Pancreas and appendix Flashcards
pancreatitis, pancreatic cancer, appendicitis (35 cards)
What is the pathophysiology of acute pancreatitis?
Autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis.
Common causes of acute pancreatitis
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Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa),
Scorpion venom
Hyperlipidaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs
What drugs can cause acute pancreatitis
azathioprine
mesalazine
didanosine
bendroflumethiazide
furosemide
sodium valproate
What are the common features of acute pancreatitis?
- Severe epigastric pain that may radiate to the back
- vomiting
*epigastric tenderness - low-grade fever.
What are Cullen’s sign and Grey-Turner’s sign?
- Periumbilical discolouration (Cullen’s sign)
- flank discolouration (Grey-Turner’s sign)
What investigations are used for acute pancreatitis?
- Serum amylase and lipase
- early ultrasound imaging: determine cause
What is the significance of serum amylase in acute pancreatitis?
Raised in 75% of patients, typically > 3 times the upper limit of normal, with a specificity of around 90%.
What is the significance of serum lipase in acute pancreatitis?
More sensitive and specific than serum amylase, useful for late presentations > 24 hours as it has a longer half-life
How is a diagnosis of acute pancreatitis made
a diagnosis of acute pancreatitis can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level
What are some scoring systems for severe pancreatitis?
Ranson score, Glasgow score, and APACHE II.
What common factors indicate severe pancreatitis?
Age > 55 years, hypocalcaemia, hyperglycaemia, hypoxia, neutrophilia, elevated LDH and AST.
Define mild acute pancreatitis
absence of both organ failure and local complications
How is acute pancreatitis managed?
In a hospital setting with:
* fluid resuscitation
* analgesia - IV opioid
* nutrition
* potential surgery
What is the recommendation for nutrition in acute pancreatitis?
- patients should not routinely be made ‘nil-by-mouth’ unless there is a clear reason
- Enteral nutrition should be offered within 72 hours of presentation unless contraindicated.
What does NICE state about antibiotics in acute pancreatitis?
Do not offer prophylactic antimicrobials; potential indications include infected pancreatic necrosis.
What are local complications of acute pancreatitis?
- Peripancreatic fluid collections
- pseudocysts
- pancreatic necrosis
- pancreatic abscess
- haemorrhage
What systemic complication is associated with acute pancreatitis?
Acute respiratory distress syndrome, associated with a high-mortality rate of around 20%.
What is chronic pancreatitis?
an inflammatory condition that affects both the exocrine and endocrine functions of the pancreas.
What is the most common cause of chronic pancreatitis?
alcohol excess
What are some other causes of chronic pancreatitis besides alcohol?
- Genetic: cystic fibrosis, haemochromatosis
- Ductal obstruction: tumours, stones, structural abnormalities (e.g., pancreas divisum, annular pancreas)
Presentation of chronic pancreatitis
- pain typically worse 15-30 minutes after a meal
- steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
- diabetes mellitus develops in the majority of patients, typically >20 years after symptom onset
How is chronic pancreatitis investigated
- abdominal x-ray may show pancreatic calcification
- CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%
- functional tests: faecal elastase may be used to assess exocrine function
How is chronic pancreatitis managed
- Pancreatic enzyme supplements (creon)
- Analgesia
- Antioxidants
- alcohol/ smoking cessation
What is the peak incidence of appendicitis
can occur at any age but is most common in young people aged 10-20 years
