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G.I. > Pancreas > Flashcards

Pancreas Flashcards

(42 cards)

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1
Q

Exocrine system of pancreas - which cells?

A

Acinar cells secrete pancreatic enzymes

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2
Q

Endocrine system - which cells?

A

Islets of Langerhans secrete hormones into the blood

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3
Q

Islets of Langerhans

A

> B cells (insulin)
Alpha cells (glucagon)
Delta cells (somatostatin)
F cells (secrete pancreatic polypeptides)

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4
Q

B cell secrete?

A

Insulin

70% of Islet cells

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5
Q

Alpha cells secrete?

A

Glucagon

20% of islet cells

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6
Q

Delta cells secrete?

A

Somatostatins
Inhibit release of GI hormones
5% of islet cells

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7
Q

F cells secrete?

A

Pancreatic Polypeptides

1% of islet cells

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8
Q

How are pancreatic fluid secretions regulated?

A

By vagus nerve and gastrin levels

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9
Q

Acinar cells secrete?

A

> Protease (trypsin and chymotrypsin)
Pancreatic lipase
Pancreatic amylase

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10
Q

Epithelial cells lining the ducts secrete?

A

> Bicarbonate

> Water

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11
Q

Pancreatitis

A

An acute inflammatory process in the pancreas - involves regional tissues and remote organs

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12
Q

Causes of pancreatitis?

A

I GET SMASHED

Idiopathic
Gallstones***
Ethanol (alcohol)***
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcaemia, hyperthyroidism, hyperlipidaemia
ERCP
Drugs (azathioprine)
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13
Q

Most common causes of pancreatitis?

A

Gallstones and ethanol

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14
Q

Pathophysiology

A

• bile reflux theory
> obstruction of CBD/PD
> Causes reflux of bile into pancreas
> Hyperstimulation of pancreatic acinar cells

> Damage to acinar cells will release activated trypsin —> necrosis, vascular damage, auto digestion of pancreatic tissue

4 main stages

  1. oedema and fluid shifts –>
  2. Autodigestion of blood vessels (retroperitoneal haemorrhage) –>
  3. Infarction due to blood supply (necrosis) –>
    4 Infection (abscesses)
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15
Q

Presentation of pancreatitis

A

Clinical//

  • acute onset epigastric pain radiating to the back
  • double over
  • nausea and vomiting
  • jaundice (sometimes)
  • identify the trigger - GET SMASHED

Examination//

> diffuse upper abdo tenderness
> soft
> normal bowel sounds
> fullness in epigastrium? - pseudocyst
> Can present like peritonitis with guarding and absent BS if severe

> Cullen’s sign (umbilicus)
Grey turner’s sign (flank)
Erythema ab igne

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16
Q

Investigations - pancreatitis

A

> IV access
Bloods - FBC, coat
U/E, LFT, Ca, glucose, CRP, lactate, amylase/lipase

> ABGs - hypoxia and ARDs
> Plain imaging 
> USS
> CT scan
> ERCP
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17
Q

How elevated would amylase be in pancreatitis?

Study These Flashcards
A

3 x ULN

ULN of amylase is 100.

18
Q

What investigation should be used on ALL patients with suspected pancreatitis?

Study These Flashcards
A

Ultrasound Scan

19
Q

What is the CT scan used for?

Study These Flashcards
A

As a follow up investigation

Looking for complications.

20
Q

Prognostic scoring system for pancreatitis?

Study These Flashcards
A

> Glasgow Criteria
Score higher than 3 is severe pancreatitis

pao2< 8kpa
age >55
neutrophils (abc > 15)
calcium < 2
renal function
enzymes
albumin
sugar (glucose > 10mmol/L)

> Ranson’s criteria
– looks at markers on admission and 48 hours later

21
Q

When should you re-score a patient (Glasgow criteria)?

Study These Flashcards
A

24 hours later

22
Q

Complications of pancreatitis?

Study These Flashcards
A

Local//

  • fluid collection
  • pseudocysts
  • abscess
  • necrosis
  • infection
  • ascites
  • pleural effusion

Systemic//

  • pulmonary failure
  • renal failure
  • shcok
  • sepsis
  • metabolic acidosis
  • hyperglycaemia
  • hypocalcaemia
  • MODS
23
Q

Management

Study These Flashcards
A

> Fluid resus, correct electrolytes, careful fluid balance, oxygen, sometimes abx, sometimes nutrition

> Lap chole if due to gallstones

24
Q

Pseudocyst

Study These Flashcards
A

> Complication of acute and chronic pancreatitis
Due ti pancreatic duct communication
Can cause biliary obstruction, gastric outlet obstruction

25
Pseuodcyst - presentation
Pain, nausea, vomiting, (jaundice) and weight loss
26
Pseudocysts - Treatment
nothin endoscopic drainage radiological drainage surgical drainage
27
Abscesses
Drainage to control sepsis | CT/US sided retroperitoneal or transperitoneal drainage
28
Haemorrhage
Some pseudocysts can erode into nearby vessels
29
Pancreatic necrosis - what investigation would you use?
``` CT for assessment sterile or infected? Fine needle aspiration for microbio Percutaneous drain Necrosectomy ```
30
Chronic pancreatitis
Progressive and irreversible damage | Loss of exocrine and endocrine function
31
Chronic pancreatitis - presentation
> Can present similarly to acute pancreatitis > Alcohol history, smokers, medications > Masses, ascites, jaundice O/E
32
Chronic pancreatitis - imaging
CXR/AXR, USS, CT pancreas, MRI, ERCP
33
Chronic pancreatitis - causes
Main cause is alcohol Idiopathic Pancreatic duct obstruction (congenital or acquired) Autoimmune Tropical countries Hereditary (CF, A1AT) AXR and CT - calcifications and stones in pancreas
34
Management of chronic pancreatitis
CREON enzyme therapy Surgical options Complications// ``` Splenic vein thrombosis Pseudoaneurysm Splenic artery Pleural effusions Ascites Pancreatic cancer Pseudocysts Biliary obstruction Duodenal obstruction ```
35
Exocrine tumours
Adenocarcinoma (95% of pancreatic tumours)
36
Gastrinoma
Endocrine tumour Produces gastrin Increases stomach acid
37
Insulinoma
Endocrine tumour Produces insulin Encourages sugar uptake and storage Hypoglycaemia
38
Glucagonoma
Produces glucagon Increases serum blood sugars Hyperglycaemia
39
Symptoms of pancreatic tumours
``` > Painless jaundice > Loosepale stools > Dark urine > Weight loss > Back pain ```
40
Risk factors
Smoking Charred meat Obesity Type I and type II DM
41
Initial management - pancreatic tumours
inoperable cases// > ERC or percutaneous drain and stent insertion decompression of obstructed biliary ducts operable cases// > laparoscopy and staging > ercp
42
Treatment
TNM staging Curative vs palliative Surgery, chemo, radiotherapy Surgical resection or palliative bypass POOR PROGNOSIS

G.I. (20 decks)

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