitis?

A

Modified Glasgow Criteria

21
Q

What factors does the Modified Glasgow Criteria take into consideration?

A

PaO2 < 8

Age > 55

Neutrophilia x10^9

Calcium < 2 mmoles

Renal function, urea >16

Enzymes, LDH > 600

Albumin < 32

Sugar, glucose > 10

22
Q

How many points does the Modified Glasgow Criteria say is mild acute pancreatitis?

A

0-1

23
Q

How many points does the Modified Glasgow Criteria say is moderate acute pancreatitis?

A

2

24
Q

How many points does the Modified Glasgow Criteria say is severe acute pancreatitis?

A

>3

25
Q

What is chronic pancreatitis?

A

Persistent inflammation of the pancreas, characterised by glandular destruction and permanent loss of function/irreversible change of pancreatic structure

26
Q

What are the causes of chronic pancreatitis?

A

AAAACC

Alcohol

Anatomical bbnormalities

Autoimmune pancreatitis

Reoccuring acute pancreatitis

CF

Hypercalcaemia

27
Q

What congenital anatomical abnormalities can cause chronic pancreatitis?

A

Annular pancreas

Pancreas divisum

28
Q

What mode of inheritence is congenital pancreatitis?

A

Autosomal dominant

29
Q

How does chronic pancreatitis present?

A

Asymptomatic in early disease

Weight loss

Steatorrhoea

Epigastric pain

  • Exacerbated by food/alcohol
  • Severity decreases over time

Jaundice

Diabetes

30
Q

What investigations are used in chronic pancreatitis diagnosis?

A

US

  • Increased pancreatic size
  • Cysts
  • Dilated duct diameter

>Serum Amylase

  • Acute exacerbation

Abdominal CT with IV contrast

  • Calcification of pancreas
31
Q

How is chronic pancreatitis managed?

A

Pancreatic enzyme supplements

Analgesia/coeliac plexus block

Insulin

Avoid alcohol and smoking

Stenting

32
Q

Name some complications of chronic pancreatitis

A

Diabetes

Pseudocyst development

Pancreatic carcinoma

33
Q

Describe diabetic screening in chronic pancreatitis

A

Annual Hb1Ac

34
Q

When does diabetes occur in patients with chronic pancreatitis?

A

20 years after symptom onset

35
Q

What is the most common histological type of pancreatic cancer?

A

Adenocarcinoma, mostly occuring at the head

36
Q

What sex is pancreatic cancer more common in?

A

M>F

37
Q

What age is pancreatic cancer most common?

A

Onset at 65

38
Q

What is the prognosis of pancreatic cancer?

A

Poor, average survival upon diagnosis is 6 months as metastasise early

39
Q

What are the causes of pancreatic cancer?

A

Chronic pancreatitis

Smoking

Obesity

Alcohol

Diabetes

HNPCC

Diet

  • Red meat
40
Q

How does pancreatic cancer present?

A

Epigastric pain, radiates to back

Weight loss

Fatigue

Diarrhoea

Steatorrhoea

N&V

Hepatomegaly

Supraclavicular lymphadenopathy

Courvoisier sign/palpable gallbladder

New onset diabetes

Trousseau’s sign/migratory thrombophlebitis

41
Q

What is Courvoisier sign?

A

Palpable gallbladder not tender to touch along with jaundice, suggesting pancreatic cancer

42
Q

What investigations are used in pancreatic cancer diagnosis?

A

CT pancreas

CT thorax, abdomen, pelvis for staging

EUS with percutaneous biopsy

Cholestatic LFTs

  • Increased ALP
  • Increased gamma GT
  • Increased bilirubin

Tumour markers

  • CA19-9
43
Q

What pancreatic cancer sign can be seen in imaging?

A

Double duct sign, due to obstruction of pancreatic and common bile duct

44
Q

How is pancreatic cancer managed?

A

Surgery

  • Whipples pancreaticoduodenectomy or modified whipples (pylorus sparing)
  • Total or distal pancreatectomy

Palliative radiotherapy or chemotherapy

Stenting to relieve symptoms

45
Q

Describe stage 1 pancreatic cancer

A

<2cm

46
Q

Describe stage 2 pancreatic cancer

A

>2cm

47
Q

Describe stage 3 pancreatic cancer

A

Grown into neighbouring tissue

48
Q

Describe stage 4 pancreatic cancer

A

Metastatic

49
Q

What is a useful test of exocrine function in chronic pancreatits?

A

Faecal elastase

Gastrointestinal (14 decks)

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