Pancreatic disease

Question 1

What is acute pancreatitis?

Answer 1

Acute inflammation of the pancreas causing upper abdomen pain and elevation of serum amylase

Question 2

What is the aetiology of acute pancreatitis?

Answer 2

Mainly alcohol abuse
Gallstones
Trauma
Drugs, viruses, pancreatic carcinoma, metabolic, autoimmune
Idiopathic

Question 3

What forms of trauma can cause acute pancreatitis?

Answer 3

Blunt
Post op
Post ERCP

Question 4

What is the pathogenesis of acute pancreatitis?

Answer 4

Primary insult causes release of pancreatic enzymes, causing auto digestion and inflammation

Question 5

What does the endocrine portion of the pancreas cause in acute pancreatitis?

Answer 5

Oedema
Fat necrosis
Haemorrhage

Question 6

What does the exocrine portion of the pancreas secrete during acute pancreatitis?

Answer 6

Pro inflammatory cytokines

Reactive oxygen species

Question 7

What are the clinical features of acute pancreatitis?

Answer 7

Abdo pain
Vomiting
Pyrexia
Tachycardia
Oliguria
Jaundice
Laralytic ileus
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hyperglycaemia
Effusions

Question 8

Where may effusions occur in acute pancreatitis?

Answer 8

Ascitic and pleural

Question 9

What investigations are carried out for acute pancreatitis?

Answer 9

Blood tests
AXR
CXR
Abdo ultrasound
Contrast enhanced CT

Question 10

What blood tests are run for acute pancreatitis?

Answer 10

Amylase/lipase
FBC
U+E
LFT
Ca
Glucose
ABG
Lipids
Coagulation screen

Question 11

What does a CXR look for in acute pancreatitis?

Answer 11

Pleural effusion

Question 12

What does an abdominal ultrasound look for in acute pancreatitis?

Answer 12

Pancreatic oedema
Gallstones
Psudocyst

Question 13

How is acute pancreatitis managed generally?

Answer 13

Analgesia
IV fluids
Blood transfusion
Monitor urine output
Nasogastric tube
O2
May require- insulin, Ca supplements, nutritional support

Question 14

How is pancreatic necrosis in acute pancreatitis managed?

Answer 14

Investigate with CT guided aspiration

Treat with antibiotics and possible surgery

Question 15

How are gallstones in acute pancreatitis managed?

Answer 15

Investigate with endoscopic ultrasound/MRCP/ERCP

Treat with cholecystectomy

Question 16

What are the complications of acute pancreatitis?

Answer 16

Abscess

Psuedocyst

Question 17

How is an bless as a result of acute pancreatitis treated?

Answer 17

Antibiotics and drainage

Question 18

How is a psuedocyst as a result of acute pancreatitis managed?

Answer 18

Ultrasound/CT
Endoscopic drainage
Surgery if persistent pain or complications

Question 19

What are the complications of a pseudocyst?

Answer 19

Jaundice
Infection
Haemorrhage
Rupture

Question 20

What is the prognosis of acute pancreatitis?

Answer 20

Mild- mortality 2%

Severe- mortality 15%

Question 21

What is chronic pancreatitis?

Answer 21

Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function

Question 22

What is the cause of pancreatitis?

Answer 22

Alcohol
Cystic fibrosis
Congenital anatomical abnormalities
Hereditary pancreatitis
Hypercalcaemia
Diet

Question 23

What are the major effects of chronic pancreatitis?

Answer 23

Duct obstruction
Abnormal sphincter of Oddi
Genetic polymorphisms

Question 24

How ar the ducts obstructed in pancreatitis?

Answer 24

Caluculi
Inflammation
Protein plugs

Question 25

How does the sphincter of Oddi function change in chronic pancreatitis?

Answer 25

Spasm causes increase in pancreatic pressure | Relaxation causes reflux of duodenal contents

Question 26

What is the pathology of pancreatitis?

Answer 26

Glandular atrophy and replacement by fibrous tissue Ducts become dilated, tortuous and structured Inspissated secretions may calcify Exposed nerves due to perineural loss Splenic, s mesenteric and portal veins may thrombus

Question 27

What are the clinical features of chronic pancreatitis?

Answer 27

``` Abdo pain Weight loss Steatorrhoea Decrease in Ca, Mg and vit A, D, E, K Jaundice Portal hypertension GI haemorrhage Psuedocysts Pancreatic carcinoma ```

Question 28

What are the features of abdominal pain in chronic pancreatitis?

Answer 28

Exacerbated by food and alcohol | Severity decreases with time

Question 29

What can exocrine insufficiency in chronic pancreatitis cause?

Answer 29

Diabetes in 30%

Question 30

What investigations are carried out for chronic pancreatitis?

Answer 30

``` AXR Ultrasound Endoscopic ultrasound CT Blood tests Pancreatic function tests ```

Question 31

What does an AXR look for in chronic pancreatitis?

Answer 31

Calcification of pancreas

Question 32

What does an ultrasound look for in chronic pancreatitis?

Answer 32

Pancreatic size Cysts Duct diameter Tumours

Question 33

What do blood test results look like in chronic pancreatitis?

Answer 33

Serum amylase increased in acute exacerbations Decreased albumin, Ca, Mg, vit B12 Increases LFTs, prothrombin time, glucose

Question 34

How is chronic pancreatitis managed?

Answer 34

Pain control Low fat diet Pancreatic enzyme supplements

Question 35

How is pain control achieved in chronic pancreatitis?

Answer 35

``` Avoid alcohol Opiate analgesia Celiac plexus block Referral to pain clinic Endoscopic treatment of pancreatic duct stones and strictures Surgery in selected cases ```

Question 36

What is the prognosis for chronic pancreatitis?

Answer 36

``` Death from acute exacerbations Cardiovascular complications of diabetes Associated cirrhosis Drug dependence Suicide ```

Question 37

What are the types of pancreatic cancer?

Answer 37

Duct cell mutinous adenocarcinoma Carcinosarcoma Cystadenocarcinoma Acinar cell carcinoma

Question 38

What are the clinical features of pancreatic cancer?

Answer 38

``` Upper abdo pain Painless obstructive jaundice Weight loss Anorexia, fatigue, diarrhoea, steatorrhoea, nausea, vomiting Tender subcutaneous fat nodules Thrombophlebitis migrant Ascites, portal hypertension ```

Question 39

What are the physical signs of pancreatic cancer?

Answer 39

``` Hpatomegaly Jaundice Adbo mass and tenderness Ascites, splenomegaly SUpraclavicular, lymphadenopathy Palpable gallbladder ```

Question 40

What investigations are carried out for pancreatic cancer?

Answer 40

Abdo ultrasound CT Endoscopic ultrasound