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Medicine Gastrointestinal > Pancreas > Flashcards

Pancreas Flashcards

(49 cards)

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1
Q

Parts of the pancreas

A

Uncinate process, head, neck, body, tail

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2
Q

Functions of the pancreas

A

Exocrine - acinar cells secrete pancreatic enzymes

Endocrine - Islets of Langerhans secrete hormones into blood

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3
Q

Cells that make up the Islets of Langerhans and what these cells secrete

A 
Beta cells (74%) - secrete insulin
Alpha cells (19%) - secrete glucagon
Delta cells (5%) - secrete somatostatin
F cells (1%) - secrete pancreatic polypeptide
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4
Q

What are secretions of pancreatic fluid regulated by?

A

Vagus nerve and gastrin levels

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5
Q

Secretions from acinar cells

A

Protease, pancreatic lipase, pancreatic amylase, other enzymes e.g. nuclease, deoxyribonuclease, gelatinase and elastase

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6
Q

What does protease do?

A

Converts polypeptides to peptides

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7
Q

What does pancreatic lipase do?

A

Converts triglycerides into fatty acids and monoglycerides

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8
Q

What does pancreatic amylase do?

A

Turns carbohydrates into dissacharides/monosaccharides

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9
Q

What do the epithelial cells lining the ducts secrete?

A

Bicarbonate and water

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10
Q

Pancreatitis

A

Acute inflammatory process in the pancreas which involves regional tissues and remote organs

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11
Q

Aetiology of pancreatitis - I GET SMASHED

A 
I = idiopathic
G = gallstones
E = ethanol
T = traums
S = steroids
M = mumps
A = autoimmune
S = scorpion bite
H = hypercalcaemia, hyperparathyroidism, hyperlopidaeia
E = ERCP
D = drugs
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12
Q

Clinical presentation of acute pancreatitis

A

Acute onset epigastric pain radiating to the back, very severe - patient doubling over. Nausea and vomiting, jaundice

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13
Q

Examination findings of acute pancreatitis

A

Diffuse upper abdominal tenderness, soft abdomen, fullness in epigastrium, normal bowel sounds, erythema ab igne, Cullen’s sign, Grey turner’s sign

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14
Q

Erythema ab igne

A

Hot water bottle rash. Caused by long-term exposure to heat

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15
Q

Cullen’s sign

A

Superficial oedema and bruising in subcutaneous fatty tissue around umbilicus

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16
Q

Grey turner’s sign

A

Bruising of the flanks

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17
Q

Investigations for pancreatitis

A

Blood tests - FBC and coagulation, U&Es, LFTs, calcium, glucose, amylase/lipase, CRP lactate
Arterial blood gas
CXR, AXR, ultrasound, CT

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18
Q

Diagnostic level of serum amylase in pancreatitis

A

3x upper limit of normal

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19
Q

What may a CXR show in pancreatitis?

A

Pleural effusion

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20
Q

What may an AXR show in pancreatitis?

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A

Sentinel loop

21
Q

What may an ultrasound show in pancreatitis?

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A

Gallstones, common bile duct size, free fluid, cholecystitis

22
Q

What may a CT scan show in pancreatitis?

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A

Fluid collections, ascites, bleeding, abscess, pancreatic/peripancreatic necrosis

23
Q

What 2 criteria options are there for diagnosing severe pancreatitis?

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A

Glasgow criteria and Ranson’s criteria

24
Q

Glasgow criteria - PANCREAS

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A

More than 3 of the following is severe pancreatitis and critical care should be considered:

  • P = PaO2 <8kPa (60mmHg)
  • A = age >55 years
  • N = neutrophils (WBC >15 x 109/l)
  • C = calcium <2mmol/l
  • R = renal function (urea>16mmol/l)
  • E = enzymes (AST/ALT >200iu/L or LDH > 600iu/L)
  • A = albumin <32g/l
  • S = sugar (glucose >10mmol/L)
25
Ranson's criteria
``` A score of 3 or more indicates severe pancreatitis: -At admission o>55 years old o Blood glucose >11mmol/l) o Serum LDH >500iu/L o AST >200iu/l o WCC >16 -At 48 hours from admission o HCT fall >10% o Blood urea >16 mmol/L o Serum calcium <2mmol/l o Arterial PO2 <8 kPA o Base defecit <4mmol/l ```
26
Four main stages in pathophysiology of pancreatitis
``` 1 = Oedema and fluid shifts can result in hypovolaemic shock, fluids and enzymes in the peritoneal cavity autodigest fats affecting Ca++ binding and can result in hypocalcaemia 2 = Autodigestion of blood vessels leading to retroperitoneal haemorrhage 3 = Infarction due to compromised blood supply leading to pancreatic necrosis 4 = Necrotic tissue becomes infected leading to abscess formation ```
27
Local complications of pancreatitis
Fluid collection, pseudocysts, abscess, necrosis +/- infection, ascites, pleural effusion
28
Systemic complications of pancreatitis
Pulmonary failure, renal failure, shock, sepsis, metabolic acidosis, hyperglycaemia, hypoglycaemia, MODS
29
Pancreatic pseudocysts: - What is it? - Symptoms - Treatment
- Complication of acute and chronic pancreatitis - Pain, nausea, vomiting, weight loss, jaundice - Nothing, endoscopic drainage, radiological drainage, surgical drainage
30
How are pancreatic abscesses drained?
CT/US guided retroperitoneal or transperitoneal drainage
31
Pancreatic necrosis - which investigations are required?
CT for assessment, fine needle aspiration for micro
32
Treatment for pancreatic necrosis
Percutaneous drain, necrosectomy and lavage
33
Aetiology of chronic pancreatitis
Alcohol, idiopathic, pancreatic duct obstruction, autoimmune, hereditary
34
Management of chronic pancreatitis
Manage acute episodes appropriately, creon as enzyme replacement therapy if pancreatic insufficiency, Puestow procedure, Frey procedure
35
Complications of chronic pancreatitis
Splenic vein thrombosis, pseudoaneurysm, pleural effusions, ascites, pancreatic cancer, pseudocysts, biliary obstruction, duodenal obstruction
36
Management of duodenal obstruction
Stent, bypass, resection
37
Pancreatic tumours: - Exocrine - Endocrine
``` Exocrine = adenocarcinoma Endocrine = gastrinoma, insulinoma, glucagonoma ```
38
Symptoms of pancreatic insufficiency
Bloating, pain, loose fatty pale stools, weight loss, increased stool frequency
39
Symptoms of pancreatic cancer
Jaundice, weight loss, back pain
40
Risk factors for pancreatic cancer
Smoking, charred meat, obesity, diabetes
41
Investigations for pancreatic cancer
Ultrasound, triple phase CT, MRI and MRCP
42
Initial management of inoperable pancreatic cancer
ERCP or PTC and stent insertion, decompression of obstructed biliary ducts
43
Initial management of operable pancreatic cancer
Laparoscopy and staging, ERCP stent, resection or palliative bypass
44
Treatment for pancreatic cancer
Surgery, chemotherapy, radiotherapy
45
Procedures for resectable pancreatic tumours
Whipples procedure, distal pancreatectomy, total pancreatectomy
46
Procedures for non-resectable pancreatic tumours
Biliary bypass, gastric bypass, double bypass
47
Survival time for stage I/II pancreatic cancer
11-22 months post resection, 7-25% 5 year survival
48
Survival time for stage III pancreatic cancer
6-11 months
49
Survival time for stage IV pancreatic cancer
2-6 months

Medicine Gastrointestinal (24 decks)

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