Pancreatic Disorders

Question 1

define acute pancreatitis

Answer 1

acute inflammation of the pancreas that causes release of exocrine enzymes that results in self-mediated autodigestion

Question 2

causes of acute pancreatitis

Answer 2

GET SMASHED 
gallstones 
ethanol 
trauma 
steroids
mumps
autoimmune
scorpion sting (rare)
hypecalcaemia, hypothermia or hyperlipiaemia
ercp
drugs

Question 3

most common causes of acute pancreatitis

Answer 3

gallstones causing blockage of pancreatic duct and alcohol misuse

Question 4

risk factors of acute pancreatitis

Answer 4

blunt abdominal trauma
infection (e.g. mumps or mycoplasma pneumonia)
autoimmune disorder
surgery (near pancreas or ERCP)
alcoholism

Question 5

clinical features of acute pancreatitis

Answer 5

severe upper abdominal pain or sudden onset vomiting (LUQ)

sudden nausea and vomiting

Question 6

signs of acute pancreatitis

Answer 6

mild pyrexia
tachycardic
epigastric guarding and tenderness
bruising around peri-umbilical area (Cullens Sign)

Question 7

differentials of acute pancreatitis

Answer 7

renal failure
ectopic pregnancy
perforated duodenal ulcer
small bowel perforation

Question 8

investigations of acute pancreatitis

Answer 8

ERCP - check for inflammatory fibrosis
US - look for gallstones
MRCP - assess damage degree

Question 9

what would blood tests show for acute pancreatitis?

Answer 9

raised serum amylase and lipase levels

Question 10

medical management of acute pancreatitis

Answer 10

IV fluids with crystalloids 
anti-emetics 
analgesia 
supplemental O2 
calcium (if hypocalcaemic) and insulin (if pancreatic damage)

Question 11

surgical management of acute pancreatitis

Answer 11

endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy

Question 12

common complications of acute pancreatitis

Answer 12

pancreatic necrosis
pseudocyst
pancreatic abscess
vascular complications

Question 13

definition of chronic pancreatitis

Answer 13

chronic inflammation and fibrosis of the exocrine and endocrine components of the pancreas

Question 14

causes of chronic pancreatitis

Answer 14

chronic alcohol excess
genetic causes (e.g. CF)
obstructive causes (e.g. cancer)
metabolic (⬆️ triglycerides)

Question 15

clinical features of chronic pancreatitis

Answer 15

epigastric pain (radiating to back) - worsens after eating fatty food 
nausea and vomiting 
decreased appetite 
exocrine dysfunction
endocrine dysfunction

Question 16

differentials of chronic pancreatitis

Answer 16

acute cholecystitis 
peptic ulcer disease 
acute hepatitis 
AAA
acute pancreatitis

Question 17

blood tests for chronic pancreatitis

Answer 17

FBC, U+E, creatine, LFTs, calcium, amylase and HBa1c

fasting glucose

Question 18

investigations for chronic pancreatitis

Answer 18

AXR and CT - show/detect calcification
faecal elastase
OGTT

Question 19

conservative management for chronic pancreatitis

Answer 19

ethanol abstinence
good diet
smoking cessation
review for drug use and management

Question 20

medical management for chronic pancreatitis

Answer 20

pain control
insulin therapy
pancreatic enzyme replacement

Question 21

surgical management and considerations of chronic pancreatitis

Answer 21

if medical and conservative management fails, consider coeliac plexus block or pancreatectomy

Question 22

common complications of chronic pancreatitis

Answer 22

diabetes 
pseudocyst
pancreatic cancer
malabsorption/steatorrhoea 
GI tract haemorrhage

Question 23

are most pancreatic cancers exocrine or endocrine?

Answer 23

exocrine adenocarcinomas (~90%)

Question 24

risk factors for pancreatic cancer

Answer 24

smoking 
poor diet (high BMI, red meat, low fibre)
chronic/hereditary pancreatitis 
FM of pancreatic cancer
genetics (e.g. BRCA1/2)

Question 25

clinical features of pancreatic cancer

Answer 25

``` epigastric/back pain - worse when supine obstructive jaundice dark urine + pale stools itching (pruritus) weight loss/reduced appetite haematemesis acute pancreatitis ```

Question 26

findings upon examination for pancreatic cancer

Answer 26

``` ascites epigastric mass palpable gallbladder jaundice presence of tumour marker ```

Question 27

differentials of pancreatic cancer

Answer 27

``` gallstone peptic ulceration gastric/colorectal cancer pancreatitis hepatitis/liver abscess ```

Question 28

blood tests for pancreatic cancer

Answer 28

FBC - for anaemia/thrombocytosis LFTs - to confirm jaundice through raised bilirubin, ALP + GGT serum glucose tumour markers (CA19-9)

Question 29

initial investigations for pancreatic cancer

Answer 29

abdominal CT US of abdomen (liver, bile duct and pancreas) endoscopic US for biopsy of tumour

Question 30

staging procedures for pancreatic cancer

Answer 30

CT with IV contrast PET dynamic contrast PET

Question 31

what are the two types of exocrine pancreatic tumours?

Answer 31

primary solid non-endocrine epithelial tumour (e.g. ductal adenocarcinoma) primary cystic non-endocrine epithelial tumours (e.g. serous cystic neoplasms)

Question 32

likelihood of resectability of tumour

Answer 32

10-20%

Question 33

management of resectable pancreatic tumours

Answer 33

distal pancreatectomy for tail and body tumours whipple's procedure for proximal tumours adjuvant to chemotherapy

Question 34

management of non-resectable tumours

Answer 34

palliative chemo/radiotherapy bile duct stent to relieve obstructions pain management pancreatic supplements (e.g. creon)

Question 35

common complications of pancreatic cancer

Answer 35

obstructive jaundice duodenal obstruction DVT PE