Flashcards in Lesson 3A (Part 4) Deck (23)
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1
What is superior to sonography in detecting calcifications and ductal dilation?
CT
2
What is a hallmark for chronic pancreatitis? (4)
1. Ductal dilation
2. Calcifications
3. Pain
4. History of ETOH
- alcohol
3
What do up to 1/3 of patients with chronic pancreatitis have?
A focal inflammatory mass in the pancreas
4
What can masses in the head of the pancreas cause?
Dilation of the CBD and pancreatic duct
5
What is chronic pancreatitis difficult to diagnose from?
Pancreatic carcinoma
6
What can help rule of malignancy for chronic pancreatitis?
Biopsy
7
What are the 2 most significant vascular complications in either acute or chronic pancreatitis?
1. Pseudoaneurysms
2. Venous thrombosis
8
What is the most common vascular complication with pancreatitis?
Splenic vein thrombosis
9
What can splenic vein thrombosis lead to?
Upper GI bleed from gastric varices known as sinistral
10
Sinistral
Left sided portal hypertension
- occurs in 22% of patients with chronic pancreatitis
11
How do pseudoaneurysms form?
When enzyme rich peripancreatic fluid, often within a pseudocyst, leads to autodigestion and weakening of the walls of adjacent arteries
12
What do arteries under go pseudoaneurysms?
Aneurysmal dilatation with the bulge contained within the pseudocyst
13
How can you rule out an pseudoaneurysm?
But applying colour doppler to the cystic collection
14
Why does portal and splenic vein thrombosis occur in chronic pancreatitis? (2)
1. Intimal injury due to recurrent inflammation
2. Results in chronic fibrosis
15
What is portal and splenic vein thrombosis caused by?
Pseudocyst compression on the adjacent vessels
16
Can portal and splenic vein thrombosis can occur simultaneously?
Yes
17
What do collaterals do?
Convey blood to the liver bypassing the clot
18
ERCP
Endoscopic retrograde cholangio-pancreatography
19
Why owuld you use endoscopic retrograde cholangio-pancreatography?
Diagnose or therapeutic reasons
- liver, bile ducts, pancreas or gallbladder
20
What are the benefits of ERCP? (3)
1. Not a painful procedure
- it is uncomfortable
2. Low incidence of complications
3. Provides important information that cannot be obtained by other diagnostic examinations
21
What therapeutic measures can be performed at the time of ERCP? (2)
1. To remove stones in the bile ducts
2. To relieve obstruction of the bile ducts
22
How is ERCP done? (5)
1. The procedure is performed by using a long, flexible, viewing instrument
- a duodenoscope
2. The fiber optic tip of the endoscope transmits digital video images to a TV screen
3. Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the endoscope into the opening of the papilla, and into the bile ducts and/or the pancreatic duct
4. Contrast material is then injected
5. X-rays are taken of the bile ducts and the pancreatic duct
23
