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Pancreatic Pathology Flashcards

(49 cards)

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1
Q

What is acute pancreatitis?

A

Acute inflammation of the exocrine pancreas resulting in reversible destruction/auto digestion by it’s own digestive enzymes

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2
Q

What causes acute pancreatitis?

A

I GET SMASHED

Idiopathic

Gallstones

Ethanol

Trauma

Scorpio stings

Mumps

Autoimmune

Steroids

Hypercalcaemia, hypothermia

ERCP

Drugs

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3
Q

What drugs can cause acute pancreatitis?

A

Sodium valproate

Azathioprine

Mesalazine

Fuorsemide/thiazide diuretics

Tetracycline

Co-trimoxazole

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4
Q

How does acute pancreatitis present?

A

Acute epigastric pain

  • Sitting forward relieves pain
  • Radiation to the back

N&V

Fever

Tachycardia

Cullen’s sign

Grey Turner’s Sign

Jaundice

Palpable mass if pseudocyst present

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5
Q

What is Cullen’s sign?

A

Bruising around umbilicus due to retroperitoneal haemorrhage

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6
Q

What is Grey Turner’s sign?

A

Bruising around flanks due to retroperitoneal haemorrhage

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7
Q

What investigations are used in acute pancreatitis diagnosis and monitoring?

A

>Amylase and lipase

LFT

  • Decreased albumin
  • AST>ALT suggesting alcohol use

FBC

  • >WCC

U&E

  • >Urea

Hyperglycaemia

Hypocalcamemia

>CRP

LDH

Coagulation

US

CT

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8
Q

Is amylase or lipase better to use in acute pancreatitis diagnosis and why?

A

Lipase is more sensitive and specific

Serum amylase may rise and fall quite quickly and lead to a false negative result

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9
Q

What CT signs are present in acute pancreatitis?

A

Pseudocysts

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10
Q

What are we looking for on an US in acute pancreatitis?

A

Gallstones

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11
Q

Why does hypocalcaemia occur in acute pancreatitis?

A

Lipase uses Ca2+ up

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12
Q

Why is LDH present in acute pancreatitis?

A

Tissue damage

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13
Q

Why is coagulation assessed in acute pancreatitis?

A

DIC is a complication

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14
Q

What is the management of acute pancreatitis?

A

IV fluids

Analgesia

Ca

Insulin

Urinary catheter

Naso-jejunal feeding, to avoid pancreatic stimulation

Treat cause

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15
Q

Name some complications of acute pancreatitis?

A

Pseudocyst/peripancreatic fluid collections

Pancreatic cancer

DIC

Acute Respiratory Distress Syndrome

Pancreatic abscess

Chronic pancreatitis

Pancreatic necrosis

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16
Q

What is a pseudocyst?

A

Fluid collection in lesser sac

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17
Q

What blood test is pseudocyst associated with?

A

Raised amylase

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18
Q

When do pseudocysts become present?

A

No earlier than 4 weeks after acute pancreatic attack

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19
Q

How are pseudocysts managed?

A

Symptomatic cases may be observed for 12 weeks as half resolve

Cystogastrostomy or aspiration

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20
Q

What criteria assesses the severity of acute pancreatitis?

Study These Flashcards
A

Modified Glasgow Criteria

21
Q

What factors does the Modified Glasgow Criteria take into consideration?

Study These Flashcards
A

PaO2 < 8

Age > 55

Neutrophilia x10^9

Calcium < 2 mmoles

Renal function, urea >16

Enzymes, LDH > 600

Albumin < 32

Sugar, glucose > 10

22
Q

How many points does the Modified Glasgow Criteria say is mild acute pancreatitis?

23
Q

How many points does the Modified Glasgow Criteria say is moderate acute pancreatitis?

24
Q

How many points does the Modified Glasgow Criteria say is severe acute pancreatitis?

25
What is chronic pancreatitis?
Persistent inflammation of the pancreas, characterised by glandular destruction and permanent loss of function/irreversible change of pancreatic structure
26
What are the causes of chronic pancreatitis?
**AAAACC** Alcohol Anatomical bbnormalities Autoimmune pancreatitis Reoccuring acute pancreatitis CF Hypercalcaemia
27
What congenital anatomical abnormalities can cause chronic pancreatitis?
Annular pancreas Pancreas divisum
28
What mode of inheritence is congenital pancreatitis?
Autosomal dominant
29
How does chronic pancreatitis present?
Asymptomatic in early disease Weight loss Steatorrhoea Epigastric pain * Exacerbated by food/alcohol * Severity decreases over time Jaundice Diabetes
30
What investigations are used in chronic pancreatitis diagnosis?
US * Increased pancreatic size * Cysts * Dilated duct diameter \>Serum Amylase * Acute exacerbation Abdominal CT with IV contrast * Calcification of pancreas
31
How is chronic pancreatitis managed?
Pancreatic enzyme supplements Analgesia/coeliac plexus block Insulin Avoid alcohol and smoking Stenting
32
Name some complications of chronic pancreatitis
Diabetes Pseudocyst development Pancreatic carcinoma
33
Describe diabetic screening in chronic pancreatitis
Annual Hb1Ac
34
When does diabetes occur in patients with chronic pancreatitis?
20 years after symptom onset
35
What is the most common histological type of pancreatic cancer?
Adenocarcinoma, mostly occuring at the head
36
What sex is pancreatic cancer more common in?
M\>F
37
What age is pancreatic cancer most common?
Onset at 65
38
What is the prognosis of pancreatic cancer?
Poor, average survival upon diagnosis is 6 months as metastasise early
39
What are the causes of pancreatic cancer?
Chronic pancreatitis Smoking Obesity Alcohol Diabetes HNPCC Diet * Red meat
40
How does pancreatic cancer present?
Epigastric pain, radiates to back Weight loss Fatigue Diarrhoea Steatorrhoea N&V Hepatomegaly Supraclavicular lymphadenopathy Courvoisier sign/palpable gallbladder New onset diabetes Trousseau's sign/migratory thrombophlebitis
41
What is Courvoisier sign?
Palpable gallbladder not tender to touch along with jaundice, suggesting pancreatic cancer
42
What investigations are used in pancreatic cancer diagnosis?
CT pancreas CT thorax, abdomen, pelvis for staging EUS with percutaneous biopsy Cholestatic LFTs * Increased ALP * Increased gamma GT * Increased bilirubin Tumour markers * CA19-9
43
What pancreatic cancer sign can be seen in imaging?
Double duct sign, due to obstruction of pancreatic and common bile duct
44
How is pancreatic cancer managed?
Surgery * Whipples pancreaticoduodenectomy or modified whipples (pylorus sparing) * Total or distal pancreatectomy Palliative radiotherapy or chemotherapy Stenting to relieve symptoms
45
Describe stage 1 pancreatic cancer
\<2cm
46
Describe stage 2 pancreatic cancer
\>2cm
47
Describe stage 3 pancreatic cancer
Grown into neighbouring tissue
48
Describe stage 4 pancreatic cancer
Metastatic
49
What is a useful test of exocrine function in chronic pancreatits?
Faecal elastase

Gastrointestinal (14 decks)

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