Pancreas- Inflammation and tumours Flashcards
(52 cards)
where is the uncinate process
beneath the head of the pancreas
what is the venous drainage of the pancreas
pancreatic duodenal into SMV
inf. pancreatic vein into splenic
what is the exocrine function of the pancreas
acinar cells secrete pancreatic enzymes
what is the endocrine function of the pancreas
iselts of langerhans secrete hormones into the blood
what do the different cells of the iselts of langerhans secrete
beta- insulin
alpha- glucagon
delta- somatostatin
F cells- pancreatic polypeptide
what are secretions of pancreatic fluid regulated by
vagus nerve and gastrin levels
what are the secretions from acinar cells and there role
protease- polypeptides to peptides
pancreatic lipase- triglycerides into fatty acids and monoglycerides
pancreatic amylase- carbohydrates into dissaccharides/ momsaccharides
+other enzymes
what do the epithelial cells lining the duct secrete
bicarbonate, water
how much pancreatic fluid do you secrete a day
one litre
what tissues does pancreatitis involve
regional tissues and distal organs
how are the majority of pancreatitis’ managed
analgesia and IV fluids
what are the causes of acute pancreatitis
Idiopathic
Gall stones
Ethanol
Trauma
Steroids Mumps + other infections + malignancy Autoimmune Scorpion bites Hyper: calcaemia, parathyroidism, lipidaemia ERCP Drugs (azathoprin)
what are the theories behind the pathophysiology of acute pancreatitis
bile reflux- obstruction of CBD/PD
hyperstimulation of pancreatic ancinar cells with cholecystokinin
enzymes released and activated, then autodigest the pancreas
what do the activates enzymes do outwith the pancreas
interstitial inflammation and oedema (hypovolaemic shock)
fat necrosis by lipase and phospholipase (hypocalcaemia)
proteolysis by proteases
haemorrhage (elastase)
what leads to the formation of a psuedocyst
trigger- parenchymal inflammation- peripancreatic exudation or PD leakage
what does hypoperfusion in pancreatitis lead to
necrosis: release of toxic metabolites into blood and peritoneal cavity
(if bacteria infected necrosis or abscess)
how does an acute pancreatitis present
acute onset epigastric pain- radiating through to the back- very severe
nausea and vomiting
jaundice
trigger identified
what is found on exam in acute pancreatitis
diffuse upper abdominal tenderness, soft, normal bowel sounds, fullness in epigastrium
if severe can present like peritonitis with widespread guarding and absent bowel sounds
what are the signs of pancreatitis
cullens (staining around umbilicus) and grey turners (staining around the flanks)
what initial investigations should be done
IV access, bloods (FBC and coagulation, U&Es, LFTs, calcium, glucose, amylase/lipase, CRP and lactate)
arterial blood gas
ultrasound FOR ALL PATIENTS WITH PANCREATITIS
CT to assess severity (follow up, for potential intervention, look for complications)
what should ERCP be used for in pancreatitis
not as a diagnostic tool, but for treatment for CBD stones with obstruction
what does the glasgow criteria assess
prognostic
what does the ransons criteria assess
severity of pancreatitis- a score or 3 or more indicates severe pancreatitis
what are the local complications of pancreatitis
fluid collection, pseudocysts, abscess, necrosis +/- infection, asites, pleural effusion
