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MSPA- Gastroenterology > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What is the epidemiology of pancreatitis ?

A

It is acute inflammation of the pancreas leading to the spillage of pancreatic enzymes and cytokines. It accounts for 3% abdominal pain related hospital admission. It can occur at any age with an overall mortality of 10%.

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2
Q

What is the acronym I GET SMASHED stands for ?

A

It stands for the etiologies of pancreatitis.
I= Ideopathic
G= Gallstone
E= Ethnole
T= Trauma
S= Steroids
M= Mumps
A= Autoimmune
S= Scorpion sting
H= Hypertriglyceridaemia
E= ERCP
D= Drugs

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3
Q

What are the elements of history in acute pancreatitis ?

A

– Family history of blood disorders
– Recent foreign travel
– Recent changes in medications
– Surgery or recent anaesthesia
– History of gallstones
– Alcohol intake
– Fever, pain, rigors (cholangitis)
– Weight loss
– Known history of peri-ampullary tumors
– Any change to stool/urine colour

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4
Q

What is the pathogenesis of acute pancreatitis ?

A

Inflammation of the pancreas cause the pancreatic enzymes mediated destruction of pancreatic paranychma and often SIRS due to cytokine storm.

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5
Q

What is the pathology of mild pancreatitis ?

A

interstitial oedema with little or no necrosis.

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6
Q

What is the pathology of severe pancreatitis ?

A

extensive necrosis , thrombosis and
intraparenchymal haemorrhage.

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7
Q

What is the pathophysiology of chronic pancreatitis ?

A

Pancreatitc fibrosis with loss of both endocrine/exocrine function.

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8
Q

What are the symptoms of acute pancreatitis ?

A

Sudden onset of epigastric pain which radiates to the back and relived by sitting forward as well as N/V.

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9
Q

What are the severity dependent signs of acute pancreatitis ?

A

– Dehydration
– Epigastric guarding
– Tachycardia, tachypnoea,
mild pyrexia
– If biliary obstruction: jaundice
– Cullen’s sign
– Grey Turner’s sign
– renal, pulmonary dysfunction and DIC.

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10
Q

What is the Atlanta classification of mild pancreatitis ?

A
  • No organ failure
  • No local or systemic
    complications
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11
Q

What is the Atlanta classification of moderate pancreatitis ?

A
  • Transient organ failure
    (<48hrs)
  • Local or systemic
    complications
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12
Q

What is the Atlanta classification of severe pancreatitis ?

A
  • Persistent organ failure
    (>48hrs)
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13
Q

What are the elements of modified IMRE score ?

A

– P: PaO2 <8kPa (arterial)
– A: Age >55
– N: Neutrophilia (WCC >15)
– C: Calcium <2mmol/L
– R: Renal (urea >16)
– E: Enzymes (LDH >600, AST
>200)
– A: Albumin (32g/L)
– S: Sugar (blood glucose >10)

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14
Q

What is the IMRE score for severe pancreatitis and its management ?

A

> 3 and the management is ICU/HDU care with hourly monitoring of vitals.

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15
Q

What is the Amylase profile in acute vs chronic pancreatitis ?

A

In acute it is 3X the upper limit of normal and it chronic it can be normal.

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16
Q

What are the bloods in pancreatitis ?

A

FBC, CRP, LFT’ s, U&E, Calcium, Albumin, glucose

17
Q

What are the workups to rule out complications of pancreatitis ?

A
  • ABG
    *CXR (Look for free air under diaphragm)
  • Ultrasound Abdomen
  • CT pancreas (to judge severity/complications)
18
Q

What are the prophylaxis in acute pancreatitis ?

A

– Antithrombotic prophylaxis
– Stress ulcer prophylaxis

19
Q

How is the feeding management in pancreatitis ?

A

Initially NPO, reintroduce feeding when possible via NGT, NJT,
or TPN.

20
Q

What is the general management of acute pancreatitis ?

A

Supportive management with acute abdomen protocol.

21
Q

What are the complications of acute pancreatitis ?

A
  • Pseudocyst formation
  • Pancreatic abscess
  • Necrotising pancreatitis
  • Intra abdominal sepsis
  • Necrosis of transverse colon
  • Pancreatic haemorrhage
    /pseudoaneurysm GDA
  • Chronic pancreatitis
  • Systemic
    (ARDS/effusions/ATN)
  • Metabolic (hyperglycaemia,
    hypocalcaemia)
  • Mortality
22
Q

What are the 2 phases of necrotising pancreatitis ?

A
  • SIRS in the first 1 to 2 weeks.
  • 2+ weeks Sepsis.
23
Q

What accounts for 80% of mortality with acute pancreatitis ?

A

Infected pancreatic
necrosis.

24
Q

What are the measures to prevent acute pancreatitis ?

A
  • Removal of gallstones as it is the cause of 30% of recurrence.
  • Alcohol withdrawal.
  • Seek and treat ↑Ca,↑lipids.
25
Q

what is the incidence of pancreatic neoplasm presenting with acute pancreatitis ?

A

10%

26
Q

what is the pathogenesis of chronic pancreatitis ?

A

Protein precipitates form in pancreatic tubules causing calcium deposit and obstruction of acini which causes patchy fibrosis and lose of exocrine and endocrine function. The patients presents with episodic and continuous pain.

27
Q

What are the causes of chronic pancreatitis ?

A
  • Recurrent acute pancreatitis
  • Secondary to pancreatic duct obstruction
  • Autoimmune diseases
  • Idiopathic
28
Q

What is the indication for surgery in chronic pancreatitis ?

A

Intractable pain

29
Q

What is the non-surgical management of chronic pancreatitis ?

A
  • Treat causative agent
  • Dietary modifications
  • Enzyme supplementation
  • Analgesia
30
Q

What is the surgical technique in chronic pancreatitis and tumor ?

A

Whipple’s procedure

31
Q

What are the facts of pancreatic cancer ?

A
  • Tumour doubling time for pancreatic cancer is 60
    days
  • 85% are unresectable
  • Mean survival of bypassed patients is 6 months
  • 90% of patients with pancreatic adenocarcinoma
    pass away within 12 months
32
Q

What are the symptoms of pancreatic cancer ?

A
  • Weight loss and painless jaundice.
  • Pruritus, plain stool and dark urine.
  • Cachexia
33
Q

What are the signs of pancreatic cancer ?

A

– Virchow node / Trousseau sign
– Migrating thrombophlebitis
– Courvoisier’s law

34
Q

What is Courvoisier’s law?

A

According to Courvoisier’s law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones. Therefore, malignancy of the biliary tree or pancreas should be
strongly suspected.

35
Q

What is the age range of pancreatic cancer ?

A

6th or 7th decade is the time for the diagnosis of 80% of cases.

36
Q

What are the risk factors for pancreatic cancer ?

A

– Age
– Smoking
– Alcoholism
– Diabetes
– Chronic pancreatitis

37
Q

Sister Mary Joseph nodule is seen in ?

A

Pancreatic cancer.

MSPA- Gastroenterology (14 decks)

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