pirates of the pancreas

Question 1

what is acute pancreatitis

Answer 1

inflammation of the pancreas over a short period of time
acinar cells release proteases, lipases, amylases which destroy the tissues and blood vessels
can cause oedema

Question 2

what are causes of acute pancreatitis

Answer 2

I GET SMASHED 
idiopathic 
gallstones
ethanol 
trauma 
steroids 
mumps 
autoimmune disease
scorpion sting 
hyperlipid/calcaemia 
ERCP 
drug reactions

Question 3

how may acute pancreatitis present

Answer 3

epigastric pain that can radiate to the back - is relieved by kneeling 
fever 
dehydration 
circulatory failure 
anorexia 
jaundice 
periumbilical and flank bruising 
dyspepsia

Question 4

what investigations would you do for acute pancreatitis

Answer 4

bloods - look for increased amylase and lipase in the blood
CT - look for complications like lung perforations, necrosis, fluid
US - look for gallstones

Question 5

how could you manage acute pancreatitis

Answer 5

NIL BY MOUTH
NG tubes or enteric tubes instead
IV fluids and analgesics
urinary catheter to monitor output 
monitor respiratory rate, blood gas, O2%
treat underlying cause 
ERCP to remove gallstones

Question 6

what are complications of acute pancreatitis

Answer 6

HDAMN
haemorrhage
disseminated intravascular coagulation (excessive blood clot formation)
acute respiratory distress syndrome (because all blood vessels dilate in response to inflammation)
multi-organ failure
necrosis

Question 7

what is chronic pancreatitis

Answer 7

long term inflammation of the pancreas which causes irreversible structural changes

Question 8

what causes chronic pancreatitis

Answer 8

cystic fibrosis 
hypercalcaemia 
alcohol 
malnourishment 
pancreatic duct obstruction
acute pancreatitis

Question 9

nvm

Answer 9

nvm

Question 10

how does chronic pancreatitis present

Answer 10

pain - epigastric, relived by sitting forwards, worse after meals, radiates to back
diarrhoea 
jaundice 
malnourishment/anorexia 
erythema 
diabetes mellituis
steatorrhea

Question 11

what tests could you do for chronic pancreatitis

Answer 11

CT - calcification
bloods - amylase, bilirubin
ERCP

Question 12

how could you treat chronic pancreatitis

Answer 12

conservative - smoking, alcohol cessation 
pancreatic enzyme injections 
analgesics 
treat diabetes if needed
diet modification - low fat

Question 13

what are complications of chronic pancreatitis

Answer 13

PODS
pseudocysts
organ failure
diabetes mellitus 
steatorrhea

Question 14

what types of pancreatic cancer are there

Answer 14

adenocarcinoma (duct cells)
carcinosarcoma
acinar cell
cystadenocarcinoma

Question 15

what are risk factors for pancreatic cancer

Answer 15

smoking 
adult onset of diabetes 
alcohol 
acute pancreatitis 
genetics

Question 16

how can pancreatic cancer present

Answer 16

obstructive jaundice
nausea
vomiting
fatigue
steatorrhea
upper abdominal pain
weight loss
poor appetite
portal hypertension
palpable and enlarged gallbladder
diabetes

Question 17

what investigations could you do for pancreatic cancer

Answer 17

US
CT
MRI
biopsy
CXR
bloods - LFTs, bilirubin levels

Question 18

how could you treat pancreatic cancer

Answer 18

pancreatoduodenectomy - if patient fit and tumour <3cm
pyloris preserving pancreas duodenectomy
opiates
chemotherapy
relive jaundice
treat any obstruction
stent to open any ducts the tumour is occluding
RFA
Celiac plexus block (for pain)
Whipple (if its head of pancreas)

Question 19

what are complications of pancreatic cancer

Answer 19

metastatic disease
paraneoplastic manifestations
thromboembolism