Inflammation and Tumours of the Pancreas

Question 1

what cells are found in the exocrine pancreas?

Answer 1

acinar cells

Question 2

what does the exocrine pancreas secrete?

Answer 2

pancreatic digestive enzymes

Question 3

what cells are found in the endocrine pancreas?

Answer 3

islets of langerhans

Question 4

what does the endocrine pancreas secrete?

Answer 4

hormones

Question 5

name the four different types of islets

Answer 5

beta cells
alpha cells
delta cells
F cells

Question 6

what do beta cells secrete?

Answer 6

insulin

Question 7

what do alpha cells secrete?

Answer 7

glucagon

Question 8

what do delta cells secrete?

Answer 8

somatostatin

Question 9

what do F cells secrete?

Answer 9

pancreatic polypeptide

Question 10

what two things regulate pancreatic secretions?

Answer 10

the vagus nerve

gastrin levels

Question 11

what three things are secreted from the acinar cells?

Answer 11

proteases
lipase
amylase

Question 12

name two proteases secreted by the pancreas?

Answer 12

trypsin

chymotrypsin

Question 13

what do proteases do?

Answer 13

breakdown polypeptides into peptides

Question 14

what does lipase do?

Answer 14

breakdown triglycerides

Question 15

what does amylase do?

Answer 15

breaks down carbohydrates into di/monosaccharides

Question 16

what two things are secreted from the epithelial cells lining ducts in the pancreas?

Answer 16

bicarbonate

water

Question 17

what is acute pancreatitis?

Answer 17

an acute inflammatory process in the pancreas

Question 18

what mnemonic is used to remember the causes of acute pancreatitis?

Answer 18

I GET SMASHED

Question 19

name all of the causes of acute pancreatitis

Answer 19

idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion bite 
hypercalcaemia and hyperlipidaemia 
ERCP
drugs

Question 20

name a drug that can cause acute pancreatitis

Answer 20

azathioprine

Question 21

where does pain from pancreatitis present?

Answer 21

the epigastrium

Question 22

where does pain from pancreatitis radiate to?

Answer 22

the back

Question 23

what can be associated with the pain from pancreatitis?

Answer 23

nausea
vomiting
jaundice

Question 24

what are bowel sounds like in pancreatitis?

Answer 24

normal

Question 25

what does fullness in the epigastrium in a patient with pancreatitis suggest?

Answer 25

a pseudocyst

Question 26

name three classic signs of acute pancreatitis

Answer 26

erythema ab igne cullen's sign grey turner's sign

Question 27

name four initial investigations for acute pancreatitis

Answer 27

bloods ABG USS CT

Question 28

what blood result is diagnostic of acute pancreatitis?

Answer 28

amylase more than three times the upper limit of normal

Question 29

what is USS used for in patients with acute pancreatitis?

Answer 29

gallstones CBD size cholecystitis

Question 30

what is CT used for in patients with acute pancreatitis?

Answer 30

as follow up to assess the severity and to look for any complications

Question 31

when is the best time to do a CT in a patient with acute pancreatitis?

Answer 31

around 5 days after the onset of symptoms

Question 32

name five possible complications of acute pancreatitis

Answer 32

``` fluid collections necrosis ascites bleeding abscess ```

Question 33

what should not be used to diagnose acute pancreatitis?

Answer 33

ERCP

Question 34

what can ERCP be used for?

Answer 34

treating gallstones

Question 35

what score on the glasgow criteria is considered to be severe pancreatitis?

Answer 35

more than 3

Question 36

how is acute pancreatitis managed initially?

Answer 36

fluid resuscitation oxygen antibiotics if needed

Question 37

what can pancreatic pseudocysts cause?

Answer 37

biliary and gastric outlet obstruction

Question 38

how does a pancreatic pseudocyst present?

Answer 38

pain nausea & vomiting jaundice weight loss

Question 39

how is a pancreatic pseudocyst treated?

Answer 39

drainage or resection

Question 40

what three methods of drainage can be used on a pancreatic pseudocyst?

Answer 40

endoscopic radiological surgical

Question 41

why are pancreatic abscesses drained?

Answer 41

to control sepsis

Question 42

how is a pancreatic abscess drained?

Answer 42

using CT/US guided retro/transperitoneal drainage

Question 43

what imaging can be used to assess pancreatic necrosis?

Answer 43

CT

Question 44

what two states can pancreatic necrosis be in?

Answer 44

sterile | infected

Question 45

what is chronic pancreatitis?

Answer 45

progressive and irreversible damage causing a loss of exocrine and/or endocrine function

Question 46

how does chronic pancreatitis present?

Answer 46

same as acute, with masses, ascites or jaundice on examination

Question 47

name five investigations that can be done for chronic pancreatitis?

Answer 47

``` x-ray ultrasound CT MRI ERCP ```

Question 48

name five causes of chronic pancreatitis

Answer 48

``` alcohol idiopathic pancreatic duct obstruction autoimmune hereditary ```

Question 49

what should be used to treat pancreatitis if there is pancreatic insufficiency?

Answer 49

creon as enzyme replacement

Question 50

what do surgical procedures can be done to treat chronic pancreatitis?

Answer 50

pustow procedure | frey procedure

Question 51

name an exocrine tumour of the pancreas

Answer 51

adenocarcinoma

Question 52

name three endocrine tumours of the pancreas

Answer 52

gastrinoma insulinoma glucagonoma

Question 53

what does a gastrinoma do?

Answer 53

produces gastrin and increases stomach acid

Question 54

what does an insulinoma do?

Answer 54

produces insulin and causes hypoglycaemia

Question 55

what does a glucagonoma do?

Answer 55

produces glucagon, causing hyperglycaemia

Question 56

what investigations can be done for pancreatic cancers?

Answer 56

ultrasound CT MRI MRCP