pancreatitis

Question 1

divided into

Answer 1

acute and chronic

Question 2

can acute return to normal

Answer 2

yes

Question 3

what is seen in chronic pancreatitis

Answer 3

continuing inflammation with irreversible structural damage

Question 4

is chronic pancreatitis reversible

Answer 4

no

Question 5

what is acute pancreatitis

Answer 5

inflammation of the pancreatic gland initiated by any acute injury

Question 6

what are most common causes of acute

Answer 6

• gallstones

- alcohol

Question 7

causes of acute

Answer 7

I GET SMASHED

• idiopathic
• gallstone
• ethanol (alcohol)
• trauma
• steroids
• mumps
• autoimmune
• scorpion sting
• hypercalcaemia
• ERCP
• drugs

Question 8

how can gallstone cause pancreatitis

Answer 8

by obstructing to pancreatic drainage at the ampulla by a stone

Question 9

what happens pathologically in gallstone pancreatitis

Answer 9

1. trypsinogen is cleaved to trypsin
2. trypsin is degraded by chmotryspin C is impaired
3. intracellular calcium increases
4. increased calcium causes more trypsinogen
5. acinar cell damage

Question 10

what does alcohol interfere with in pancreatitis

Answer 10

calcium homeostasis in pancreatic acinar cells

Question 11

what does alcohol activate in pancreas

Answer 11

pancreatic stellate cells by acetylaldehyde

Question 12

what do pancreatic stellate cells produce

Answer 12

collagen and matrix proteins

Question 13

where is the pain in acute

Answer 13

upper abdominal

Question 14

symptoms of acute

Answer 14

• epigastric pain
• nausea
• vomiting
• pain spreads to back
• previous gallstones
• alcoholic binge
• tachycardia
• hypotension

Question 15

signs of acute

Answer 15

• absent bowel sounds
• Cullens sign
• Grey Turners (bruising)

Question 16

what investigations are done for acute

Answer 16

• serum amylase
• urinary amylase
• serum lipase
• CRP level
• CXR
• ultrasound
• CT
• MRCP

Question 17

is serum amylase a sensitive test

Answer 17

yes

Question 18

what are other causes of elevated serum amylase

Answer 18

• upper GI perforation

- peritonitis

Question 19

is urinary amylase diagnostic

Answer 19

yes

Question 20

are serum amylase levels elevated for a long time

Answer 20

no

Question 21

what is CRP level useful for

Answer 21

severity and prognosis

Question 22

what is a mandatory investigation

Answer 22

CXR

Question 23

why is a CXR done

Answer 23

to exclude gastroduodenal perforation - this also raises serum amylase

Question 24

what is ultrasound used for

Answer 24

to identify a possible gallstone

Question 25

what is ERCP used for

Answer 25

treatment measure to remove bile duct stones

Question 26

what is required early for treatment for acute

Answer 26

- IV fluids - urinary catheter to monitor circulating volume and renal function

Question 27

what does nasogastric suction do

Answer 27

prevents abdominal distension and vomitus | = reduces risk of aspiration pneumonia

Question 28

treatment methods of acute

Answer 28

- antibiotics - analgesia - feeding - anticoagulation

Question 29

why is anticoagulation given

Answer 29

LMWH heparin is given for prophylaxis of DVT

Question 30

what is treatment of gallstone pancreatitis

Answer 30

endoscopic intervention with sphincterotomy and stone extraction

Question 31

how else can stones be removed

Answer 31

by ERCP

Question 32

complications of acute pancreatitis

Answer 32

- SIRS - necrosis - abscess - pleural effusion - pneumonia - GI bleed - hypoglycaemia

Question 33

what is the cause of chronic

Answer 33

alcohol

Question 34

pathology of chronic

Answer 34

an increase in activated trypsin within the pancreas

Question 35

what cells produce chymotrypsin C

Answer 35

acinar cells

Question 36

what does chymotrypsin C do

Answer 36

inactivate trypsin

Question 37

where is CFTR

Answer 37

apical surface of the acinar cells

Question 38

how many types of autoimmune chronic pancreatitis

Answer 38

2

Question 39

who is most likely to get type 1 ACP

Answer 39

middle aged men

Question 40

what causes type 1 ACP

Answer 40

IgG 4 lecels

Question 41

can type 1 ACP spread

Answer 41

yes

Question 42

can type 2 ACP spread

Answer 42

no

Question 43

symptoms of chronic

Answer 43

- epigastric pain - pain radiates to back - anorexia - weight loss - malabsorption - diabetes can occur - steatorrhoea

Question 44

what can exacerbate pain in chronic

Answer 44

alcohol

Question 45

investigations for chronic

Answer 45

- serum amylase and lipase - serum IgG4 levels - faecal elastase - gene mutation - ultrasound - CT - MRI with MRCP

Question 46

what are serum amylase and lipase levels

Answer 46

elevated

Question 47

what is ultrasound useful for

Answer 47

initial analysis

Question 48

what does CT enhance

Answer 48

more detail - presence of pancreatic calcification - dilated pancreatic duct

Question 49

what has MRCP replaced

Answer 49

ERCP

Question 50

differential diagnosis of chronic

Answer 50

pancreatic malignancy

Question 51

treatment for abdominal pain in chronic

Answer 51

- NSAIDs - opiate - tricyclic antidepressants -

Question 52

can patients become pain free

Answer 52

yes after 6-10 years

Question 53

why does patient get steatorrhoea

Answer 53

due to malabsorption

Question 54

how to treat malabsorption in chronic

Answer 54

pancreatic enzyme supplements

Question 55

is associated diabetes easy to control

Answer 55

no

Question 56

treatment for autoimmune pancreatitis

Answer 56

glucocorticoid therapy e.g. prednisolone

Question 57

complications of chronic

Answer 57

- pancreatic pseudocyst - ascites - pleural effusions - pancreatic cancer

Question 58

what is pancreatic pseudocyst

Answer 58

fluid collection surrounded by granulation tissue

Question 59

dangers of larger cysts

Answer 59

may occlude nearby structures including duodenum