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Gastrointestinal Conditions (JBR) > Pancreas Stuff > Flashcards

Pancreas Stuff Flashcards

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1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas leading to the release of exocrine enzymes which cause auto-digestion of the organ

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2
Q

What are causes of acute pancreatitis?

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps 
Autoimmune 
Scorpion stings
Hyperlipidaemia/Hypercalcaemia
ERCO
Drugs
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3
Q

Which drugs can cause acute pancreatitis?

A

Vaproic acid
Azathioprine
L-asparaginase
Corticosteroids

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4
Q

How much alcohol would be considered a risk factor for acute pancreatitis?

A

> 80g per day

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5
Q

Which other viral conditions besides mumps can cause acute pancreatitis?

A

Coxsackie B

Hepatitis

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6
Q

During acute pancreatitis, the pancreas releases lytic pancreatic enzymes. What are these and wha tis there effect?

A

Lipases - intra and peri-pancreatic fat necrosis

Proteases - tissue destruction and haemorrhage

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7
Q

What is the macroscopic appearance of acute pancreatitis?

A

Focal areas of necrosis in body of the pancreas

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8
Q

What is the macroscopic appearance of moderate acute pancreatitis?

A

Intrahepatic fat necrosis

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9
Q

What is the macroscopic appearance of severe acute pancreatitis?

A

Complete pancreatic destruction with haemorrhage and fat necrosis

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10
Q

What is the microscopic appearance of acute pancreatitis?

A

Fat necrosis

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11
Q

How does acute pancreatitis present?

A 
Sudden severe nose epigastric apin which radiates through to the back
Nausea and vomiting 
pyrexia 
Tachycardia
Indigestion
Abdominal tenderness
Weight loss
jaundice
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12
Q

How would you investigate acute pancreatitis?

A 
Amylase
FBC, U&Es, LFTs, PT, CRP
AXR/CXR
AUS, CT/MRI
Glaspow Prognostic score
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13
Q

What would be seen on CXR/AXR for acute pancreatitis?

A

Pleural effusion

Sentinel loop

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14
Q

What is an AUS used for in acute pancreatitis diagnosis?

A

Rule out biliary pancreatitis

Gallstones, cholecystitis, CBD diameter, free fluid

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15
Q

What is a CT used for in acute pancreatitis?

A

Assess severity, interventions, follow-up

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16
Q

What makes up the Glasgow Prognostic Score? (PANCREAS)

A 
PaO2 < 8 kPa (60 mmHg)
Age > 55
Neutrophils - WCC > 15
Calcium < 2
Renal - Urea < 16
Enzymes - AST/ALT > 200 or LDH > 600
Sugar - Glucose > 100
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17
Q

How is the Glasgow prognostic score interpreted?

A

Any score over 3 means acute severe pancreatitis

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18
Q

What are possible complications from acute pancreatitis?

A 
Death
Shock
Pseudocyst 
Pancreatic abscess
Hypo/hyperglycaemia 
necrosis +/- infection
Fluid 
Pulmonary oedema 
Pleural effusion
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19
Q

What can a pancreatic pseudocyst (collection of fluid in typically the lesser sac) cause?

Study These Flashcards
A

Obstruction of biliary system/gastric outlet

20
Q

How do you treat a pancreatic pseudocyst?

Study These Flashcards
A

Endoscopic or surgical drainage (Cystogastrotomy/Cystjejunostomy)

21
Q

How do you treat an abscess?

Study These Flashcards
A

CT/US guided drainage

Control sepsis

22
Q

How do you assess necrosis?

23
Q

How do you treat pancreatic necrosis?

Study These Flashcards
A

Necrosectomy + lavage

24
Q

What are complications of pancreatic necrosis?

Study These Flashcards
A

Haemorrhage + splenic pseudoaneurysm

25
What are systemic complications of acute pancreatitis?
``` Pumonary/renal failure Shock, sepsis metabolic acidosis hyperglycaemia Hypocalcaemia MODS ```
26
What does MODS stand for?
Multi-organ dysfunction syndrome
27
How do you treat mild acute pancreatitis?
Analgesics, IV fluids (NBM)
28
How do you treat severe acute pancreatitis?
HDU/ITU admission Abx if infection NG tube for feeding
29
What is chronic pancreatitis?
Chronic irreversible inflammation and/or fibrosis of the pancreas resulting in permanent loss of function
30
Chronic pancreatitis is a _______ which my develop post-?
Relapsing disorder | post-acute
31
What are causes of chronic pancreatitis?
``` Alcohol Cholelithiasis CF Hyperparathyroidism FHx/Hereditary Autoimmune Congenital: pancreas divisum ```
32
What is the pathophysiology of chronic pancreatitis?
Replacement of pancreas via chronic inflammation by scar tissue Destruction of exocrine acini and islets
33
What are macroscopic changes from chronic pancreatitis?
Exocrine pancreas is replaced by chronic inflammation and fibrosis
34
how does chronic pancreatitis present?
Severe abdominal pain and endocrine or exocrine dysfunction Nausea/vomiting Decreased appetite
35
How do you investigate chronic pancreatitis?
FBC, U&Es, LFTs, creatinine, Calcium, amylase, glucose, HbA1c, secretin stimulation test, CT scan, MRCP, EUS (only very frail)
36
What are signs on examination of chronic pancreatitis?
``` Tenderness peritonism mass Ascites Jaundice ```
37
How do you treat chronic pancreatitis?
Analgesics Treat substance misuse Lipase, Creon (replace pancreatic enzymes), octreotide, surgery(to manage complications)
38
What is the most common pancreatic cancer?
Exocrine Adenocarcinoma
39
What are the risk factors for adenocarcinoma of the pancreas?
``` Smoking Poor diet Obesity Diabetes Alcohol FHx Chronic pancreatitis ```
40
How does pancreatic adenocarcinoma present?
``` Epigastric discomfort or backache Jaundice Acute pancreatitis Unexplained weight loss Anorexia Steatorrhoea epigastric mass Haematemesis Malaena Ascites ```
41
What are investigations for pancreatic adenocarcinoma?
FBC, LFTs, serum glucose, CA 19-9, USS, CT
42
How do you manage pancreatic adenocarcinoma?
Whipple's procedure (proximal pancreaticoduodenectomy with pylorus preservation), chemotherapy, stenting, analgesics, Creon, domperidone
43
What are the different types of endocrine tumours of the pancreas?
``` Insulinoma Gastrinoma Glucagonoma Carcinoid tumour Multiple endocrine neoplasia type 1 ```
44
What are the signs of insulinoma?
Confusion, sweating, dizziness, weakness, LOC, fasting hypoglycaemia, relief of symptoms after eating or with glucose
45
What are signs of gastrinoma?
Sever peptic ulceration, abdominal pain, diarrhoea, Zollinger-Ellison syndrome
46
What are signs of glucagonoma?
``` Weight loss Diabetes Stomatitis Diarrhoea Necrolytic migratory erythema ```
47
What is multiple endocrine neoplasia type 1?
Genetic condition | Includes neoplastic lesions of the pituitary, parathyroid and pancreas

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