Flashcards in Inflammation and Tumours of the Pancreas Deck (66):
What is an acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems?
What is interstitial oedema a predominant feature of the gland?
Mild acute pancreatitis
What is associated with organ failure/and or local complication such as necrosis, pseudocyst or abscess. Most often this is an expression of the development of pancreatic necrosis although patients with oedematous pancreatitis may manifest clinical features of a severe attack?
Severe actue pancreatitis
What are three obstructive factors of pancreatitis?
1. Biliary disease
2. Benign pancreatic duct stricture
3. Tumours of the ampulla or pancreas
What are 2 toxic factors for pancreatitis?
2. Viral infection - mumps, coxsackie B and viral hepatitis
What are two metabolic factors for pancreatitis?
What are two genetic defects for pancreatitis?
1. Cationic trypsinogen gene (N29I, RII7H)
2. CF gene (CTFR)
Name an iatrogenic cause of pancreatitis
What are 4 drugs that can induce acute pancreatitis?
1. Valproic acid
Name an inflammatory cause of pancreatitis?
IgG4-related autoimmune disease
When inflammation of the parenchyma occurs, what does the resulting peripancreatic exudation or pancreatic ductal leakage cause?
On examination what does tenderness, peritonism, distention, bowel sounds and skin markings suggest?
Other than FBC, clotting, U&es, LFTs - what 4 other blood tests would you do for acute pancreatitis?
What 5 imaging methods would you use for diagnosing acute pancreatitis?
3. CT pancreas
With acute pancreatitis, what might you see on an AXR?
What is an US used for in acute pancreatitis?
To rule out biliary pancreatitis
What is a CT scan used for in acute pacnreatitis?
To assess severity
What are fluid collections, pancreatic necrosis, ascites, bleeding and abscesses complications of?
What shouldn't be used as a diagnostic tool, but is used for treatment for CBD stones with obstruction, cholangitis and acute biliary pancreatitis?
What is the Glasgow Prognostic Score for pancreatitis (3 factors means acute severe)?
Neutrophils: WBC > 15x109/l
Enzymes (AST/ALT > 200 or LDH > 600)
What can be said about pain felt in acute pancreatitis?
Epigastric/diffuse abdominal pain with radiation to back
What condition has painful jaundice, temperature, loss of appeitite and weight loss, abdominal tenderness, indigestion and nausea with vomiting, alongside radiating pain to back?
What are pulmonary failure, renal failure, shock, sepsis, metabolic acidosis, hyperglycaemia, hypocalcaemia anad MODS systemic complications of?
What is a complication of acute pancreatitis and chronic pancreatitis, which might have pancreatic duct communication?
What two things can a pseudo-cyst cause?
Biliary obstruction and gastric outlet obstruction
What are the two methods of treating a pseudocyst?
Endoscopic drainage and surgical drainage
How are pancreatic abscesses treated?
CT/US guided retroperitoneal or transperitoneal drainage, control sepsis
How can pancreatic necrosis be assessed?
With acute biliary pancreatis what is the treatment for the presence of obstruction like acute cholangitis?
ERCP with spincteroctomy
With acute biliary pancreatitis what is done if there is suspected obstruction?
US or MRCP
With severe biliary pancreatitis with no obstruction, what is the treatment?
What does chronic pancreatitis result in?
Permanent loss of endocrine and exocrine function?
What is the main cause of chronic pancreatitis?
What is a congenital cause of pancreatic duct obstruction leading to chronic pancreatitis?
What is treatment for autoimmune pancreatitis (increased IgG4)
What class of aetiology does cyanogenetic gluycosides, deficiency in methionine and trace elements zinc and selenium?
Tropic causes of chronic pancreatitis
What type of pancreatitis has exocrine pancreatic insufficiency and can be present in CF and alpha-antitrypsin deficiency?
Hereditary chronic pancreatitis
With hereditary chronic pancreatitis, what is there a 53-fold increased risk of?
Pancratic ductal adenocarcinoma > 40 years
Can high calcium cause chronic pancreatitis?
Do alcohol and smoking lead to chronic pancreatitis?
With diagnosing chronic pancreatitis, what 3 other blood tests would you do other than FBC, clotting, U&Es, LFTs, amylase, CRP, glucose and Ca?
2. CA 19-9
3. Pancreatic function tests
What two things can be seen on AXR with tropical pancreatitis?
Calcification and pancreatic duct dilatation
What two things can a CT see for chronic pancreatitis?
Dilated pancreatic duct and calcification
If there is suspected cancer from chronic pancreatitis, what investigation is done?
CT guided or endocsopic ultrasound guided biospy
What surgical procedure relates to duodenum preserving pancreatic head resection with reconstruction and chronic pancreatitis with inflamamtory head tumour?
Is pleural effusion a complication of pancreatitis?
What do oedema due to acute flare up, clacification, fibrosis and pancreatic head tumour all cause as a complication of chronic pancreatitis?
Common bile duct stenosis
What are 3 treatment methods for common bile duct stenosis?
Stent, bypass, resection
What complication of chronic pancratitis is this: oedema due to acute flare up, fibrosis, pseudocyst, pancreatic head tumour, nasea, vomiting, weight loss, pain?
Duodenal/gastric outlet obstruction
What are the three methods of treating duodenal/gastric outlet obstruction?
Stent, bypass, resection
What is the main type of exocrine pancreatic carcinoma, and where is it normally located?
Located in pancreatic head
What are 3 types of endocrine pancreatic cancer?
Gastrinoma, insulinoma, glucagonoma
What endocrine pancreatic cancer produces gastrin causing increased stomach acid, causing gastric/duodenal ulcers?
What endocrine pancreatic cancer produces insulin, causing the body to store sugar rather than burn it, hypoglycemia?
What type of endocrine pancreatic cancer produces glucagon, increases blood sugar levels and leads to hyperglycaemia?
What two features of jaundice are present with pancreatic cancer?
What type of pain is present with pacnreatic cancer?
Back pain and abdominal pain
Diabetes II and II - are they both risk factors for pancreatic cancer?
What is the first investigation for pancreatic cancer suspected, with jaundice?
With pancreatic cancer diagnosis, what is done after ultrasound?
Triple phase CT scan or MRI/MRCP
For inoperable pancreatic cancer, what two methods of managmenet can be done?
What is T1 stage of pancreatic cancer?
Carcinoma in situ
What does N1 and NO mean in pacnreatic cancer stagin?
N1 - lymph node spread
N2 - no spread
What does M1 and M0 mean in pancreatic cancer staging?
M1 - metastases to liver or lungs
M0 - no metastases
For staging laparoscopy for pancreatic cancer surgery, what 4 procedures are resectable?
1. Whipple resection
2. Total pancreatectomy
3. Distal pancreatectomy
4. Midsegment pancreatectomy