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Y3R5: Medicine I 🩺 > L11: Pancreatic Disorders > Flashcards

L11: Pancreatic Disorders Flashcards

1
Q

Introduction to Pancreas

A

 Complicated exocrine and endocrine gland
located in the upper abdominal region

 It lies behind the peritoneum of the posterior
abdominal wall

 Divided into head, body, and tail

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2
Q

Types of Diseases of Pancreas

A

1- Acute Pancreatitis.
2- Chronic Pancreatitis.
3- Pancreatic Tumors.

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3
Q

Def of Acute Pancreatitis

A

Acute inflammation of the pancreas characterized clinically by two of the
following:

  • Symptoms: Characterized epigastric pain.
  • Laboratory: Elevated serum amylase and lipase level more than 3 times upper limit of normal.
  • Radiology: Consistent with pancreatitis, usually using CT or MRI.
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4
Q

Common Causes of Acute Pancreatitis

A
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5
Q

Rare Causes of Acute Pancreatitis

A

 Ascaris blocking pancreatic outflow.
 Ischemia from bypass surgery.
 Infections other than mumps (EBV, CMV).
 Pregnancy.
 Idiopathic
 Hereditary pancreatitis; AD.
 Cystic fibrosis
 Smoking.

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6
Q

Pathogenesis of Acute Pancreatitis

A
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7
Q

Pathology of Acute Pancreatitis

A
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8
Q

Severity of clinical features may not always correlate with pathology

A

….

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9
Q

Dx of Acute Pancreatitis

A
  • The diagnosis of acute pancreatitis (AP) relies on:
     Acute abdominal pain
     Increased serum pancreatic enzymes
     Imaging procedures.
  • Etiological diagnosis; A further aspect in diagnosis of
  • AP is the identification of the etiological factor.
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10
Q

Clinical Dx of Acute Pancreatitis

A
  • Acute abdominal pain
  • Abdominal enlargement
  • Tender rigid abdomen; guarding
  • Cullen and Grey-Turner’s signs; internal hemorrhage.
  • Hematemesis and melena
  • Patients are agitated; continuously changing their posture.
  • Fever: chemical, not due to infection.
  • Jaundice: compression or obstruction of bile duct
  • Tetany: transient hypocalcemia
  • Hypovolemic shock: can lead to renal failure
  • ARDS: Acute respiratory distress syndrome
  • Coma.
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11
Q

Characters of Acute Abdominal Pain in Acute Pancreatitis

A
  • Localized to the epigastrium, frequently radiates to the back.
  • Usually severe.
  • Sudden onset
  • Persistent for at least one or two days.
  • Often made worse by walking and lying supine and better by sitting and leaning forward.
  • Nausea and vomiting.
  • History of alcohol intake or biliary colic in the past.
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12
Q

Abdominal Enlargment of Acute Pancreatitis

A
  • Paralytic ileus.
  • Pancreatic ascites.
  • Pseudo cyst or abscess.
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13
Q

Lab Dx of Acute Pancreatitis

A
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14
Q

Assessment of severity of acute pancreatitis

A
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15
Q

Rad Dx of Acute Pancreatitis

A
  • Plain Radiographs
  • Ultrasonography
  • Computed tomography (CT)
  • MRCP
  • Endoscopic ultrasonography (EUS)
  • ERCP
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16
Q

Plain Radiograoph

Rad Dx of Acute Pancreatitis

A
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17
Q

US

Rad Dx of Acute Pancreatitis

A
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18
Q

CT

Rad Dx of Acute Pancreatitis

A
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19
Q

MRCP

Rad Dx of Acute Pancreatitis

A

Non-invasive

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20
Q

EUS

Rad Dx of Acute Pancreatitis

A
  • Help to detect small ampullary lesion and microlithiasis
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21
Q

ERCP

Rad Dx of Acute Pancreatitis

A

Endoscopic Retrograde Cholangiopancreatography (ERCP).

  • In patient suspected to have biliary obstruction.
  • Evidence of ascending cholangitis.
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22
Q

Classification of Acute Pancreatitis

A

1- Mild acute pancreatitis: is associated with minimal
organ dysfunction and uneventful recovery.

2- Severe acute pancreatitis: is associated with organ failure

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23
Q

Complications of Acute Pancreatitis

A
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24
Q

DDx of Acute Pancreatitis

A
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25
Q

TTT of Acute Pancreatitis

A
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26
Q

Pain Control in Acute Pancreatitis

A
  • with meperidine up to 100/150mg intramuscularly every 3-4 hours as necessary. Better tolerated than morphine, which may induce spasm of the sphincter of Oddi
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27
Q

TTT of Complications of Acute Pancreatitis

A
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28
Q

DDx of hyperamylasemia

A
29
Q

Medical causes of acute abdomen

VIP

A
30
Q

Def of Chronic Pancreatitis

A
  • Continuous, prolonged, inflammatory and fibrosing process of the pancreas.
  • Results in irreversible
     Morphologic changes.
     Permanent endocrine and exocrine pancreatic dysfunction.
31
Q

Etiology of Chronic Pancreatitis

A
32
Q

Hereditary pancreatitis

A
  • Autosomal Dominant (AD)
  • Defect in control mechanism of enzyme proteolytic activity
33
Q

Cystic fibrosis

A
  • Autosomal Recessive (AR)
  • Cystic fibrosis transmembrane regulator (CFTR) gene
  • Disturbed chloride transport across cellular membranes.
34
Q

Autoimmune pancreatitis

A
  • Autoimmune pancreatitis ( IgG4 ) ↑
  • Associated with autoimmune disease (Polyarteritis nodosa, SLE, Sjogren syndrome)
35
Q

CP of Chronic Pancreatitis

A
36
Q

Lab Investigations of Chronic Pancreatitis

A
37
Q

Exocrine function test in Chronic Pancreatitis

A
  • 72-h fecal fat test.
  • Secretin test: gold standard, measures exocrine function but difficult to perform.
    (Measurement of secretory volume after intravenous secretin- stimulation by assessing T2 high signal changes in the duodenum).
38
Q

Rad Investigations for Chronic Pancreatitis

A
  • XR: pancreatic calcifications
  • U/S or CT: calcification, dilated pancreatic ducts, pseudocyst
  • MRCP or ERCP: pancreatic ducts-narrowing and dilatation
  • EUS most sensitive method
39
Q

Managment of Chronic Pancreatitis

A
  • General management
  • Endoscopy
  • Surgery
  • Steatorrhea TTT
40
Q

General Managment

Managment of Chronic Pancreatitis

A

 Stop alcohol
 Enzyme replacement
 Analgesics
 Celiac ganglion block (trans-abd. or EUS)

41
Q

Endoscopy

Managment of Chronic Pancreatitis

A

Sphincterotomy and/or pancreatic stent using ERCP;
 If duct dilated.
 Remove stones from pancreatic duct.

42
Q

Surgery

Managment of Chronic Pancreatitis

A

Surgery: 2nd option

  • to drain pancreatic duct (pancreatojejunostomy)
  • Resect pancreas if duct contracted.
43
Q

Dealing With Steatorrhea

Managment of Chronic Pancreatitis

A
  • Pancreatic enzyme replacement
  • Restrict fat, increase carbohydrate and protein (may also decrease pain)
44
Q

Complications of Chronic Pancreatitis

A
  • Neither endoscopy nor surgery can improve function.
  • After 20 years of chronic pancreatitis, there is a 6% cumulative risk of developing pancreatic adenocarcinoma
45
Q

Prognosis of Pancreatic Cancer

A

Aggressive with few symptoms until the cancer is advanced.

46
Q

When do symptoms of Pancreatic Cancer appear?

A

 Earlier from cancers in the head
 Later if in the body and tail

47
Q

Pathological types of Pancreatic Cancer

A
  • Exocrine pancreatic cancer; It is the most common type (Mostly adenocarcinoma (95%)
  • Endocrine pancreatic cancer; Neuroendocrine or islet-cell tumors (uncommon).
48
Q

Endocrine Pancreatic Cancers

A
49
Q

PPT Factors for Pancreatic Cancer

A
50
Q

CP of Pancreatic Cancer

A
51
Q

CP of Glucagonomas

A
  • Hyperglycemia
  • Dermatitis
  • Stomatitis
  • Weight loss and anemia.
52
Q

CP of Insulinomas

A
  • Increased Insulin secretion leading to Hypoglycemia.
  • Palpitations, Tachycardia, Tremors, Sweating and Irritability
  • Headache, Visual disturbances, Confusion, Seizures, or even coma
53
Q

CP of Somatostatinomas

A

Somatostatin Decreases production of;

  • Insulin —> Hyperglycemia
  • Pancreatic enzyme —>Diarrhea or steatorrhea
  • Cholecystokinin —-> Dilated GB , stones
54
Q

CP of Gastrinomas (ZES)

A

Peptic ulcer
 Multiple
 Post bulbar (unusual site)
 Refractory
 Recurrent
 Associated with diarrhea

55
Q

CP of VIPomas

A
56
Q

CP of Carcinoid tumor

A
57
Q

Investigations for Pancreatic Cancer

A
  • Lab
  • Rad
  • Bx
58
Q

Lab Investigations for Pancreatic Cancer

A
59
Q

Rad Investigation for Pancreatic Cancer

A
60
Q

Bx in Pancreatic Cancer

A
  • Types of Biopsy:
  • Percutaneous needle biopsy: Under imaging guidance (US or CT)
  • Endoscopic ultrasound guided biopsy
  • Laparoscopy biopsy.
  • Surgically resectable tumors must not be biopsied
61
Q

TTT of Pancreatic Cancer

A
  • Surgery —-> Localized tumor
  • Radiation and Chemotherapy —> Locally advanced tumors
  • Palliative Treatment —> advanced tumors
62
Q

TTT of Localized Pancreatic Cancer

A
63
Q

Types of Surgery in Pancreatic Cancer

A
64
Q

Surgery in Pancreatic Cancer in cases of liver metastasis

A
  • Should be resected when possible.
  • Radiofrequency or cryosurgical ablation; In patients with unresectable liver metastasis
65
Q

TTT of Pancreatic Cancer if locally advanced

A
66
Q

TTT of Pancreatic Cancer if Advanced

A
67
Q

Medical treatment for pancreatic endocrine neoplasms

A
68
Q

Somatostain analogue (octereotide)

Medical treatment for pancreatic endocrine neoplasms

A

Can improve symptoms in all the functional pancreatic endocrine neoplasms except Somatostatinomas.

69
Q

Lu 177

Medical treatment for pancreatic endocrine neoplasms

A

Lutetium Lu 177-dota-tate
 Peptide Receptor Radionuclide Therapy (PRRT)
 Binds to somatostatin receptors.
 Beta radiation

Y3R5: Medicine I 🩺 (39 decks)

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