*Biliary tract and pancreas disorders 3 (Lecture 11) Flashcards Preview

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Flashcards in *Biliary tract and pancreas disorders 3 (Lecture 11) Deck (85)
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1

What are the 3 main pancreatic diseases?

Acute pancreatitis
Chronic pancreatitis
Pancreatic tumours

2

What are the 5 parts of the pancreas?

Uncinate process
Head
Neck
Body
Tail

3

What do alpha islet cells release?

Glucagon

4

What do Beta islet cells release?

Insulin

5

What do Delta islet cells release?

somatostatin

6

What do PP cels release?

Pancreatic polypeptide

7

What are the 2 categories of acute pancreatitis?

Mild acute
Severe acute

8

What is the predominant feature of mild acute pancreatitis?

interstitial oedema of the gland
Associated with minimal organ dysfunction and an uneventful recovery

9

What is severe acute pancreatitis?

Associated with organ failure and/ or local complications such as necrosis (with infection), pseudocyst or abscess

10

What viral infections can cause acute pancreatitis?

Mumps
Coxsackie B (can cause hand foot and mouth disease)
Viral hepatitis

11

What other factor can cause acute pancreatitis apart from GET SMASHED?

Genetic factors

12

What genetic factors can cause acute pancreatitis?

Cationic trypsinogen gene
CF gene

13

What drugs can cause pancreatitis? (4)

Valproic acid
Azathioprine
L-asparaginase
Corticosteroids

14

What autoimmune disease can cause pancreatitis?

IgG4-related autoimmune disease

15

What causes necrosis of the pancreas during pancreatitis?

Inflammation of the parenchyma causing hypoperfusion

16

How is acute pancreatitis diagnosed?

History (e.g. gallstones, alcohol, drugs, trauma, infection, ERCP)
Examination
Blood tests
Imaging

17

What is peritonism?

having the clinical signs of shock and peritonitis

18

Possible examination findings for acute pancreatitis? (5)

Tenderness
Peritonism
Distension
Bowel sounds
Skin markings

19

Blood tests performed to look for acute percents?

FBC
Clotting
U&Es
LFTs
Amylase
CRP
Glucose
Ca

20

Imaging for acute pancreatitis? (5)

CXR/AXR
AUS
CT pancreas
MRI
ERCP

21

Findings on AXR suggestive of possible AP? (2)

Pleural effusion
Sentinel loop

22

What is a sentinel loop?

dilatation of a segment of small intestine

23

What is the purpose of carrying out an US for AP?

To rule out biliary pancreatitis
Look for:
Gallstones
Cholecystitis
CBD diameter
Free fluid

24

What is the purpose of carrying out a CT scan for acute pancreatitis?

Assess severity of pancreatitis
Decide on interventions and follow up
Look for complications (e.g. fluid collection, necrosis, ascites, bleeding, abscess)

25

Use of ERCP in AP?

Not as a diagnostic tool!
Used for treatment of CBD stones with obstruction cholangitis as an emergency procedure
Used for treatment of acute biliary pancreatitis (if no index cholecystectomy possible)

26

What is the glasgow prognostic score?

PaO2 less than 8kPa
Age greater than 55 years
Neutrophils greater than 15 X 10^9/L
Calcium less than 2mmol/L
Renal function: urea greater than 16mmol/L
Enzymes (AST/ ALT greater than 200 or LDH greater than 600)
Albumin less than 32 g/L
Sugar (glucose less than 10 mol/L)
*any 3 factors means acute severe pancreatitis

27

What Glasgow prognostic score = acute severe pancreatitis?

3

28

Apart form the Glasgow prognostic score, what is another scoring system that can be used to acute pancreatitis?

Ranson score (only for alcohol-induced pancreatitis)
Balthazar score - used to assess percentage of necrosis and severity score from a CT scan (CT severity index)

29

Symptoms of acute pancreatitis? (7)

Epigastric/ diffuse abdominal pain +/- radiation to the back
Nausea and vomiting
Indigesiton
Abdominal tenderness
Loss of appetite +/- weight loss
Temperature
Jaundice (pain)

30

What type of acute pancreatitis are most pancreatitis?

Mild pancreatitis (85% - mortality = 1%)