Pancreatic disorders Flashcards
(24 cards)
What is acute pancreatitis?
Pancreatitis is inflammation of the pancreas, which can beacute(sudden onset, potentially reversible) orchronic(long-term, progressive damage leading to fibrosis and pancreatic insufficiency).
What is the difference between acute and chronic pancreatitis?
Acute pancreatitis:Premature activation of pancreatic enzymes → autodigestion of pancreas → inflammation & necrosis
Chronic pancreatitis:Recurrent inflammation → fibrosis → loss of exocrine & endocrine function
What are the common causes of acute pancreatitis?
I GET SMASHED
Idiopathic
Gallstones
Ethanol: oxidative stress
Trauma
Steroids: (autoimmune pancreatitis )
Mumps: viral infections
Autoimmune: IgG4 related pancreatitis
Scorpion venom
Hypercalcemia & Hypertriglyceridemia: calcium deposits and toxic lipid metabolism
ERCP:post procedural irritation
Drugs: e.g. thiazides, tetracyclines
What are the most common causes of chronic pancreatitis?
TIGAR-O
Toxic (alcohol, smoking)
Idiopathic
Genetic (CFTR, SPINK1 mutations)
Autoimmune
Recurrent acute pancreatitis (leads to chronic fibrosis)
Obstructive: Stricures, tumours blocking pancreatic ducts
What is the clinical presentation of acute pancreatitis?
Pain: Severe epigastric pain, radiates to back
Aggravating Factors: Eating, lying flat
Relieving Factors: Leaning forward
Nausea/Vomiting common
Weight Loss: Due to nausea/anorexia
Jaundice: If biliary obstruction
Steatorrhea is Uncommon
Diabetes Mellitus is Rare
What is the clinical presentation of chronic pancreatitis?
Pain:
Chronic, dull epigastric pain
Aggravating Factors:
Alcohol, fatty meals
Relieving Factors:
Not well relieved
Nausea/Vomiting:
Less common
Weight Loss:
Common, due to malabsorption
Jaundice:
If bile duct strictures develop
Steatorrhea:
Common (due to exocrine insufficiency)
Diabetes Mellitus:
Common (endocrine dysfunction)
What are the signs and physical symptoms?
Epigastric tenderness(severe in acute pancreatitis)
Hypotension, tachycardia(SIRS response)
Grey Turner’s sign(flank bruising – retroperitoneal hemorrhage)
Cullen’s sign(umbilical bruising – peritoneal hemorrhage)
Abdominal distension & reduced bowel sounds(paralytic ileus in severe cases)
What are the first line blood tests in acute pancreatitis?
First line blood tests:
Serum amylase or lipase >3 times the upper limit of normal which is diagnostic of acute pancreatitis
FBC: leukocytosis
CRP: > 150mg/L which is a severity marker
U&E: Hypocalcemia, saponification in fat necrosis
LFTs: Elevated ALT/AST, ALP, bilirubin → suggest gallstone pancreatitis
Glucose: Hyperglycemia may occur due to islet cell damage
ABG: Metabolic acidosis in severe disease
Trigylcerides: >11mmol/L Elevated in hyperlipidemia-induced pancreatitis
What are the imaging investigations in acute pancreatitis?
Abdominal Ultrasound– First-line to check forgallstones
CT Abdomen with Contrast– Best forseverity assessment, necrosis, abscess
MRCP/ERCP– Ifbiliary obstructionsuspected
What is the management of acute pancreatitis?
Supportive Care:
- NPO (Nil by Mouth)– Rest the pancreas
- IV Fluids– Aggressive hydration (e.g., Ringer’s Lactate)
- Analgesia– IVopioids (morphine, fentanyl)preferred
- Antiemetics– Ondansetron/Metoclopramide
Treat Underlying Cause:
- Gallstones– ERCP (if obstructed), Cholecystectomy (later)
- Alcohol-induced– Abstinence, referral for alcohol support
- Hypertriglyceridemia– Insulin therapy, lipid-lowering agents
ICU Referral for Severe Disease:
- Persistent organ failure (>48h)
- Necrotizing pancreatitis→ Surgical/IR drainage if infected
What is the management of chronic pancreatitis?
Lifestyle Modifications:
- Alcohol cessation, smoking cessation
- Low-fat diet, diabetes management
Medical Treatment:
- Analgesia (Stepwise Approach): NSAIDs → Tramadol → Opioids
- Pancreatic Enzyme Supplementation(Creon) for malabsorption
- Diabetes Management(if pancreatic endocrine dysfunction)
Surgical Intervention(if refractory):
- Endoscopic stentingfor strictures
- Pancreatectomyfor severe cases
What are the possible complications of acute pancreatitis?
Early Complications (within 1 week):
- SIRS, Shock(systemic inflammation)
- Acute Respiratory Distress Syndrome (ARDS)
- Renal Failure(AKI from hypovolemia)
- DIC (disseminated intravascular coagulation)
Late Complications (>1 week):
1. Pancreatic Necrosis± Infection (requires drainage)
2. Pancreatic Pseudocyst(fluid collection needing drainage)
3. Abscess Formation
What are the possible complications of chronic pancreatitis?
Exocrine Insufficiency→Steatorrhea, Malnutrition
Endocrine Insufficiency→Diabetes Mellitus
Pancreatic Cancer Risk(especially with smoking, alcohol use)
What are pancreatic neoplasms?
Pancreatic neoplasms refer to tumors arising from the pancreas, which can bebenign(non-cancerous) ormalignant(cancerous).
The most common type ispancreatic ductal adenocarcinoma (PDAC), a highly aggressive malignancy. It Is an exocrine tumour.
What are the different types of exocrine tumors?
95%
Pancreatic Ductal Adenocarcinoma (PDAC):
Most common (~90%); arises from pancreatic ducts, poor prognosis
Acinar Cell Carcinoma:
Rare; produces digestive enzymes, associated with fat necrosis
Solid Pseudopapillary Tumor:
Rare, young women, better prognosis
Pancreatic Cystic Neoplasms:
Includes serous/mucinous cystadenomas & intraductal papillary mucinous neoplasms (IPMN)
What are the different types of Endocrine (neuroendocrine) tumors?
5%
Insulinoma:
Hypoglycemia symptoms, usually benign
Gastrinoma (Zollinger-Ellison Syndrome):
Excess acid → refractory peptic ulcers
Glucagonoma:
Hyperglycemia, necrolytic migratory erythema
VIPoma:
Severe watery diarrhea (Verner-Morrison syndrome)
Somatostatinoma:
Diabetes, gallstones, steatorrhea
What are the risk factors of pancreatic cancers?
Modifiable:
Smoking
Chronic pancreatitis
Obesity and T2DM
High fat diet
alcohol
Non-modifiable:
age>60
Family history
Male
African-carribean
Genetic conditions (MEN-I, Peutz-Jeghers Syndrome)
What are the clinical presentations of pancreatic cancer?
Painless jaundice:
Biliary obstruction (Courvoisier’s sign: painless jaundice + palpable gallbladder)
Epigastric pain:
Often radiates to the back, worse at night
Unintentional weight loss:
Cancer-related cachexia
New-onset diabetes mellitus:
Particularly in non-obese adults
Steatorrhea:
Due to pancreatic exocrine insufficiency
Depression & fatigue:
Paraneoplastic effect
What are the signs and physical symptoms of pancreatic cancer?
Courvoisier’s Sign:
Palpable, non-tender gallbladder + painless jaundice = likely pancreatic cancer
Trousseau’s Syndrome:
Migratory thrombophlebitis (hypercoagulability associated with malignancy)
Sister Mary Joseph Nodule:
Periumbilical metastasis
Virchow’s Node:
Left supraclavicular lymph node metastasis
What are the blood test investigations for pancreatic cancer?
LFTs: Raised ALP, bilirubin if obstructed
Tumor Markers (CA 19-9):
Elevated inPDAC, but not diagnostic
Fasting Glucose/HbA1c:
New-onset diabetes can be a clue
Coagulation Tests:
Hypercoagulable state (Trousseau’s syndrome)
What are the imaging investigations for pancreatic cancer?
CT Pancreas (Triple-phase contrast):
First-line for diagnosis, staging
MRI/MRCP:
Better for small cystic lesions, bile duct involvement
Endoscopic Ultrasound (EUS) + Biopsy:
Gold standard for tissue diagnosis
PET-CT:
Identifies distant metastases
How is pancreatic cancer staged?
Stage I:
Confined to the pancreas (<2 cm)
Stage II:
Local spread, but no distant metastasis
Stage III:
Involves major vessels, non-resectable
Stage IV:
Distant metastases present (liver, peritoneum, lungs)
How is pancreatic cancer managed?
A. Resectable Disease (Early-stage, No Metastases):
Surgical Resection (Whipple’s Procedure)– Head of pancreas
Distal Pancreatectomy– Body/tail tumors
Adjuvant Chemotherapy (Gemcitabine, FOLFIRINOX)
B. Locally Advanced (Unresectable, but No Distant Mets):
Neoadjuvant Chemotherapy(attempt to downstage for surgery)
Palliative Biliary Stenting(relieve jaundice)
C. Metastatic Disease (Stage IV):
Chemotherapy (FOLFIRINOX, Gemcitabine + Nab-paclitaxel)
Pain management– NSAIDs, opioids, celiac plexus block
Nutritional Support– Enzyme supplementation (Creon)
What are the possible complications of pancreatic cancer?
Obstructive Jaundice:
Bile duct compression
Duodenal Obstruction:
Tumor invasion
Diabetes Mellitus:
Loss of insulin-producing cells
Exocrine Insufficiency:
Malabsorption, steatorrhea
Distant Metastases:
Liver, peritoneum, lungs
