pancreatitis

Question 1

what is the classical acute pancreatitis

Answer 1

They get sudden onset severe abdominal pain and patients may be seriously shocked

Elevated serum amylase

pain may go to the back

indigestion

temperature a

jaundice

Question 2

Pathogenesis of acute pancreatitis

1. Bile reflux, duct ____ due to ___ damage to the sphincter of Oddi all cause pancreatic duct ______ injury
   - The loss of _____ barrier allows the _______ of pancreatic acini
2. Release of lytic pancreatic enzymes - ____ and ____

Answer 2

1. Bile reflux, duct obstruction due to stone damage to the sphincter of Oddi all cause pancreatic duct epithelial injury
   - The loss of protective barrier allows the autodigestion of pancreatic acini
2. Release of lytic pancreatic enzymes - proteases and lipases

Question 3

______- cause tissue destruction and haemorrhage

Answer 3

Proteases - cause tissue destruction and haemorrhage

Question 4

_____ - intra-and peripancreatic fat necrosis.

This atttracts _____

Answer 4

Lipases - intra-and peripancreatic fat necrosis

This attracts calcium

Question 5

______ is an almost immediate consequence of acute of Release of lytic pancreatic enzymes - proteases and lipases

Answer 5

haemorhage

Question 6

what are the systemic complications of acute?

Answer 6

pulmonary failure 
renal failure (HIGHLY LIKELY)
sepsis
metabolic acidosis 
Death 
Shock 
Hypocalcaemia 
Hyperglycaemia

Question 7

what is chronic pancreatitis

Answer 7

Relapsing disorder may develop insidiously or following bouts of acute pancreatitis

Question 8

what are the causes of chronic pancreatitis?

Answer 8

Alcohol
Cholelithiasis
Cystic fibrosis
Hyperparathyroidism
Familial
viral infection
hypothermia 
trauma
drugs

Question 9

what is the pathology of chronic?

Answer 9

Get the replacement of pancreas by chronic inflammation and scar tissue

Destruction of exocrine acini and islets (islets tend to last longer)

Question 10

in chronic The inflammation and firbosis mimicks a ____ in the head of the pancreas

Answer 10

tumour

Question 11

in acute P what is the management If they are a surgical candidate:

Answer 11

Cholecystectomy

Question 12

in acute P what is the management If they are a non surgical candidate:

Answer 12

• ERCP/ES if frail

They will have a sphincterotomy too to prevent blockage of stones as this will allow them to pass straight through to the duodenum

Question 13

minimal organ dysfunction and uneventful recovery. Predominant feature is interstitial oedema of the gland

Answer 13

mild acute pancreatitis

Question 14

what is the pancreatitis associated with organ failure and /or local complication such as necrosis, pseudocysts or abscess

Answer 14

severe acute pancreatitis

Question 15

mumps, coxsackie B and viral hepatitis

Answer 15

what viruses can cause acute pancreatitis

Question 16

how is a diagnosis of ACUTE pancreatitis made?

Answer 16

history ,

examination (tenderness, peritonism, distension, bowel sounds and skin markings)

and blood tests

Question 17

what blood tests are usually done?

Answer 17

FBC, Clotting, U & E’s, LFT’s, Amylase, CRP, Glucose, Ca

Question 18

what is the FBC like in acute pancreatitis ?

Answer 18

leukocytosis

Question 19

what do the lipase and amylase show in acute pancreatitis?

Answer 19

both raised but amylase raised by 3x ULN

Question 20

what does haematocrit tell you

Answer 20

it is a predictor of pancreatic necrosis

Question 21

what is ABG like for acute pancreatitis

Answer 21

hypoxaemia and disturbances in acid base balance

Question 22

what imaging may be done in acute pancreatitis

Answer 22

CXR/AXR, AUS, CT Pancreas, MRI, ERCP- these are not diagnostic but can be useful

Question 23

what is the first imaging tool you ask for and why? for acute pancreatitis

Answer 23

US to rule out biliary pancreatitis

Question 24

what may be seen on CXR/AXR of acute pancreatitis?

Answer 24

sentinel loop or pleural effusion

Question 25

what is a sentinel loop

Answer 25

localised ileus from nearby inflammation

Question 26

what are the local complications of acute pancreatitis

Answer 26

``` fluid collections pancreatic necrosis ascites bleeding abscess pseudocyst formation ```

Question 27

what are pseudocysts

Answer 27

collections of fluid with high enzyme concentrations

Question 28

complication of AP and CP which can cause biliary obstruction and gastric outlet obstruction the patient has pain, nausea, vomiting, jaundice, weight loss

Answer 28

pseudocyst

Question 29

what is the treatment for a pseudocyst

Answer 29

endoscopic drainage or surgical drainage

Question 30

This is basically an infected cyst

Answer 30

pancreatic abscess

Question 31

what is the treatment of pancreatic abscess

Answer 31

Drain abscess, control sepsis | Via CT/US guided retroperitoneal or transperitoneal drainage

Question 32

what is CT used for in pancreatitis

Answer 32

to assess severity of necrosis

Question 33

this is a progressive and irreversible destruction of the pancreatic tissue which results in the loss of endocrine and exocrine function

Answer 33

chronic pancreatitis

Question 34

what are the causes of CP?

Answer 34

``` alcohol - 60-80% pancreatic duct obstruction autoimmune tropical pancreatitis hereditary hypercalcaemia in hyperparathyroidism ```

Question 35

what is the rare but important hereditary cause of CP

Answer 35

CF

Question 36

what are some acquired causes of pancreatic duct obstruction

Answer 36

cholelithiasis, stricture, tumour pseudocyst

Question 37

what is a congenital cause of pancreatic duct obstruction

Answer 37

pancreas divisum

Question 38

what are the first tests to order in CP

Answer 38

blood tests CT US AXR

Question 39

what may AXR and CT show for CP

Answer 39

calcifications

Question 40

what may need to be supplemented in CP

Answer 40

insulin, lipase,fat soluble vitamins

Question 41

what surgery can be done for unremitting pain or weight loss in CP

Answer 41

Pustow procedure for dilated pancreatic duct - pancreeatic duct is anastomosed to jejunum

Question 42

what are the complications of chronic CP?

Answer 42

splenic vein thrombosis - risk of pancreatic cancer - pseudocyst - pseudoaneurysms - bile duct or duodenal obstruction - pancreatic ascites - pleural effusion - diabetes

Question 43

what is a pseudoaneurysm?

Answer 43

erosion of a pseudocyst into an artery

Question 44

what is the treatment for biliary or duodenal obstriction

Answer 44

stent, bypass or resection