Pancreatic Disease

Question 1

Define Acute Pancreatitis

Answer 1

Acute inflammation of the pancreas characterised by upper abdominal pain, and elevation of serum amylase.

Question 2

Aetiology of Acute Pancreatitis

Answer 2

Alcohol Abuse 60-75%
Gallstones 25-40%
Trauma
Misc (drugs, viruses, carcinoma, metabolic, autoimmune)
Idiopathic

Question 3

Pathogenesis of Acute Pancreatitis

Answer 3

Primary Injury causes lymosomal and zymogen fusion, activating trypsin, causing a zymogen activation cascade.

Secretory Vesicles are extruded,triggering Pro-inflammatory cytokines, reactive oxygen species, resulting in oedema, fat necrosis, and haemorrhage.

Question 4

Effects of Autodigestion

Answer 4

Release of pro-inflammatory cytokines and oxygen reactive species excluded and molecular fragments attract inflammatory cells. (Pro-inflammatory Cytokine & Reactive Oxygen Species)

Oedema
Fat necoris
haemoraage

Question 5

Endoscopic Investigations

Answer 5

ERCP
EUS
Bloods: Amylase, U&E's, LFTS, CA2+, glucose, ABG, lipids and coag screen
AXR, CXR
CT

Question 6

Describe the general management of pancreatitis

Answer 6

Assess Severity (bloods, GCS, CRP)

Analgesia 
IV fluid 
Blood transfusion (haermorragic?)
Monitor Urine output
NG tube
Oxygen

Possible insulin
Rarely Ca2+ supplements
Nutrition (severe)

Pancreatic Necrosis –> CT guided aspiration–>antibiotics–> possible surgery.

In the case of gallstones, EUS, MRCP, ERCP. Cholecystectomy.

Question 7

Chronic Pancreatitis

Answer 7

Continuous inflammation of the pancreas characterised by irreversible glandular destruction causing pain and/or permanent loss of function

Question 8

Cause of Chronic Pancreatitis

Answer 8

Alcohol 80%
Cystic Fibrosis
Congential abnormalites
Heridary pancreatitus 
Hypercalcaemia
Diet (tropical pan, antioxidants)

Question 9

Pathogenesis of Chronic pancreatitus

Answer 9

Duct Obstruction
Abnormal sphincter of oddi
Genetic polymorphicsms

Question 10

Pathology of

Answer 10

Glandular atrophy and fibrious tissue replacement
Dilated ducts, tortous and strictured
Exposed nerves due to loss of perineural cells
Thrombosis of splenic, superioir mesenteric and portal veins due to portal hypertension

Question 11

Clinical feautures

Answer 11

Early disease asymptomattic
abdo pain
weight loss

Question 12

Examples of Primary Injury to the Pancreas causing pancreatitis

Answer 12

Injury to acinar cells, caused by alcohol abuse, gallstones, drugs, or ductal cell injury.

Ductal cell injury is caused by delayed or absent secretion (CFTR - CF)

Question 13

Signs and Symptoms of acute pancreatitis

Answer 13

Cullen Sign

Grey Turners

Question 14

Describe Cullen Signs

Answer 14

Superficial oedema and bruising of the subcutaneous fatty around the umbilicus.

Question 15

Describe Grey’s Turner sign

Answer 15

Bruising of the flank- sign of haemorrhagic pancreatitis

Question 16

Acute Pancreatitis complications

Answer 16

Abscess –> Abx + Drainage.

Pseudocyst - (fluid collection without an epithelia lining).

Question 17

Describe the presentation, diagnostics, complications. and treatment of Pseudocyst

Answer 17

Pseudocyst - fluid collection without an epithelial lining,

Present with hyperamylasemia and or pain.

Diagnosed with US or CT.

Complications - Jaundice, infection, haemorrage, rupture (<6cm diameter self resolving)

Endoscopic drainage/surgery if pesistant pain or complications