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Systems: Alimentary AB > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

(50 cards)

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1
Q

Acute Pancreatitis

A

-Acute inflammation of the pancreas resulting in upper abdominal pain and elevation of serum amylase (>4x upper limit of normal) and can be associated with multi-organ failure in severe cases

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2
Q

What is the epidemiology of acute pancreatitis?

A
  • Incidence 20-300 cases/million

- Mortality 6-12/million

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3
Q

What is the aetiology of acute pancreatitis?

A
  • Alcohol abuse
  • Gallstones
  • Trauma
  • Miscellaneous
  • Idiopathic
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4
Q

What falls into the miscellaneaos category of acute pancreatitis aetiology?

A
  • Drugs (steroids, azathioprine, diuretics)
  • Viruses (mumps, coxsackie B4, HIV, CMV)
  • Pancreatic carcinoma
  • Metabolic (increased CA, increased triglycerides, decreased temp)
  • Auto-immune
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5
Q

What is the pathogenesis of acute pancreatitis?

A
  • Primary insult
  • Release of activated pancreatic enzymes
  • Autodigestion
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6
Q

What are the 2 pathways that can occur as a result of autodigestion?

A
  • Pro-inflammatory cytokines and reactive oxygen species

- Oedema, fat necrosis and haemorrhage

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7
Q

What are the clinical features of acute pancreatitis?

A
  • Abdominal pain
  • Vomiting
  • Pyrexia
  • Tachycardia, hypovolemic shock
  • Oliguria, acute renal failure
  • Jaundice
  • Paralytic ileus
  • Retroperitoneal haemorrhage
  • Hypoxia
  • Hypocalcaemia
  • Hyperglycaemia
  • Effusions
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8
Q

ERCP

A

Endoscopic retrograde cholangio-pancreatography

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9
Q

What blood tests should be carried out in acute pancreatitis?

A
  • Amylase, lipase
  • FBC
  • U+Es
  • LFTs
  • Ca
  • Glucose
  • ABG
  • Lipids
  • Coagulation screen
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10
Q

What X-rays should be carried out in acute pancreatitis?

A
  • Abdominal X-ray for ileus

- Chest X-ray for effusion

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11
Q

What are you looking for on an abdominal ultrasound in acute pancreatitis?

A
  • Pancreatic oedema
  • Gallstones
  • Pseudocysts
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12
Q

What type of CT should be carried out in acute pancreatitis?

A

Contrast enhanced

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13
Q

What criteria is used to assess the severity of acute pancreatitis?

A

Glasgow criteria

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14
Q

What indicates severe acute pancreatitis within 24hrs of admission?

A
  • Glasgow criteria score >3

- CRP>150mg/l

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15
Q

What are the points in the Glasgow criteria assessment?

A

-WCC >15x10^9/l
-Blood glucose >10mmol/l
-Blood urea>16mmol/l
-AST>200iu/l
-LDH>600iu/l
-Serum albumin <32g/l
-Serum calcium<2mmol/l
Arterial PO2 <7.5kPa

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16
Q

What is the general management for acute pancreatitis?

A
  • Analgesia
  • IV fluids
  • Blood transfusion if Hb<10g/dl
  • Monitor urine output
  • NG tube
  • Oxygen
  • Insulin if required
  • Nutrition-
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17
Q

What is the specific management of acute pancreatitis if there is pancreatic necrosis?

A
  • CT guided aspiration
  • Antibiotics
  • Surgery if required
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18
Q

What is the specific management of acute pancreatitis if there is gallstones?

A
  • EUS/MRCP/ERCP

- Cholecystectomy

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19
Q

What is the specific management of acute pancreatitis if there is an abscess?

A
  • Antibiotics

- Drainage

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20
Q

Pseudocyst

A

Fluid collection without an epithelial lining resulting in persistent hyperamylasaemia with or without pain

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21
Q

How is a pseudocyst diagnosed?

Study These Flashcards
A
  • Ultrasound

- CT

22
Q

What are the complications of a pseudocyst?

Study These Flashcards
A
  • Jaundice
  • Infection
  • Haemorrhage
  • Rupture
23
Q

When will a pseudocyst resolve spontaneously?

Study These Flashcards
A

<6cm diameter

24
Q

What is the treatment for a pseudocyst if there is persistent pain or complications?

Study These Flashcards
A
  • Endoscopic drainage

- Surgery

25
What are the different outcomes of acute pancreatitis?
- Mild AP mortality<2% - Severe AP mortality 15% - Subsequent course dependent on removal of aetiological factor
26
Chronic pancreatitis
Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function
27
What is the epidemiology of chronic pancreatitis?
- M>F - Age 35-50 years - Incidence 3.5/100,000 per year
28
What is the aetiology of chronic pancreatitis?
- Alcohol - Cystic fibrosis - Congenital anatomical abnormalities - Hereditary pancreatitis (rare autoimmune dominant) - Hypercalcaemia - Diet
29
What anatomical abnormalities can result in chronic pancreatitis?
- Annular pancreas | - Pancreas divisum
30
What genes are associated with chronic pancreatitis?
- PRSS1 - SPINK1 - CFTR
31
What is the pathogenesis of chronic pancreatitis?
- Duct obstruction (calculi, inflammation, protein plugs) - Abnormal sphincter of Oddi function (spasm raising intrapancreatic pressure, relaxation causing reflux of duodenal contents) - Genetic polymorphisms (abnormal trypsin activation)
32
What is the pathology of chronic pancreatitis?
- Glandular atrophy and replacement by fibrous tissue - Ducts become dilated, tortous and strictured - Inspissated secretions may calcify - Exposed nerves due to loss of perineural cells - Splenic, superior mesenteric and portal veins may thrombose leading to portal hypertension
33
What are the clinical features of chronic pancreatitis?
- Early disease is asymptomatic - Abdominal pain - Weight loss - Exocrine insufficiency - Endocrine insufficiency - Jaundice - Portal hypertension - GI haemorrhage - Pseudocysts - Pancreatic carcinoma
34
Describe the exocrine insufficiency in chronic pancreatitis.
- Fat malabsorption leading steatorrhoea - Decrease in fat soluble vitamins - Decrease in Ca and Mg - Protein malabsorption leading weight loss and decrease in vitamin B12
35
What does the endocrine insufficiency in chronic pancreatitis lead to ?
Diabetes
36
What investigations should be carried out in chronic pancreatitis?
- Plain AXR - Ultrasound - EUS - CT - Blood tests - Pancreatic function tests
37
What may be found in blood tests of chronic pancreatitis?
- Serum amylase increased in acute exacerbations - Decrease in albumin, Ca, Mg, vit B12 - Increase in LFTs, prothrombin time, glucose
38
What is involved in pain control management for chronic pancreatitis?
- Avoid alcohol - Pancreatic enzyme supplements - Opiate analgesia - Celiac plexus block - Referral to pain clinic/psychologist - Endoscopic treatment of pancreatic duct stones and strictures - Surgery in selected cases
39
What is involved in the management of the endocrine and exocrine problems associated with chronic pancreatitis?
- Low fat diet - Pancreatic enzyme supplements (may need acid suppression to prevent hydrolysis in stomach) - Insulin for diabetes mellitus
40
What is the prognosis for chronic pancreatitis?
- Death from complications of acute on chronic attacks, cardiovascular complications of diabetes, associated cirrhosis, drug dependence, suicide - Continued alcohol intake 50% 10yr survival - Abstinence 80% 10yr survival
41
What is the epidemiology of carcinomas of the pancreas?
- Incidence 11/100,000 per year - M>F - More common in Western countries
42
What are the pathological types of pancreatic carcinomas?
- Duct cell mucinous adenocarcinomas - Carcinosarcoma - Cystadenocarcinoma - Acinar cell
43
What are the clinical features of pancreatic carcinomas?
- Upper abdominal pain - Painless obstructive jaundice - Weight loss - Anorexia, fatigue, diarrhoea/steatorrhoea, nausea, vomiting - Tender subcutaneous fat nodules - Thrombophlebitis migrans - Ascites, portal hypertension
44
What are the physical signs of pancreatic carcinomas?
-Hepatomegaly -Jaundice -Abdominal mass -Abdominal tenderness -Ascites, splenomegaly -Supraclavicular lymphadenopathy PRESENCE OF ABOVE SIGNS USUALLY INDICATES AN DUNRESECTABLE TUMOUR -Palpable gallbladder (with ampullary cancer)
45
What imaging is used in pancreatic carcinomas?
- USS - CT - MRI - EUS
46
What are the management options for pancreatic carcinoma?
- Radical surgery - Palliation of jaundice - Pain control - Chemotherapy only in controlled trials
47
What is the radical surgery in pancreatic carcinoma?
- Pancreatoduodenectomy (Whipple) | - Patient is fit, tumour <3cm, no metastases
48
What is available for palliation of jaundice?
- Stent | - palliative surgery (cholechoduodenotomy)
49
What pain control is there for pancreatic carcinoma?
- Opiates - Coeliac plexus block - Radiotherapy
50
What is the prognosis for pancreatic carcinoma?
- Inoperable cases mean survival <6months with 1% 5yr survival - Operable cases 15% 5yr survival

Systems: Alimentary AB (37 decks)

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