Diseases of the Pancreas

Question 1

What is acute pancreatitis?

Answer 1

Normal pancreas that has now become inflamed - may return to normal

Question 2

Why does acute pancreatitis occur?

Answer 2

Increased activation of digestive enzymes causing necrosis of pancreatic tissue, gallstones can also obstruct the pancreatic duct and cause ductal hypertension

Question 3

Causes of acute pancreatitis (GET SMASHED)

Answer 3

Gallstones, ethanol, trauma/tumours, spider-scorpion bites, mumps/malignancy, autoimmunity, steroids, hyperlipidaemia/calcaemia, ERCP, drugs

Question 4

Symptoms of acute pancreatitis

Answer 4

Severe epigastric pain -> back, fever, nausea, loss of appetite, tachycardia, hypotension, reduced bowel sounds if ileus, GREY TURNERS SIGN, CULLEN’S SIGN

Question 5

Complications of acute pancreatitis

Answer 5

Pseudocysts, abscesses, pleural effusion, ARDS, organ failure, necrosis, perforation, chronic pancreatis

Question 6

Investigations of acute pancreatitis

Answer 6

Elevated amylase, lipase and Ca
FBC etc
Erect CXR/AXR for pseudocysts 
US for stones 
CT for complications

Question 7

Prognosis classification of acute pancreatitis

Answer 7

Glasgow prognosis score (PANCREAS) =/> 3 for severe pancreatitis

Question 8

Treatment of acute pancreatitis

Answer 8

1. Analgesia + IV fluids
2. NJ feeding
3. ERCP/cholectomy if gallstones
4. Pseudocyst/abscess endoscopic drainage

Question 9

What is chronic pancreatitis?

Answer 9

Long-term necrosis and calcification with irreversible structure changes to pancreas

Question 10

What can chronic pancreatitis lead to?

Answer 10

Pain, splenic vein thrombosis, pleural effusion, ascites, pseudocysts, pancreatic cancer, duodenal obstruction
Endocrine deficiency - diabetes
Exocrine deficiency - enzyme def = malabsorption = steatorrhea

Question 11

Causes of chronic pancreatitis

Answer 11

Alcohol, idiopathic, pancreatic duct obstruction , hereditary - CF + A1AT def + hyperthyroidism

Question 12

Investigations of chronic pancreatitis

Answer 12

Diagnosis mainly on history
Amylase may be normal
CT scan shows calcification, dilated duct

Question 13

Treatment of chronic pancreatitis

Answer 13

1. Stop alcohol
2. Address diabetes + enzyme supplement eg. CREON
3. Opioids and NSAIDs for pain
4. Endoscopic drainage of pseudcyst
5. Surgery if tolerable - Pustow procedure

Question 14

What is the Pustow procedure?

Answer 14

Joining of duo/jejunum to pancreas so pancreatic juice can drain

Question 15

Types of pancreatic cancer

Answer 15

Adenocarcinoma (95%) - exocrine

Insulinoma, glucagonoma + gastroma - endocrine

Question 16

Where does adenocarcinoma usually develop

Answer 16

Head of pancreas and ampulla of Vater

Question 17

What causes adenocarcinoma

Answer 17

Smoking, alcohol, high caffeine, chronic pancreatitis, diabetes

Question 18

Symptoms of adenocarcinoma

Answer 18

Jaundice, dark urine, pale stools, abdo and back pain, weight loss

Question 19

Investigations of adenocarcinoma

Answer 19

US - obstructed ducts

CT - confirm mass legions

Question 20

Treatment of adenocarcinoma of pancreas

Answer 20

1. Pancreatico-duodenectomy (Whipple’s resection_

2. Palliation - pain relief, stening, cholectcystojejunectomy/gastroenterotomy

Question 21

What does insulinoma cause

Answer 21

Increased insulin = Hypoglycaemia

Question 22

What does glucagonoma cause

Answer 22

Increased glucagon

= hyperglycaemia

Question 23

What does gastrinoma cause

Answer 23

Increased gastrin = acid hypersecretion = peptic ulcers

Question 24

Example of gastrinoma

Answer 24

Zollinger-Ellison syndrome