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Pancreatic Disease Flashcards

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1
Q

What is the main diagnostic investigation for acute pancreatitis?

A

Elevation of serum amylase

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2
Q

What are the symptoms of acute pancreatitis?

A

Upper abdominal pain that radiates to the back
Vomiting
Pyrexia

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3
Q

What are the signs of acute pancreatitis?

A

Hypoxic
Renal failure
Jaundice
Tachycardia

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4
Q

What is the pathology for acute pancreatitis?

A

Acute inflammation of the pancreas
Primary insult
Release of activated pancreatic enzymes resulting in auto-digestion
Leading to oedema, fat necrosis and haemorrhage

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5
Q

What is the aetiology for acute pancreatitis?

A 
I GET SMASHED 
Idiopathic 
Gallstones
Ethanol abuse
Trauma 
Steroids 
Mumps virus 
Autoimmune
diseases
Scorpion Stings 
Hypertriglyceridemia & hypercalcaemia 
ERCP 
Drugs
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6
Q

What are the non-

radiological investigations for acute pancreatitis?

A 
Amylase
Lipase 
Arterial BG
FBC:
U&E's
LFT's
Glucose 
Lipids 
Coagulation screen
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7
Q

What are the radiological investigations for acute pancreatitis?

A

CT
AXR
USS
ERCP

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8
Q

What is the aetiology for chronic pancreatitis?

A 
Males>females 
Middle aged
Alcohol 
CF 
Hereditary pancreatitis 
Hypercalceamia
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9
Q

Describe the pathology of chronic pancreatitis

A

Continuing inflammatory disease of the pancreas
Irreversbile glandular destruction
Permanent loss of function

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10
Q

What are the symptoms of chronic pancreatitis?

A

Abdominal pain
Weight loss
Exorcrine insufficiency
Fat in poo

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11
Q

What are the signs of chronic pancreatitis?

A 
Jaundice 
Portal hypertension 
Steatorrhoea 
Diabetes 
Decrease in Vitamin B12
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12
Q

Why could someone with chronic pancreatitis present with diabetes?

A

Loss of glandular function would mean their release of insulin and glucagon would be compromised

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13
Q

Why would someone with chronic pancreatitis present with steatorrhoea?

A

Their production and release of pancreatic lipase would be compromised
Therefore their ability to digest and absorb fat would be compromised
The fat would consequently not be absorbed and pass out at the other end

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14
Q

What is the treatment for acute pancreatitis?

A 
Analgesia 
IV fluids 
Blood transfusion (hb<10g/dl)
Monitor urine output 
NG tube 
Oxygen 
Insulin 
Rarely Ca supplements 
Nutrition in severe cases

Gallstones cause:
Cholecystectomy

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15
Q

What is the treatment for chronic pancreatitis?

A 
Alcohol cessation
Pancreatic enzyme supplements
Nutritional support 
Coeliac plexus blocks 
Endoscopic treatment of pancreatic duct 
Surgery in selected  cases
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16
Q

What are the non-radiological investigations for chronic pancreatitis?

A

Serum amylase
Albumin
LFT’s

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17
Q

What are the risk factors the pancreatic cancer?

A 
Male
>70
Smoking 
Obesity 
Chronic pancreatitis 
Liver cirrhosis
DM
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18
Q

What is the most common type of cancer in the pancreas?

A

Adenocarcinoma

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19
Q

What are the symptoms of pancreatic carcinoma?

A 
Mid-epigastric pain 
Nausea
Fatigue 
Vomiting 
Weight loss 
Anorexia 
Steatorrhoea
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20
Q

What are the physical signs of pancreatic carcinoma?

A 
Ascites
Portal hypertension 
Hepato/splenomegaly
Abdominal mass
Supraclavicular lymphadenopathy
Palpable galbladder 
Obstructive Jaundice
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21
Q

Where would a pancreatic tumour be likely obstructing if jaundice was a presenting sign?

A

Common bile duct

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22
Q

What are imaging techniques used for in pancreatic carcinoma?

A

Diagnosis and staging

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23
Q

What are the imaging techniques used for pancreatic carcinoma?

A

USS
CT
MRI
EUS

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24
Q

What is an alarm sign for pancreatic carcinoma?

A

Unintentional weight loss

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25
Why does pancreatic cancer have such a poor prognosis?
Due to the fact it often presents as late disease | Often very asymptomatic
26
What is acute pancreatitis?
Acute inflammation of the pancreas
27
What is a major symptoms in AP?
Upper abdominalpain that radiates to the back
28
What is a major diagnostic signs of AP?
Elevation of serum amylase
29
Which procedure can provide a route for infection leading to AP?
ERCP | Recent endoscopy procedures
30
Which criteria is used to assess the severity of AP?
Glasgow criteria
31
What score is required with the glasgow criteria to have AP?
>3
32
What is the criteria for WCC in the glasgow criteria?
>15x10(9)
33
What is the treatment for AP
``` Analgesia - morphine IV fluids blood transfusion Monitor urine Naso-gastric tube Cholycystectomy (if gall stones are present) Oxygen May need insulin Sometimes Ca supplements Nutritional support ```
34
What are some complications of AP?
Abscess | Pseudocyst
35
How should a cyst in AP be treated?
With drainage | And with AB
36
What is chronic pancreatitis?
Continuing inflammatory disease of the pancreas
37
How is CP characterised?
By irreversible glandular destruction and typically causing pain and or permanent loss of function
38
What are the major aetiological factors for CP?
``` Alcohol CF Hereditary Hypercalcaemia Diet ```
39
What happens to ducts in CP?
Dilated, tortorous and strictured
40
What is presentation of CP?
``` Early disease is asymptomatic Abdo pain Weight loss Exocrine insufficiency Endocrine insufficiency Jaundice Portal hypertension GI haemorrhage ```
41
Why is diabetes present in 30% of those with CP?
Due to endocrine insufficiency
42
What investigations should be carried out in suspected in CP?
``` USS CT Amylase Albumin LFT's ```
43
What is the management for CP?
``` Avoid alcohol Pancreatic enzyme supplements Coelia plexus block Referral to pain clinic Low fat diet Insulin for DM ```
44
Is pancreatic cancer more common in M or F?
M
45
What is the presentation of pancreatic cancer?
``` Upper abdo pain Painless obstructive jaundice Weight loss Anorexia Vomiting Fatigue Recurrent bouts of pancreatitis Diarrhoea Tended subcutaneous fat nodules Ascites Portal hypertension ```
46
What are the signs of pancreatic cancer?
``` Hepatomegaly Jaundice Abdominal mass Abdominal tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder ```
47
What investigations should be done for pancreatic cancer?
``` CT MRI USS PET EUS ```
48
What is the treatment for pancreatic cancer?
Radical surgery Palliation of jaundice Pain control Chemotherapy
49
What are risk factors or pancreatic cancer?
``` M >70yrs Smoking Obesity Alcohol Chronic pancreatitis Liver cirrhosis DM ```
50
What should be closely monitored in a patient with AP?
``` Pulse BP Urine output CVP Arterial Line ```
51
If cholelithiasis is the cause of AP what treatment should be undertake?
Cholecystectomy
52
If alcohol is the cause of AP what treatment should be given?
Abstinence and counselling
53
If hyperlipidaemia is the cause of AP what treatment should be given?
Diet control | Statins
54
If the patients medication is the cause of AP what should be done?
Medication should be stopped | Temporarily at least
55
Why do patients present with stearrohoea in pancreatic problems?
As there can be a pancreatic enzyme deficiency
56
PaO2 cut off Glasgow Criteria
<8kPa
57
Age risk in Glasgow criteria
>55yrs
58
Calcium cut off Glasgow criteria
<2mmol/L
59
BG sugar cut off glasgow criteria
>10mmol/L
60
Urea cut off glasgow criteria
>16mmol/L
61
What is Grey Turner's Sign
Flank bruising
62
What is Cullen's Sign
Periumbilical bruising
63
What are grey turners and cullens signs of?
Acute pancreatitis

Alimentary System (29 decks)

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