Pancreatic Disease/Surgery of Pancreatic Disorders Flashcards Preview

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Flashcards in Pancreatic Disease/Surgery of Pancreatic Disorders Deck (40):
1

What is acute pancreatitis and how does it present?

Acute inflammation of the pancreas presenting with upper abdominal pain and elevation of serum amylase

2

What is the normal level of elevated serum amylase in acute pancreatitis?

4 times the normal upper limit

3

What are the two main causes of acute pancreatitis?

Alcohol abuse
Gallstones

4

Give the less common causes of acute pancreatitis

Trauma
Drugs
Viruses
Pancreatic carcinoma
Metabolic disorders
Autoimmune disorders
Idiopathic

5

Other than abdominal pain, what are the typical presentations of acute pancreatitis?

Nausea and vomiting
Collapse due to fluid loss
Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

6

What is the first line treatment in suspected acute pancreatitis?

ERCP

7

What would an endoscopic ultrasound be useful for showing in acute pancreatitis?

Gallstones/obstruction of the bile or pancreatic ducts, pancreatic oedema or pseudocysts

8

Name 3 other investigations done in suspected acute pancreatitis

Amylase and lipase
Bloods - FBC, ABGs, U+Es, calcium, glucose, lipids, coagulations screen
AXR/CXR
Contrast CT

9

What scoring system is used to determine the severity of acute pancreatitis and what score would indicate severe pancreatitis?

The Glasgow Criteria Score
Severe if score > 3

10

What treatments are used in the general management of acute pancreatitis?

Analgesia
IV fluids
Blood transfusion
Urine output monitoring
Naso-gastric tube if unable to eat
Nutrition
Oxygen
Occasionally insulin

11

If pancreatic necrosis is present in pancreatitis, what treatment is necessary?

CT guided aspiration, antibiotics and/or surgery

12

If the cause of acute pancreatitis is gallstones, what may be used to treat?

EUS, MRCP or ERCP
Cholecystectomy

13

What surgical treatment is indicated in acute pancreatitis presenting with jaundice or cholangitis?

Cholecystectomy

14

When would a necrosectomy be indicated?

In acute pancreatitis with necrosis

15

What treatment is indicated for a pseudocyst in acute pancreatitis?

Diagnosis via ultrasound or CT then endoscopic drainage or surgery if persistent pain or complications

16

At would diameter would a pseudocyst normally resolve without medical/surgical treatment?

< 6cm

17

What is chronic pancreatitis?

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

18

What is the major cause of chronic pancreatitis?

Alcohol abuse

19

What is the pathogenesis of chronic pancreatitis?

Duct obstruction leading to calculi formation, inflammation and protein plugs

20

What happens to the pancreatic ducts in chronic pancreatitis?

Become dilated, tortuous and strictured, calcification may occur

21

What veins may thrombose and cause portal hypertension as a result of chronic pancreatitis?

Splenic, superior mesenteric and portal veins

22

What is the typical presentation of chronic pancreatitis?

Upper abdominal pain and weight loss
Endocrine and exocrine insufficiencies
Jaundice
Portal hypertension
GI haemorrhage
Pseudocysts
Pancreatic carcinoma

23

What features of abdominal pain are indicative of chronic pancreatitis?

Pain aggravated by binge drinking
Pain more frequent and less treatable by abstinence

24

What investigations are done in suspected chronic pancreatitis?

Abdominal x-ray
Ultrasound
EUS
CT
Bloods
Pancreatic function tests

25

What are the main treatments of chronic pancreatitis?

Pain control is central to management - opiates, coeliac plexus block, referral to pain clinic or psychologist
Abstinence from alcohol and cigarettes
Endoscopic treatment of stones and strictures
Treatment of endocrine or exocrine insufficiencies

26

Why should patients with chronic pancreatitis abstain from cigarettes?

Cigarettes won't cause chronic pancreatitis but will aggravate it once it is established

27

Under what circumstances would surgical treatment of chronic pancreatitis be given?

Suspicion of malignancy
End stage disease with intractable pain

28

What is the prognosis of chronic pancreatitis in patients who continue to drink alcohol?

50% 10 year survival rate

29

What is the main histological type of pancreatic carcinoma?

Duct cell mucinous adenocarcinoma (75%)

30

What location in the pancreas is the most common site of carcinomas?

Head of the pancreas (60%)

31

What are the histological types of pancreatic carcinoma?

Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell carcinoma

32

What histological type of pancreatic cancer has the best prognosis?

Cystadenocarcinoma

33

What are the three main common presentations of pancreatic carcinoma?

Upper abdominal pain (75%)
Painless obstructive jaundice (25%)
Weight loss (90%)

34

What are the possible physical signs of pancreatic carcinoma?

Hepatomegaly
Jaundice
Abdominal mass and/or tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
Palpable gall bladder (ampullary carcinoma)

35

What investigations would be done if suspecting pancreatic carcinoma?

USS/EUS
CT
MRI
ERCP
Percutaneous needle biopsy
Laparoscopic/laparotomy investigation

36

What percentage of pancreatic carcinomas are operable at the stage of presentation?

10%

37

What is are the main treatments of pancreatic carcinoma?

Palliative care for jaundice - stent, palliative surgery
Pain control - opiates, coeliac plexus block, radiotherapy

38

What is the mean survival of patients with inoperable pancreatic carcinoma?

< 6 months

39

What is the 5 year survival rate of patients with ampullary tumours?

30-50%

40

What are the surgical management options for pancreatic carcinoma?

PPPD
Palliative drainage via ERCP, PTC stenting, or palliative bypass
Palliative bypass or duodenal stent for duodenal obstruction
Palliative bypass at the time of surgery in the event of a failed resection