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Pancreatic Disease Flashcards

(46 cards)

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1
Q

The endocrine portion of the pancreas is contained where?

A

Pancreatic islets

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2
Q

What is produced by the pancreatic islets?

A

Insulin by beta cells
Glucagon by alpha cells
Somatostatin

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3
Q

The exocrine function of the pancreas is carried out by which cells?

A

Acinar cells forming lobules

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4
Q

Describe connection of acinar lobules to the duodenum

A

Connected individually by ducts, intralobular ducts drain to main pancreatic duct to common bile duct to Sphincter of Oddi, to the duodenum

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5
Q

What is the function of the accessory pancreatic duct?

A

Connected to duodenum, utilised only if other ducts become blocked

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6
Q

What is the function of the exocrine pancreas?

A

Digestion

Secrete bicarbonate and digestive enzymes to pancreatic duct

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7
Q

What are pancreatic zymogens>

A

Inactive form of enzymes, produced in bicarbonate rich medium to prevent autodigestion

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8
Q

What is converted by enterokinase and where>

A

Trypsinogen to trypsin at brush border of duodenal enterocytes

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9
Q

What converts zymogens to active form>

A

Trypsin

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10
Q

Which enzymes are secreted by the pancreas?

A 
Proteases
Nucleases
Elastases
Phospholipases
Lipases
Alpha amylase
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11
Q

What stimulates bicarbonate secretion?

A

Secretin - activated by acid

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12
Q

Zymogen secretion is stimulated by?

A

CCK - released due to fat or amino acid in duodenum

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13
Q

Features of Acute pancreatitis

A

Acute inflammation causing upper abdominal pain
Elevation of serum amylase
Multi-organ failure in severe cases

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14
Q

Aetiology of acute pancreatitis

A 
G- Gallstones
E- Alcohol
T- Trauma
S- steroids
M- Mumps
A- Autoimmune
S- Scorpion 
H- Hypercalcaemia, hypertriglyceridemia, Hypothermia
E- ERCP
D- Drugs; azathioprine, sodium valproate, diuretics
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15
Q

Pathogenesis of acute pancreatitis

A

Primary insult causes release of activated pancreatic enzymes leading to autodigestion
Release of proinflammatory cytokines and ROS

Oedema
Fat necrosis
Haemorrhage

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16
Q

Investigations for acute pancreatitis

A

Blood tests - amylase, lipase, FBC, U&Es, CRP, ABG, lipids, Calcium, LFTs
Abdominal X-ray and Chest X ray
Abdominal US
CT contrast enhanced

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17
Q

Management of acute pancreatitis

A 
Analgesia
IV Fluids
Blood transfusion if required
Monitor urine output
Naso-gastric tube
Oxygen
Insulin
Calcium
Nutrition
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18
Q

Which scoring system is used for severity in acute pancreatitis?

A

Glasgow Criteria

If greater than 3 severe

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19
Q

Treatment for pancreatic necrosis

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A

CT guided aspiration - antibiotics and surgery

20
Q

Treatment for gallstones

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A

EUS/MRCP/ERCP

Cholecystectomy

21
Q

Complications of treatment in acute pancreatitis

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A

Abscess

Pseudocysts

22
Q

Management of abscess and pseudocysts

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A

Antibiotics and drainage of abscess

Endoscopic drainage or surgery

23
Q

Indications for US or CT in complications of acute pancreatitis

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A

Jaundice
Haemorrhage
Infection
Rupture

24
Q

Which patient group is chronic pancreatitis most common in?

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A

Males

Age 35-50

25
Causes of chronic pancreatitis
``` Alcohol Cystic fibrosis Congenital abnormalities - annular pancreas, pancreas, divisium Hereditary pancreatitis Hypercalcaemia Diet ```
26
Which genetic associations are there to chronic pancreatitis?
PRSS1 - trypsinogen mutation SPINK 1- pancreatic secretory trypsin inhibitor CFTR
27
Pathogenesis of chronic pancreatitis
Duct obstruction - calculi, inflammation, protein plugs Abnormal sphincter of Oddi - Spasm - intrapancreatic pressure increase, or relaxation - reflux of duodenal contents Genetic polymorphisms - abnormal trypsin activation
28
Consequence of fibrotic changes in the pancreas in chronic pancreatitis
Spleni , Superior mesenteric and portal veins can fibrose leading to portal hypertension
29
Clinical features of chronic pancreatitis
``` Abdominal pain Weight loss Steatorrhoea Decreased Ca/Mg Decreased Vitamin B12 Diabetes ``` ``` Jaundice Portal HT GI haemorrhage Pseudocysts Pancreatic carcinoma ```
30
Investigations of chronic pancreatitis
``` Abdominal X ray CT US EUS Bloods - amylase, albumin, LFTs, PT ```
31
Management of chronic pancreatitis
``` Avoid alcohol Pancreatic enzyme supplements Opiate analgesia Celiac plexus block Pain clinic Endoscopic treatment of strictures and stones Surgery Low fat diet Vitamin supplements Diabetic management ```
32
Complications of chronic pancreatitis
``` Acute on chronic attacks Cardiac complications of diabetes Associated cirrhosis Drug dependance Suicide ```
33
Most common tumour of the pancreas
Duct cell mucinous adenocarcinoma Carcinosarcoma Cystoadenocarcinoma Acinar cell
34
Clinical features of pancreatic cancer
``` Painless obstructive jaundice Upper abdominal pain Weight loss Anorexia, fatigue, diarrhoea, steatorrhoea, nausea, vomiting Tender subcutaneous fat nodules - metastatic fat necrosis Thrombophlebitis migrans Asvites Portal hypertension ```
35
Signs on examination for pancreatic cancer
``` Hepatomegaly Jaundice Abdominal mass, tenderness Ascites Palpable gallbladder - ampullary carcinoma Splenomegaly Supracvlavicular lymphadenotpahty ```
36
Investigations for pancreatic cancer
``` Abdominal US CT EUS Jaundice and mass - ERCP and stent Mass no jaundice - EUS percutaneous needle biopsy - Laparoscopy/Laparotomy ```
37
Management of pancreatic cancer
Radical surgery - pancreatoduodenectomy - Whipple's Palliation of jaundice - stent, cholechoduodenostomy Pain control - opiates, coeliac plexus block, radiotherapy Chemotherapy
38
Prognosis for inoperable pancreatic cancer
Less than 6 months
39
Prognosis for operable pancreatic cancer
15% 5 year survival | Ampullary 30-50% 5 year survival
40
Differentials for acute pancreatitis - pain radiating to the back
``` AAA Renal calculi Chronic pancreatitis Aortic dissection Peptic ulcer disease ```
41
When is serum amylase diagnostic of acute pancreatitis?
When 3x normal upper limit
42
Other causes of raised serum amylase
Bowel perforation Ectopic pregnancy Diabetic ketoacidosis
43
What is included within the Glasgow score?
``` PANCREAS PO2 Age over 55 Neutrophils over 15 Calcium less than 2 Renal function - Urea greater than 16 Enzymes - LDH Ablumin /AST Sugar - Blood glucose greater than 10 ```
44
Systemic complications of acute pancreatitis
Acute Respiratory Distress Syndrome Disseminated Intravascular Coagulation Hypocalcaemia Hyperglycaemia
45
Local complications of acute pancreatitis
Pancreatic necrosis | Pseudocysts
46
Management of pseudocysts
Surgical debridement | Endoscopic drainage

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