Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Pancreas- Inflammation and tumours > Flashcards

Pancreas- Inflammation and tumours Flashcards

1
Q

where is the uncinate process

A

beneath the head of the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the venous drainage of the pancreas

A

pancreatic duodenal into SMV

inf. pancreatic vein into splenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the exocrine function of the pancreas

A

acinar cells secrete pancreatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the endocrine function of the pancreas

A

iselts of langerhans secrete hormones into the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do the different cells of the iselts of langerhans secrete

A

beta- insulin
alpha- glucagon
delta- somatostatin
F cells- pancreatic polypeptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are secretions of pancreatic fluid regulated by

A

vagus nerve and gastrin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the secretions from acinar cells and there role

A

protease- polypeptides to peptides

pancreatic lipase- triglycerides into fatty acids and monoglycerides

pancreatic amylase- carbohydrates into dissaccharides/ momsaccharides

+other enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what do the epithelial cells lining the duct secrete

A

bicarbonate, water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how much pancreatic fluid do you secrete a day

A

one litre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what tissues does pancreatitis involve

A

regional tissues and distal organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how are the majority of pancreatitis’ managed

A

analgesia and IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the causes of acute pancreatitis

A

Idiopathic

Gall stones
Ethanol
Trauma

Steroids 
Mumps + other infections + malignancy 
Autoimmune 
Scorpion bites
Hyper: calcaemia, parathyroidism, lipidaemia 
ERCP
Drugs (azathoprin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the theories behind the pathophysiology of acute pancreatitis

A

bile reflux- obstruction of CBD/PD

hyperstimulation of pancreatic ancinar cells with cholecystokinin

enzymes released and activated, then autodigest the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what do the activates enzymes do outwith the pancreas

A

interstitial inflammation and oedema (hypovolaemic shock)

fat necrosis by lipase and phospholipase (hypocalcaemia)

proteolysis by proteases

haemorrhage (elastase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what leads to the formation of a psuedocyst

A

trigger- parenchymal inflammation- peripancreatic exudation or PD leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does hypoperfusion in pancreatitis lead to

A

necrosis: release of toxic metabolites into blood and peritoneal cavity

(if bacteria infected necrosis or abscess)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does an acute pancreatitis present

A

acute onset epigastric pain- radiating through to the back- very severe

nausea and vomiting

jaundice

trigger identified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is found on exam in acute pancreatitis

A

diffuse upper abdominal tenderness, soft, normal bowel sounds, fullness in epigastrium

if severe can present like peritonitis with widespread guarding and absent bowel sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the signs of pancreatitis

A

cullens (staining around umbilicus) and grey turners (staining around the flanks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what initial investigations should be done

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what should ERCP be used for in pancreatitis

A

not as a diagnostic tool, but for treatment for CBD stones with obstruction

22
Q

what does the glasgow criteria assess

A

prognostic

23
Q

what does the ransons criteria assess

A

severity of pancreatitis- a score or 3 or more indicates severe pancreatitis

24
Q

what are the local complications of pancreatitis

A

fluid collection, pseudocysts, abscess, necrosis +/- infection, asites, pleural effusion

25
Q

what are the systemic complications of pancreatitis

A

pulmonary failure, renal failure, shock, sepsis, metabolic acidosis, hyperglycaemia, hypocalcaemia, MODS (multiple organ dysfunction syndrome)

26
Q

what is the prognosis of pancreatitis

A

mild (85% of cases) is self limiting- 1%

severe: sterile necrosis (60%) - 10%
infected necrosis- 20%

27
Q

what is the management for pancreatitis

A

firstly conservative

  • fluid resus
  • correct electrolytes
  • fluid balance
  • oxygen
  • antibiotics
  • nutrition
28
Q

what can pancreatic pseudocysts cause

A

biliary obstruction, gastric outlet obstruction

29
Q

how are pancreatic psuedocysts diagnosed

A

pain, nausea, vomiting, jaundice, weight loss

30
Q

how are pseudocysts treatmd

A

endoscopic drainage

31
Q

how are pancreatic abscesses treated

A

drained to control sepsis

32
Q

how is pancreatic necrosis treated

A 
CT for assessment 
sterile or infected?
fine needle aspiration for micro 
percutaneous drainage 
necrosectomy and lavage
33
Q

what is chronic pancreatitis

A

progressive and irreversible damage, loss of exocrine +/- endocrine function

34
Q

how does chronic pancreatitis present

A

v similar to acute
alcohol, smoker, medication
masses/ ascites/ jaundice on examination

35
Q

what causes chronic pancreatitis

A

alcohol, idiopathic, pancreatic duct obstruction (stone, stricture, tumour, pseudocysts, pancreas divisum)
autoimmune
tropical countries
hereditary (cystic fibrosis and alpha-1-antitrypsin

36
Q

calcifications and stones can be found in chronic pancreatitis

A

yes

37
Q

what can be seen on a CT of chronic pancreatitis

A

calcifications and stones

38
Q

how is chronic pancreatitis managed

A

manage acute episodes

creon as enzyme replacement therapy in pancreatic insufficiency

  • bloating
  • pain
  • loose, fatty, pale stools
  • weight loss
  • increase in stool frequency

surgical options

39
Q

what is the pustow procedure

A

opening the pancreatic duct and fusing it to the jejunum

40
Q

what are the complications of pancreatic surgery

A

splenic vein thrombosis

pseudoaneurysm of the splenic artery

41
Q

what are the complications of chronic pancreatitis

A

splenic vein thrombosis

pseudoaneurysm- splenic atery

pleural effusions

ascites

pancreatic cancer

pseudocyts

biliary obstruction

duodenal obstruction

42
Q

what can pseudocysts obstruct

A

biliary obstruction

gastric outflow obstruction

43
Q

what can cause a duodenal obstruction

A

odema due to acute flare up

fibrosis and pancreatic head tumour

pseudocysts

44
Q

how is a duodenal obstruction managed

A

stent, bypass, resection

45
Q

what are the exocrine pancreatic tumours

A

adenocarcinoma (95%)

46
Q

what are the endocrine pancreatic tumours

A

gastrinoma (increases gastrin, stomach acid)

insulinoma (produces insulin, hypoglycaemia)

glucagonoma (produces glucagon, hyperglycaemia)

somatostatinoma (diabetes, steatorrhoea)

47
Q

what are the general symptoms of pancreatic cancer

A

jaundice (painless):

  • loose stools
  • steatorrhoea

weight loss

back pain

48
Q

what are the risk factors for pancreatic cancer

A

smoking, charred meat, obesity, diabetes

49
Q

what investigations can be done into pancreatic cancers

A

ultrasound, triple phase CT, MRI and MRCP

50
Q

how are inoperable pancreatic cancers (70-80%) treated

A

ERCP or PTC and stent insertion

decompression of obstructed biliary ducts

chemotherapy, radiotherapy

51
Q

how are operable pancreatic cancers managed

A

laparoscopy and staging

ERCP stent

resection or palliative bypass

surgery, chemotherapy, radiotherapy

52
Q

what is a biliary bypass

A

formation of a hepaticojejunostomy- palliative

GI (64 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions