Flashcards in *Biliary tract and pancreas disorders 3 (Lecture 11) Deck (85):
What are the 3 main pancreatic diseases?
What are the 5 parts of the pancreas?
What do alpha islet cells release?
What do Beta islet cells release?
What do Delta islet cells release?
What do PP cels release?
What are the 2 categories of acute pancreatitis?
What is the predominant feature of mild acute pancreatitis?
interstitial oedema of the gland
Associated with minimal organ dysfunction and an uneventful recovery
What is severe acute pancreatitis?
Associated with organ failure and/ or local complications such as necrosis (with infection), pseudocyst or abscess
What viral infections can cause acute pancreatitis?
Coxsackie B (can cause hand foot and mouth disease)
What other factor can cause acute pancreatitis apart from GET SMASHED?
What genetic factors can cause acute pancreatitis?
Cationic trypsinogen gene
What drugs can cause pancreatitis? (4)
What autoimmune disease can cause pancreatitis?
IgG4-related autoimmune disease
What causes necrosis of the pancreas during pancreatitis?
Inflammation of the parenchyma causing hypoperfusion
How is acute pancreatitis diagnosed?
History (e.g. gallstones, alcohol, drugs, trauma, infection, ERCP)
What is peritonism?
having the clinical signs of shock and peritonitis
Possible examination findings for acute pancreatitis? (5)
Blood tests performed to look for acute percents?
Imaging for acute pancreatitis? (5)
Findings on AXR suggestive of possible AP? (2)
What is a sentinel loop?
dilatation of a segment of small intestine
What is the purpose of carrying out an US for AP?
To rule out biliary pancreatitis
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)
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)
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
What Glasgow prognostic score = acute severe pancreatitis?
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)
Symptoms of acute pancreatitis? (7)
Epigastric/ diffuse abdominal pain +/- radiation to the back
Nausea and vomiting
Loss of appetite +/- weight loss
What type of acute pancreatitis are most pancreatitis?
Mild pancreatitis (85% - mortality = 1%)
How long does it take for all necrosis from pancreatitis to show up?
What are the local complications from Acute pancreatitis? (6)
Necrosis +/- infection
What are the systemic complications of acute pancreatitis? (8)
MODS (multi organ failure)
What problems can pseudocysts cause?
They can cause biliary and/ or gastric outlet obstruction
Symptoms of a pseudocyst? 95)
Treatment of pseudocysts?
Surgical drainage (open/laparotomy)
(cystgastrostomy or cystjejunostomy can be performed in order to drain the cyst into the stomach or jejunum)
Treatment of a pancreatic abscess?
CT/US guided retroperitoneal or transpirational drainage
drain abscess, control sepsis
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
What drugs have been shown to be beneficial for the treatment of acute pancreatitis?
no drug therapy has been shown to be beneficial
What is chronic pancreatitis?
Progressive and irreversible destruction of pancreatic tissue
Results in permanent loss of endocrine and exocrine function
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
What are the 5 main causes of chronic pancreatitis?
Pancreatic duct obstruction (cholelithiasis, structure, tumour, pseudocyst, pancreas divisum)
Tropical (deficient in methionine and trace elements)
Autoimmune pancreatitis (IgG4 subclass)
How is autoimmune chronic pancreatitis treated?
Diagnosis of chronic pancreatitis?
*same as for acute pancreatitis except IgG4 and CA 19-9 pancreatic function tests are also performed
What are the 2 main imaging signs of chronic pancreatitis?
Extensie pancreatic calcification
Pancreatic duct dilation
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
What is another name for a pancreaticojejunostomy?
What does this involve?
Other 2 similar procedures?
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)
What type of procedure is used to treat chronic pancreatitis with inflammatory head tumour?
Complications of chronic pancreatitis?
Splenic vein thrombosis
Bile duct or duodenal obstruction
Treatment of a biliary obstruction?
Stent, bypass, resection
Treatment of a duodenal obstruction?
Stent, bypass, resection
What is the treatment for a pseudocyst?
What is the most common cause of chronic pancreatitis?
Alcohol (abstinence is associated with a more favourable prognosis)
Does stopping smoking have a higher chance of favourable outcomes for chronic pancreatitis?
What is the most common type of exocrine pancreatic tumour?
Adenocarcinoma (95% of exocrine pancreatic tumours)
What are the 5 possible types of endocrine pancreatic cancers?
(tends to be smaller and more easily treated than adenocarcinoma)
Symptom of a gastroma?
Produces gastrin causing increased stomach acid = gastric/ duodenal ulcers
Symptom of an insulinoma?
Produces insulin, causing the body to store sugar rather than burn it = hypoglycaemia
Symptom of a glucagoma?
Produces glucagon, increasing blood sugar levels = hyperglycaemia
what are symptoms of somatostatinoma?
Symptoms of vipoma?
What is achlorhydria
Absence of HCl acid in gastric secretions
Symptoms of pancreatic cancer?
Jaundice (dark urine and light stools)
Weight loss (anorexia, nausea, vomiting)
Risk factors for pancreatic cancer? (4)
How is pancreatic cancer diagnosed?
Examination (abdo exam probs won't tell you anything unless they have metastases)
How can you diagnose pancreatic cancer from ERCP?
Can take brushings = biopsy
Staging system for pancreatic cancer?
What is Tis for pancreatic cancer?
Very early stage, has not had the chance to spread 9carcinoma in situ
T1 for pancreatic cancer?
The size of the tumour in the pancreas is 2cm or less in any direction
T2 for pancreatic cancer?
The tumour is more than 2cm across in any direction
T3 for pancreatic cancer?
The cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or bile duct
T4 for pancreatic cancer?
The cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels
N1 pancreatic cancer?
Has spread into lymph nodes (N0 = has not spread)
M1 pancreatic cancer?
Has spread to distant body parts (M0 = has not)
Stage 1 pancreatic cancer?
Cancer is confined to the pancreas
Stage 2 pancreatic cancer?
Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes
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
Stage 4 pancreatic cancer?
Cancer has spread to distant sites beyond the pancreas such as the liver, lungs and the peritoneum
Treatment for pancreatic cancer?
Surgery = only curative method
Types of surgery for resectable pancreatic tumours? (4)
Types of surgery for non-resectable pancreatic tumours?
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
Body and tail of the pancreas and usually the spleen are removed
Rerouting the flow of bile from the common bile duct into the intestine bypassing the pancreas