Pancreatic Disease Flashcards
Pancreatic Disease Pancreatic Surgery (35 cards)
what are the two most common causes of acute pancreatitis?
Gallstones
Alcohol
what is an important diagnostic sign in acute pancreatitis?
raised serum amylase
what are some of the less common causes of acute pancreatitis?
idiopathic trauma drugs viruses auto-immune
what is the pathogenesis of acute pancreatitis?
- insult on pancreas causes sudden release of pancreatic enzymes
- enzymes cause inflammation, release of oxygen free radicals, necrosis, autodigestion
what are some of the possible symptoms of acute pancreatitis?
tachycardia tachypnoea jaundice paralytic ileus abdominal pain, radiating to back vomiting shock pyrexia oliguria kidney failure effusions
how can acute pancreatitis be classified (ie mild, severe)? identify some of the criteria
Glasgow Pancreatitis Score >3
- raised WCC
- raised blood glucose
- raised blood urea
- low serum calcium
- low serum albumin
- low pO2
- raised AST
- raised LDH
- raised CRP
what is the management of acute pancreatitis?
general: treat symptoms
specific: treat underlying cause
what are some examples of general management of acute pancreatitis?
- analgesia
- insulin for hyperglycaemia
- albumin infusion
- oxygen
- IV fluids
- monitor urine output
- nutrition (enteral or parenteral)
what are some examples of specific management of acute pancreatitis?
- if necrosis: CT guided aspiration, antibiotics and surgery
- if gallstones: ERCP/MRCP, cholecystectomy
what are the main diagnostic investigations for acute pancreatitis?
- imaging: ERCP, USS, AXR, CXR, CT contrast
- bloods: FBC, U&E, pancreatic enzymes, glucose, calcium, ABG, urea
what are possible long-term complications which may present after acute pancreatitis?
- abscess
- pseudocyst
which clinical features of acute pancreatitis would indicate the need for an ERCP?
- jaundice
- obstructed bile duct
what is the main cause for chronic pancreatitis?
alcohol abuse
what are some of the less common causes for chronic pancreatitis?
- autoimmune
- obstruction of duct
- cystic fibrosis
- genetic abnormalities
what are the main symptoms of chronic pancreatitis?
- abdominal pain (especially when eating fatty foods)
- weight loss
- steatorrhoea
- malabsorption
- diabetes
- jaundice
- portal hypertension
what is the management of chronic pancreatitis?
- MDT management
- pain management
- alcohol counselling
- pancreatic enzyme supplements
- low fat diet
- management of diabetes (insulin)
what investigations should be done to diagnose chronic pancreatitis?
- blood tests (pancreatic enzymes, glucose, calcium, LFT, albumin)
- stool test: fecal elastase
- imaging: AXR, USS, EUS, CT scan
what are some of the pathogenic causes of chronic pancreatitis?
- duct obstruction
- abnormal Sphincter of Oddi function
what might show up on AXR in cases of chronic pancreatitis?
calcified pancreas due to calcified thickened secretions
in which type of pancreatitis is serum amylase a useful diagnostic sign?
acute pancreatitis
which type of pancreatic carcinoma is more likely to occur as a result of chronic pancreatitis?
pancreatic tumours in multiple sites
what type of cancer is pancreatic carcinoma usually?
adenocarcinoma of duct cells
what happens to the pancreatic duct during chronic pancreatitis?
it becomes tortuous and strictured
which types of pancreatic cancer are most common?
- cancer of head of pancreas
- mixed cancer in different areas of pancreas
