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GI PATHOLOGY > Pancreatic disease/surgery > Flashcards

Pancreatic disease/surgery Flashcards

(54 cards)

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1
Q

Definition of acute pancreatitis

A

Acute inflammation
Upper abdominal pain
Elevation of serum amylase

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2
Q

Causes of acute pancreatitis

A

Alcohol
Gallstones (smaller)
Trauma
Idiopathic

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3
Q

Outline the process of pancreatitis

A

Insult
Release of active digestive enzymes
Autodigestion

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4
Q

Symptoms of pancreatitis

A 
Abdominal pain
Vomiting
Fever
Paralytic ileus
Acute renal failure
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5
Q

Signs of pancreatitis

A 
Tachycardia
Jaundice
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hypergclycemia
Acites
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6
Q

What is ERCP?

A

Endoscopic retrograde cholangio pancreatography

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7
Q

What are the process of imaging in suspected pancreatitis?

A

Endoscopic ultrasound first, followed by ERCP if stones present

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8
Q

Tests given in suspected acute pancreatitis

A

Bloods
AXR + CXR
Abdominal USS
CCT

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9
Q

Bloods taken in suspected pancreatitis

A 
Amylase/lipase
FBC, U+E
LFTs
Ca2+
Glucose, Lipids
ABG
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10
Q

Scoring system used for severe pancreatitis?

A

Glasgow Criteria

Score > 3

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11
Q

What factors are tested for in the glasgow criteria for acute pancreatitis?

A 
White cell count
Glucose
Urea
AST
LDH
Albumin
Ca
Arterial O2
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12
Q

Elevated what indicates severe pancreatitis?

A

CRP >150mg/L

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13
Q

General Management of Acute pancreatitis

A 
Analgesia, Fluids, ?NG
Blood transfusion
Urine output
O2
?insulin, Ca
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14
Q

Management of pancreatic necrosis in acute pancreatitis

A

CT guided aspiration

Antibiotics +/- surgery

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15
Q

Management of gallstones in acute pancreatitis

A

USS/MRCP/ERCP

Cholecystectomy

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16
Q

Management of abscess in acute pancreatitis

A

Antibiotics

Drainage

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17
Q

What is a pseudocyst?

A

Fluid collection without an epithelium

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18
Q

Symptoms of pseudocyst

A

Persistently high amylase

May be pain

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19
Q

How is pseudocyst diagnosed?

A

Ultrasound or CT

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20
Q

Complications of pseudocyst

A

Jaundice, infection, rupture

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21
Q

When is treatment recommended for a pseudocyst?

A

Drainage or surgery

Persistent pain, complications

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22
Q

Definition of chronic pancreatitis?

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A

Continuing inflammation with irreversible glandular destruction - pain and loss of function

23
Q

In what group is chronic pancreatitis most common?

24
Q

What are the most common causes of chronic pancreatitis?

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A

Alcohol (80%)
Cystic fibrosis
Congenital
Hypercalcaemia

25
What are the congenital causes of chronic pancreatitis?
Annular pancreas | Pancreas divisum
26
What are the most recognised genes in hereditary pancreatitis?
PRSS1 CFTR SPINK1
27
What general processes lead to chronic pancreatitis?
Duct obstruction Abnormal Oddi function Genetic polymorphisms
28
What bolus commonly cause duct obstruction?
Calculi Inflammation Protein plugs
29
How can abnormal sphincter of oddi function cause pancreatitis?
Spasm (increasing pressure in pancreas) | Relaxation (causing duodenal reflux)
30
What is the pathological process leading to chronic pancreatitis?
``` Glandular atrophy leading to fibrosis Ducts dilated and strictured Calcified secretions Nerves exposed Thrombosis of veins leading to portal hypertension ```
31
What are the clinical features of chronic pancreatitis?
Asymptomatic
32
What are the clinical features of progressed pancreatitis?
Abdominal pain, worse after eating Weight loss Steatorrhoea Diabetes
33
How does pancreatic Exocrine insufficiency present itself?
Steatorrhoea (fat malabsorption) Weight loss (protein malabsorption) Malnutrition (fat sol vits)
34
How does pancreatic endocrine insufficiency present itself?
Diabetes
35
Investigations in chronic pancreatitis?
``` AXR - panc. calcification USS, EUS CT scan Bloods Pancreatic function tests ```
36
What blood tests are used for chronic pancreatitis?
Amylase (increased) Albumin, Ca/Mg/B12 (decreased) LFT, Prothrombin, gluc (increased)
37
What factors have to be managed in chronic pancreatitis?
Pain | Endocrine + exocrine function
38
How is pain managed in chronic pancreatitis?
``` Avoid alcohol Enzyme supplements Opiates Coeliac plexus block ?surgery ```
39
How is reduced exocrine function managed in chronic pancreatitis?
Low fat diet Pancreatic enzyme supps Vitamin supplements
40
How is reduced endocrine function managed in chronic pancreatitis?
Insulin
41
Prognosis of chronic pancreatitis
20% mort abstinence | 50% mort continued alcohol
42
Carcinoma of the pancreas is most likely to effect which groups?
Males 60-80 Westerners
43
The most common type of cancer in the pancreas?
Duct cell mucinous adenocarcinoma (75%)
44
Clinical features of pancreatic carcinoma?
``` ABDOMINAL PAIN JAUNDICE WEIGHT LOSS Steatorrhoea Vomiting Subcutaneous fat nodules Ascites ```
45
Physical signs of pancreatic carcinoma
``` Hepatomegaly Jaundice Abdominal mass, tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy ```
46
How is suspected pancreatic carcinoma investigated?
USS, CT, EUS
47
How is suspected pancreatic carcinoma investigated when presenting with jaundice and a mass?
ERCP with stent | EUS and biopsy
48
How is suspected pancreatic carcinoma investigated when presenting with a mass but no jaundice?
EUS with biopsy
49
After a carcinoma is confirmed, what must then be confirmed?
Whether or not the cancer is operable
50
What proportion of tumours are operable?
<10%
51
What surgery is given to operable pancreatic carcinomas?
Whipples procedure | pancreatoduodenectomy
52
What treatment is given in pancreatic carcinoma if it is inoperable
Palliation - stent Pain control Chemotherapy is in trials
53
What are the risk factors for pancreatic cancer?
Smoking Chronic pancreatitis Adult onset DM
54
How does cancer at the head of the pancreas present?
``` OBSTRUCTIVE JAUNDICE DM Abdominal pain Weight loss Vomiting Pancreatitis ```

GI PATHOLOGY (20 decks)

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