Pancreas

Question 1

What are the causes of pancreatitis?

Answer 1

Question 2

What is the Glasgow score for pancreatitis?

Answer 2

Classifies the severity of pancreatitis
0/1= mild
2 = moderate
3+ = severe

Question 3

What are the criteria for the Glasgow score?

Answer 3

P - PaO2 < 8kPa
A - Age > 55
N - Neutrophils (WBC > 15)
C - Calcium < 2
R - uRea > 16
E - Enzymes (LDH > 600, or AST?ALT > 200)
A - Albumin < 32
S - Sugar (glucose > 20)

Question 4

What is acute pancreatitis?

Answer 4

Rapid onset of inflammation and symptoms. Usually after an episode of acute pancreatitis, normal pancreatic function will return

Question 5

What is chronic pancreatitis?

Answer 5

Longer term inflammation of the pancreas. Will see a progressive and permanent deterioration in pancreatic function.

Question 6

Describe the amylase levels in acute pancreatitis?

Answer 6

3x the upper limit of normal

Question 7

What are the features of acute pancreatitis?

Answer 7

Severe epigastric pain
Pain can radiate through to back
Associated vomiting
Abdominal tenderness
May see Cullen’s sign and Grey Turners sign
Systemically unwell (e.g. low grade fever and tachycardia)

Question 8

What sign is this?

Answer 8

Cullen’s sign

Question 9

What sign is this?

Answer 9

Grey Turner’s sign

Question 10

What is the management of acute pancreatitis?

Answer 10

Initial resus - ABCDE
IV fluids(crystalloids)
Analgesia
Careful monitoring
Treatment of gallstones if gallstone pancreatitis (cholecystectomy)
Antibiotics if evidence of infection

Question 11

What are some of the features of chronic pancreatitis?

Answer 11

Chronic epigastric pain which typically worse following a meal
Loss of exocrine and endocrine function - development of DM is common
Formation of pseudocysts and abscesses

Question 12

What is the management of chronic pancreatitis?

Answer 12

Stop smoking and alcohol
Analgesia
Replacement pancreatic enzymes (e.g. Creon)
Diabetes treatment (e.g. insulin)
ERCP with stenting
Sometimes surgery is required

Question 13

What type of tumours are a majority of pancreatic cancers?

Answer 13

Adenocarcinomas

Question 14

What are the features of pancreatic cancer?

Answer 14

Painless jaundice
Courvoisier’s Law
Anorexia, weight loss, epigastric pain
Loss of exo and endocrine function

Question 15

What sign is seen on imaging of pancreatic cancer?

Answer 15

Double duct sign - presence of simultaneous dilatation of the common bile and pancreatic ducts

Question 16

What is the NICE guidance for referral of suspected pancreatic cancer?

Answer 16

Over 40 with jaundice - 2 week wait referral
Over 60 with weight loss + one other symptom in keeping with pancreatic cancer - referred for a direct access CT abdomen

Question 17

What signs are associated with pancreatic cancer?

Answer 17

Courvoisier’s Law
Trousseau’s sign of malignancy

Question 18

What is Trousseau’s sign of malignancy

Answer 18

Migratory thrombophlebitis - episodes of vessel inflammation due to blood clots which are recurrent and appear in different locations over time

Question 19

What tumour marker can be raised in pancreatic cancer?

Answer 19

CA 19-9

Question 20

What is the management of pancreatic cancer?

Answer 20

Palliation - stents to relive obstruction, palliative radio and chemo
Surgery in some cases - Whipple procedure, pancreatectomy

Question 21

What is a whipple procedure?

Answer 21

Surgery to remove a tumour in the head of the pancreas that has not spread. Involves the removal of
- Head of pancreas
- Pylorus of stomach
- Duodenum
- Gallbladder
- Bile duct
- Relevant lymph nodes