Pancreatic

Question 1

Causes of Acute Pancreatitis

Answer 1

GET SMASHED * important

Gallstones *
Ethanol *
Trauma

Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa)
Scorpion venom
Hyperlipidaemia, Hypercalcaemia
ERCP *
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

Question 2

Presentation of Acute Pancreatitis?

Answer 2

Severe epigastric pain (radiates to back)

Vomiting

Abdo tenderness

Systemically unwell (fever + tachycardia)

Question 3

Specific signs of Acute Pancreatitis?

Answer 3

Cullens Sign

Grey Turners sign

Question 4

what is cullens sign

Answer 4

periumbilical discolouration

Question 5

What is grey-turner’s sign

Answer 5

Flank discolouration

Question 6

blood Investigations for AP?

Answer 6

Serum amylase >3 times upper limit

Serum lipase (longer half life than amylase so useful for late presentations)

Question 7

Imaging for AP?

Answer 7

Early US important as aetiology may affect management e.g.g patients with biliary obstruction

Question 8

What is the Glasgow score

Answer 8

used to assess severity of pancreatitis:

PAO2 <8kPa
Age >55
Neutrophils (WBC >15)
Calcium <2
uRea >16
Enzymes (LDH >600, AST/ALT >200)
Albumin <32
Sugar (glucose >10)

Question 9

common factors indicating severe pancreatitis include:

Answer 9

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

Question 10

Complications of Acute Pancreatitis?

Answer 10

Necrosis
Infection

Abscess formation (infected pseudocyst) 
Acute peripancreatic fluid collections 

Psuedocysts
Chronic Pancreatitis

Question 11

How are Pseudocysts formed?

Answer 11

organisation of peripancreatic fluid collection walled by fibrous tisse

typically 4 weeks after acute pancreatitis

treated with cystogastrostomy / aspiration

Question 12

when would grey turners sign be identified?

Answer 12

Retroperitoneal haemorrhage

Question 13

Management of acute pancreatitis?

Answer 13

Resus
IV Fluids
Enteral nutrition if severe
Analgesia

Question 14

Role of surgery in Acute Pancreatitis?

Answer 14

Patients with AP due to gallstones should undergo early cholecystectomy

Pts with obstructed biliary system due to stones should undergo ERCP

Question 15

Cause of Chronic Pancreatitis?

Answer 15

Alcohol 80%

Ductal obstruction

Question 16

Features of CP?

Answer 16

Pain worse after meal

Steatorrhoea (pancreatic exocrine insufficiency)

Diabetes mellitus (loss of endocrine function)

Question 17

Management of CP?

Answer 17

Analgesia

Replacement Pancreatic Enzymes (Creon)

insulin regimes if DM

Question 18

Signs on investigation of CP?

Answer 18

Abdominal xray shows pancreatic calcification in 30%

CT more sensitive at detecting calcification

Question 19

What may be used to assess exocrine function if imaging inconclusive of CP?

Answer 19

Faecal elastase

Question 20

Most common pancreatic tumour?

Answer 20

Adenocarcinoma in the head of the pancreas (80%)

Question 21

Key presenting feature of Pancreatic Cancer?

Answer 21

Painless obstructive jaundice

OR

rapidly worsening glycaemic control despite good compliance

Question 22

how does PC cause obstructive jaundice?

Answer 22

tumour at the head of the pancreas compresses the bile ducts, blocking the flow of bile out of the liver

Question 23

Signs of obstructive jaundice?

Answer 23

yellow skin, sclera
pale stools
dark urine
generalised itching

Question 24

when to refer for suspected PC?

Answer 24

Over 40 with jaundice = 2 week wait

Over 60 with weight loss + 1 of:
abdo/ back pain, N+V, constipation, new onset DM

= DIRECT ACCESS CT ABDOMEN

Question 25

what does courvoisiers law state?

Answer 25

palpable gallbladder along with jaundice is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic cancer.

Question 26

PC tumour marker?

Answer 26

Ca 19.9 (also raised in CCA)

Question 27

What does a Whipple Procedure remove?

Answer 27

tumour of the head pancreas that has not spread. Involves removal of: ``` Head of the pancreas Pylorus of the stomach Duodenum Gallbladder Bile duct Relevant lymph nodes ```

Question 28

How do patients TYPICALLY present with PC?

Answer 28

Non specific anorexia, weight loss, epigastric pain

Question 29

Sensible imaging for PC?

Answer 29

ultrasound has 60-90% sensitivity high resolution CT if diagnosis suspected DOUBLE DUCT SIGN (presence of simultaneous dilatation of the common bile and pancreatic ducts)