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Flashcards in Pancreas Deck (13)
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1
Q

Anatomical structure of the pancreas (5)

A

Head: Lies within C-Shaped curve formed by the duodenum (attaches via connective tissue)
Uncinate process: Lies posterior to the superior mesenteric artery.
Neck: Overlies the superior mesenteric arteries which forms a groove in the neck.
Body: Lies behind the stomach and left to the superior mesenteric artery
Tail: Intraperitoneal. Lies next to hilum of spleen, within the splenorenal ligament with the splenic vessels

2
Q

Duct system of pancreas

A

Million berry like clusters (acini), connected by short intercalated ducts (centroacinar cells).

Drain into:
Intralobular connecting ducts
Pancreatic duct
Joins Common bile duct (Hepatopancreatic ampulla of Vater)
Duodenum
3
Q

Vasculature of the pancreas

A

Pancreatic branches of splenic artery

The head also gets supply from superior (gastroduodenal artery from coeliac trunk) and inferior pancreaticoduodenal arteries (Superior mesenteric artery)

Head venous drainage: superior mesenteric branch of hepatic portal vein

Pancreatic veins drain the rest to the splenic vein

4
Q

Lymph drainage

A

Empty into pancreaticosplenal nodes and pyloric nodes which drain into the superior mesenteric and coeliac lymph nodes.

5
Q

Causes of pancreatitis (I get smashed)

A
Idiopathic
Gall Stones
Ethanol 
Trauma
Steroids
Mumps, Malignancy
Auto-immune
Scorpion sting
Hypertryglyceridaemia, Hypercalcaemia
Endoscopic retrograde cholangiopancreatography (ERCP)
Drugs- Sodium Valproate, Metformin, Azathioprine
6
Q

Signs and symptoms of pancreatitis

A
Nausea
Vomiting
Anorexia
Mid epigastric pain radiating to back 
Tachycardia
Less common:
Grey turner's sign
Cullen's sign
Fox's sign
Chvostek's sign
7
Q

Grey turner’s sign

A

Bilateral flank blue discoloration indicating haemorrhagic pancreatitis

8
Q

Cullen’s sign

A

Peri-umbilical blue discoloration indicating haemorrhagic pancreatitis

9
Q

Fox’s sign

A

Ecchymosis (bruised skin showing blood underneath skin) over the inguinal ligament area

10
Q

Chvostek’s sign

A

Facial muscle spasm when face is tapped on parotid gland region.

11
Q

Investigations to order for pancreatitis

A

Serum lipase + amylase: 3 times above the normal
FBC: leukocytosis (due to dehydration, raised haematocrit)
CXR. Abdominal ultrasound
(see bmj for more)

12
Q

Treatment for pancreatitis

A
IV Hydration (Ringer's lactate solution)
Nutrient support (patient nbm)
Analgesia
Antiemetic
Calcium replacement (Calcium gluconate)
Magnesium sulfate (if mg low)

With gall stones (surg, candidate): Cholecystectomy
Non surgical or rapid deterioration after 48hrs treatment: ERCP with sphincterotomy

With alcohol disease: Benzodiazepine (Lorazepam)
Vitamin and mineral replacement

13
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography
Used to diagnose disease of gall bladder, liver, pancreas
Once problem discovered can be treated by:
sphincterotomy: small incision in opening of bile duct to drain gall stones
Stent Placement or removal of gall stone