*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):
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%)

31

How long does it take for all necrosis from pancreatitis to show up?

4 days

32

What are the local complications from Acute pancreatitis? (6)

Fluid collection
Pseudocysts
Abscess
Necrosis +/- infection
Ascites
Pleural effusion

33

What are the systemic complications of acute pancreatitis? (8)

Pulmonary failure
Renal failure
Shock
Sepsis
Metabolic acidosis
Hyperglycaemia
Hypoglycaemia
MODS (multi organ failure)

34

What problems can pseudocysts cause?

They can cause biliary and/ or gastric outlet obstruction

35

Symptoms of a pseudocyst? 95)

Pain
nausea
Vomiting
Jaundice
Weight loss

36

Treatment of pseudocysts?

Endoscopic drainage
Surgical drainage (open/laparotomy)
(cystgastrostomy or cystjejunostomy can be performed in order to drain the cyst into the stomach or jejunum)

37

Treatment of a pancreatic abscess?

CT/US guided retroperitoneal or transpirational drainage
drain abscess, control sepsis

38

Management of necrosis?

CT for assessment
Sterile or infected?
If sterile, it should be treated conservatively
May require drainage or necrosectomy and lavage if infected

39

What drugs have been shown to be beneficial for the treatment of acute pancreatitis?

no drug therapy has been shown to be beneficial

40

What is chronic pancreatitis?

Progressive and irreversible destruction of pancreatic tissue
Results in permanent loss of endocrine and exocrine function

41

What is pancreatic divisum?

congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts

42

What are the 5 main causes of chronic pancreatitis?

Familial
Alcohol
Hyperparathyroidism/ hypercalcaemia
CF
Alpha-antitrypsin deficiency
Pancreatic duct obstruction (cholelithiasis, structure, tumour, pseudocyst, pancreas divisum)
Tropical (deficient in methionine and trace elements)
Autoimmune pancreatitis (IgG4 subclass)

43

How is autoimmune chronic pancreatitis treated?

Steroids

44

Diagnosis of chronic pancreatitis?

History
Examination
Blood tests
Imagining
*same as for acute pancreatitis except IgG4 and CA 19-9 pancreatic function tests are also performed

45

What are the 2 main imaging signs of chronic pancreatitis?

Extensie pancreatic calcification
Pancreatic duct dilation

46

Treatment of chronic pancreatitis?

Drugs e.g. analgesics, creon, vitamins, insulin
No alcohol and low fat diet may help
Surgery (pancreatectomy or pancreaticojejunostomy) if unremitting pain/ weight loss

47

What is another name for a pancreaticojejunostomy?
What does this involve?
Other 2 similar procedures?

Pustow procedure
Dilated pancreatic duct is filleted open and joined to the jejunum (which is also filleted open)
This allows pancreatic juice to enter the jejunum
(Frey procedure is the same as the pastor procedure although the head of the pancreas gets pulled out a bit more)

48

What type of procedure is used to treat chronic pancreatitis with inflammatory head tumour?

Beger procedure

49

Complications of chronic pancreatitis?

Splenic vein thrombosis
Pseudoaneurysms
Pancreatic cancer
pseudocyst
Bile duct or duodenal obstruction
Pancreatic ascites
Pleural effusion

50

Treatment of a biliary obstruction?

Stent, bypass, resection

51

Treatment of a duodenal obstruction?

Stent, bypass, resection

52

What is the treatment for a pseudocyst?

Endoscopic drainage
Surgical drainage
Resection

53

What is the most common cause of chronic pancreatitis?

Alcohol (abstinence is associated with a more favourable prognosis)

54

Does stopping smoking have a higher chance of favourable outcomes for chronic pancreatitis?

Yes

55

What is the most common type of exocrine pancreatic tumour?

Adenocarcinoma (95% of exocrine pancreatic tumours)

56

What are the 5 possible types of endocrine pancreatic cancers?

Gastrinoma
Insulinoma
Glucagonoma
(tends to be smaller and more easily treated than adenocarcinoma)
Somatostatinoma
Vipoma

57

Symptom of a gastroma?

Produces gastrin causing increased stomach acid = gastric/ duodenal ulcers

58

Symptom of an insulinoma?

Produces insulin, causing the body to store sugar rather than burn it = hypoglycaemia

59

Symptom of a glucagoma?

Produces glucagon, increasing blood sugar levels = hyperglycaemia

60

what are symptoms of somatostatinoma?

Diabetes
Steatorrhoea

61

Symptoms of vipoma?

Severe diarrhoea
Hypokalaemia
Achlorhydria

62

What is achlorhydria

Absence of HCl acid in gastric secretions

63

Symptoms of pancreatic cancer?

Jaundice (dark urine and light stools)
Back pain
Weight loss (anorexia, nausea, vomiting)

64

Risk factors for pancreatic cancer? (4)

Smoking
Diabetes
Familial pancreatitis
Obesity

65

How is pancreatic cancer diagnosed?

History
Examination (abdo exam probs won't tell you anything unless they have metastases)
Blood tests
Imaging

66

How can you diagnose pancreatic cancer from ERCP?

Can take brushings = biopsy

67

Staging system for pancreatic cancer?

TNM

68

What is Tis for pancreatic cancer?

Very early stage, has not had the chance to spread 9carcinoma in situ

69

T1 for pancreatic cancer?

The size of the tumour in the pancreas is 2cm or less in any direction

70

T2 for pancreatic cancer?

The tumour is more than 2cm across in any direction

71

T3 for pancreatic cancer?

The cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or bile duct

72

T4 for pancreatic cancer?

The cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels

73

N1 pancreatic cancer?

Has spread into lymph nodes (N0 = has not spread)

74

M1 pancreatic cancer?

Has spread to distant body parts (M0 = has not)

75

Stage 1 pancreatic cancer?

Cancer is confined to the pancreas

76

Stage 2 pancreatic cancer?

Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes

77

Stage 3 pancreatic cancer?

Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes

78

Stage 4 pancreatic cancer?

Cancer has spread to distant sites beyond the pancreas such as the liver, lungs and the peritoneum

79

Treatment for pancreatic cancer?

Surgery = only curative method
Chemotherapy
Radiotherapy
Combinations

80

Types of surgery for resectable pancreatic tumours? (4)

Whipple resection
Total pancreatectomy
Distal pancreatectomy
Midsegment pancratectomy

81

Types of surgery for non-resectable pancreatic tumours?

Biliary bypass
Gastric bypass
Double bypass

82

What is involved in Whipple's operation?

Part of the stomach and the head of the pancreas are removed - remaining stomach and pancreas are joined separately to the small intestines

83

Distal pancreatectomy?

Body and tail of the pancreas and usually the spleen are removed

84

Biliary bypass?

Rerouting the flow of bile from the common bile duct into the intestine bypassing the pancreas

85

Gastric bypass?

Pancreatic tumour can block the duodenum - surgery directly joins the stomach and the small intestine