Liver, etc. 11 - Inflammation adn tumours of Pancreas Flashcards Preview

1st Year - Gastroenterology > Liver, etc. 11 - Inflammation adn tumours of Pancreas > Flashcards

Flashcards in Liver, etc. 11 - Inflammation adn tumours of Pancreas Deck (85):
1

What are the 3 main pancreatic diseases?

Acute pancreatitisChronic pancreatitisPancreatic tumours

2

What are the 5 parts of the pancreas?

Uncinate processHeadNeckBodyTail

3

What do alpha islet cells release?

Glucagon

4

What do Beta islet cells release?

Insulin

5

What do Delta islet cells release?

somatostatin

6

What do PP cels release?

Pancreatic polypeptide

7

What are the 2 categories of acute pancreatitis?

Mild acuteSevere acute

8

What is the predominant feature of mild acute pancreatitis?

interstitial oedema of the glandAssociated with minimal organ dysfunction and an uneventful recovery

9

What is severe acute pancreatitis?

Associated with organ failure and/ or local complications such as necrosis (with infection), pseudocyst or abscess

10

What viral infections can cause acute pancreatitis?

MumpsCoxsackie B (can cause hand foot and mouth disease)Viral hepatitis

11

What other factor can cause acute pancreatitis apart from GET SMASHED?

Genetic factors

12

What genetic factors can cause acute pancreatitis?

Cationic trypsinogen gene CF gene

13

What drugs can cause pancreatitis? (4)

Valproic acidAzathioprineL-asparaginaseCorticosteroids

14

What autoimmune disease can cause pancreatitis?

IgG4-related autoimmune disease

15

What causes necrosis of the pancreas during pancreatitis?

Inflammation of the parenchyma causing hypoperfusion

16

How is acute pancreatitis diagnosed?

History (e.g. gallstones, alcohol, drugs, trauma, infection, ERCP)ExaminationBlood testsImaging

17

What is peritonism?

having the clinical signs of shock and peritonitis

18

Possible examination findings for acute pancreatitis? (5)

TendernessPeritonismDistensionBowel soundsSkin markings

19

Blood tests performed to look for acute percents?

FBCClottingU&EsLFTsAmylaseCRPGlucoseCa

20

Imaging for acute pancreatitis? (5)

CXR/AXRAUSCT pancreasMRIERCP

21

Findings on AXR suggestive of possible AP? (2)

Pleural effusionSentinel loop

22

What is a sentinel loop?

dilatation of a segment of small intestine

23

What is the purpose of carrying out an US for AP?

To rule out biliary pancreatitisLook for:GallstonesCholecystitisCBD diameterFree fluid

24

What is the purpose of carrying out a CT scan for acute pancreatitis?

Assess severity of pancreatitisDecide on interventions and follow upLook for complications (e.g. fluid collection, necrosis, ascites, bleeding, abscess)

25

Use of ERCP in AP?

Not as a diagnostic tool!Used for treatment of CBD stones with obstruction cholangitis as an emergency procedureUsed for treatment of acute biliary pancreatitis (if no index cholecystectomy possible)

26

What is the glasgow prognostic score?

PaO2 less than 8kPaAge greater than 55 yearsNeutrophils greater than 15 X 10^9/LCalcium less than 2mmol/LRenal function: urea greater than 16mmol/LEnzymes (AST/ ALT greater than 200 or LDH greater than 600)Albumin less than 32 g/LSugar (glucose less than 10 mol/L)*any 3 factors means acute severe pancreatitis

27

What Glasgow prognostic score = acute severe pancreatitis?

3

28

Apart form the Glasgow prognostic score, what is another scoring system that can be used to acute pancreatitis?

Ranson score (only for alcohol-induced pancreatitis)Balthazar score - used to assess percentage of necrosis and severity score from a CT scan (CT severity index)

29

Symptoms of acute pancreatitis? (7)

Epigastric/ diffuse abdominal pain +/- radiation to the backNausea and vomitingIndigesitonAbdominal tendernessLoss of appetite +/- weight lossTemperatureJaundice (pain)

30

What type of acute pancreatitis are most pancreatitis?

Mild pancreatitis (85% - mortality = 1%)

31

How long does it take for all necrosis from pancreatitis to show up?

4 days

32

What are the local complications from Acute pancreatitis? (6)

Fluid collectionPseudocystsAbscessNecrosis +/- infectionAscitesPleural effusion

33

What are the systemic complications of acute pancreatitis? (8)

Pulmonary failureRenal failureShockSepsisMetabolic acidosisHyperglycaemiaHypoglycaemiaMODS (multi organ failure)

34

What problems can pseudocysts cause?

They can cause biliary and/ or gastric outlet obstruction

35

Symptoms of a pseudocyst? 95)

PainnauseaVomitingJaundiceWeight loss

36

Treatment of pseudocysts?

Endoscopic drainageSurgical drainage (open/laparotomy)(cystgastrostomy or cystjejunostomy can be performed in order to drain the cyst into the stomach or jejunum)

37

Treatment of a pancreatic abscess?

CT/US guided retroperitoneal or transpirational drainage drain abscess, control sepsis

38

Management of necrosis?

CT for assessmentSterile or infected?If sterile, it should be treated conservatively May require drainage or necrosectomy and lavage if infected

39

What drugs have been shown to be beneficial for the treatment of acute pancreatitis?

no drug therapy has been shown to be beneficial

40

What is chronic pancreatitis?

Progressive and irreversible destruction of pancreatic tissueResults in permanent loss of endocrine and exocrine function

41

What is pancreatic divisum?

congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts

42

What are the 5 main causes of chronic pancreatitis?

FamilialAlcoholHyperparathyroidism/ hypercalcaemiaCFAlpha-antitrypsin deficiencyPancreatic duct obstruction (cholelithiasis, structure, tumour, pseudocyst, pancreas divisum)Tropical (deficient in methionine and trace elements)Autoimmune pancreatitis (IgG4 subclass)

43

How is autoimmune chronic pancreatitis treated?

Steroids

44

Diagnosis of chronic pancreatitis?

HistoryExaminationBlood testsImagining*same as for acute pancreatitis except IgG4 and CA 19-9 pancreatic function tests are also performed

45

What are the 2 main imaging signs of chronic pancreatitis?

Extensie pancreatic calcificationPancreatic duct dilation

46

Treatment of chronic pancreatitis?

Drugs e.g. analgesics, creon, vitamins, insulinNo alcohol and low fat diet may helpSurgery (pancreatectomy or pancreaticojejunostomy) if unremitting pain/ weight loss

47

What is another name for a pancreaticojejunostomy?What does this involve?Other 2 similar procedures?

Pustow procedureDilated pancreatic duct is filleted open and joined to the jejunum (which is also filleted open)This allows pancreatic juice to enter the jejunum(Frey procedure is the same as the pastor procedure although the head of the pancreas gets pulled out a bit more)

48

What type of procedure is used to treat chronic pancreatitis with inflammatory head tumour?

Beger procedure

49

Complications of chronic pancreatitis?

Splenic vein thrombosisPseudoaneurysmsPancreatic cancerpseudocystBile duct or duodenal obstructionPancreatic ascitesPleural effusion

50

Treatment of a biliary obstruction?

Stent, bypass, resection

51

Treatment of a duodenal obstruction?

Stent, bypass, resection

52

What is the treatment for a pseudocyst?

Endoscopic drainageSurgical drainage Resection

53

What is the most common cause of chronic pancreatitis?

Alcohol (abstinence is associated with a more favourable prognosis)

54

Does stopping smoking have a higher chance of favourable outcomes for chronic pancreatitis?

Yes

55

What is the most common type of exocrine pancreatic tumour?

Adenocarcinoma (95% of exocrine pancreatic tumours)

56

What are the 5 possible types of endocrine pancreatic cancers?

GastrinomaInsulinomaGlucagonoma(tends to be smaller and more easily treated than adenocarcinoma)SomatostatinomaVipoma

57

Symptom of a gastroma?

Produces gastrin causing increased stomach acid = gastric/ duodenal ulcers

58

Symptom of an insulinoma?

Produces insulin, causing the body to store sugar rather than burn it = hypoglycaemia

59

Symptom of a glucagoma?

Produces glucagon, increasing blood sugar levels = hyperglycaemia

60

what are symptoms of somatostatinoma?

DiabetesSteatorrhoea

61

Symptoms of vipoma?

Severe diarrhoeaHypokalaemiaAchlorhydria

62

What is achlorhydria

Absence of HCl acid in gastric secretions

63

Symptoms of pancreatic cancer?

Jaundice (dark urine and light stools)Back painWeight loss (anorexia, nausea, vomiting)

64

Risk factors for pancreatic cancer? (4)

SmokingDiabetesFamilial pancreatitisObesity

65

How is pancreatic cancer diagnosed?

HistoryExamination (abdo exam probs won't tell you anything unless they have metastases)Blood testsImaging

66

How can you diagnose pancreatic cancer from ERCP?

Can take brushings = biopsy

67

Staging system for pancreatic cancer?

TNM

68

What is Tis for pancreatic cancer?

Very early stage, has not had the chance to spread 9carcinoma in situ

69

T1 for pancreatic cancer?

The size of the tumour in the pancreas is 2cm or less in any direction

70

T2 for pancreatic cancer?

The tumour is more than 2cm across in any direction

71

T3 for pancreatic cancer?

The cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or bile duct

72

T4 for pancreatic cancer?

The cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels

73

N1 pancreatic cancer?

Has spread into lymph nodes (N0 = has not spread)

74

M1 pancreatic cancer?

Has spread to distant body parts (M0 = has not)

75

Stage 1 pancreatic cancer?

Cancer is confined to the pancreas

76

Stage 2 pancreatic cancer?

Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes

77

Stage 3 pancreatic cancer?

Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes

78

Stage 4 pancreatic cancer?

Cancer has spread to distant sites beyond the pancreas such as the liver, lungs and the peritoneum

79

Treatment for pancreatic cancer?

Surgery = only curative methodChemotherapyRadiotherapyCombinations

80

Types of surgery for resectable pancreatic tumours? (4)

Whipple resectionTotal pancreatectomyDistal pancreatectomyMidsegment pancratectomy

81

Types of surgery for non-resectable pancreatic tumours?

Biliary bypassGastric bypassDouble bypass

82

What is involved in Whipple's operation?

Part of the stomach and the head of the pancreas are removed - remaining stomach and pancreas are joined separately to the small intestines

83

Distal pancreatectomy?

Body and tail of the pancreas and usually the spleen are removed

84

Biliary bypass?

Rerouting the flow of bile from the common bile duct into the intestine bypassing the pancreas

85

Gastric bypass?

Pancreatic tumour can block the duodenum - surgery directly joins the stomach and the small intestine