pancreas disease Flashcards
(19 cards)
what is the patho of acute pancreatitis?
occurs as consequence of premature activation of zymogen granules releasing proteases which digest the pancr
what are the causes of acute pancreatitis?
common (90%): gallstones, alcohol, idiopathic, post-ERCP
rare: post-surgical, trauma, drugs, metabolic, pancreas, renal failure
what are the clinical features of acute pancreatitis?
severe, constant upper abdominal pain radiating to back in 65% cases builds up over 15-60 minutes
nausea and vomiting common
epigastric tenderness
in contrast to perforated peptic ulcer, guarding and rebound tenderness absent as inflammation is retroperitoneal
bowel sounds absent as paralytic ileus develops
patient becomes hypoxic and develops hypovolaemic shock with oligouria
discoloration of flanks (grey turner sign) or periumbilical region (cullen sign) feature of severe pancreatitis with haemorrhage
what is the differential diagnosis of acute pancreatitis?
perforated viscus, acute cholecystitis and MI
what are the systemic complications of acute pancreatitis?
systemic inflammatory response syndrome
hypoxia
hyperglycaemia
hypocalcemia
reduced serum albumin concentration
what are the pancreatic complications of acute pancreatitis?
necrosis
abscess: circumcised collection of pus close to pancreas and containing little or no pancreatic necrotic tissue
pseudocuyst
pancreatic ascites or pleural effusion
what are the GI complications of acute pancreatitis?
upper GI bleeding
variceal haemorrhage
erosion into colon
duodenal obstruction
obstructive jaundice
what is an acute pancreatic pseudocyst?
localised peripancreatic collection of pancreatic juice and debris developing in lesser sac following inflammatory rupture of pancreatic duct
initially contained within poorly defined fragile wall which matures over 6 week period to form fibrous capsule
small ones common and resolve as pancreatitis recovers
greater than 6cm rarely disappear spontaneously and cause abdominal pain, may compress or erode surrounding structures including blood vessels to form pseudoaneurysms
what is the diagnosis of acute pancreatitis?
raised serum amylase or lipase concentrations and ultrasound or CT of pancreatic swelling
what is the initial management of acute pancreatitis?
analgesia
correction of hypovolaemia using normal saline or colloids
hypoxic patients need oxygen
hyperglycaemia corrected with insulin
prophylactic thromboembolism with los dose heparin advisable
what is chronic pancreatitis?
chronic inflammatory disease characterised by fibrosis and destruction of exocrine pancreatic tissue
what occurs in advanced cases of chronic pancreatitis?
DIABETES as islets of langerhans involved
what are the toxic-metabolic causes of chronic pancreatitis?
alcohol
tobacco
hypercalcaemia
chronic renal failure
what are the genetic causes of chronic pancreatitis?
HEREDITARY pancreatitis, SPINK-1 mutation, cystic fibrosis
what are the obstructive causes of chronic pancreatitis?
ductal adenocarcinoma
pancreas divisum
sphincter of oddi stenosis
what is the pathophysiology of chronic pancreatitis?
80% is alcohol misuse
southern india, severe chronic calcific pancreatitis occurs in non alcoholics possibly due to malnutrition and cassava consumption
alohol and other risk factors trigger acute pancreatitis through multiple mechanisms
first episode of acute pancreatitis initiates inflammatory response involving T helper cells
ongoing exposure to alcohol drives further inflammation modified by regulatory T cells with subsequent fibrosis via activation of pancreatic stellate cells
cycle of inflammation and fibrosis ensues with development of chronic pancreatitis
what are the clinical features of chronic pancreatitis?
middle-aged alcoholic men
all present with abdominal pain
50% occurs as episodes of acute pancreatitis although each attack results in degree of permanent pancreatic damage
relentless, slowly progressive chronic pain without acute exacerbations occurs in 35%
remainder no pain but present with diarrhoea
weight loss from anorexia, avoidance of food due to post-prandial pain, malabsorption, diabetes
what is the pain in abdomen caused by in chronic pancreatitis?
how is pain releived?
INCREASED PRESSURE within pancreatic ducts and direct involvement of pancreatic and peripancreatic nerves by inflammatory process
pain relieved by leaning forwards or drinking alcohol
opiate analgesics
when does steatorrhoea occur?
when more than 90% of exocrine tissue destroyed
protein malabsorption only in most advanced cases
