Surgical Jaundice Flashcards
what is Pancreas divisum?
this is what occurs if the pancreatic ducts don’t fuse - main pancreatic duct enters minor papilla and vise versa (these people have a predisposition to pancreatitis)
what is an Annular Pancreas
when two ventral buds of the pancreas rotate in the wrong direction around the duodenu,m = predisposes to obstruction
what is the fucntion of the pancreas?
Exocrine and Endocrine
Exocrine = 98% digestive enzymes, bicarbonate ions (buffer gastric acid)
Endocrine = islets of langerhans = insulin, glucagon, somatostatin, via portal vein into liver
How might pancreatic exocrine dysfunction occur?
- pancreatic insufficiency (Cystic Fibrosis)
- Disruption to flow of enzymes = compression, obstruction, inflammation of duct
What is Pancreatitis?
inflammation of the pancreas
why is pancreatitis dangerous?
b/c the cytokine tide released by the pancreatic cellular injury, combined with it’s retroperitoneal position - can cause widespread damage
What are your main considerations in acute vs. subacute pancreatitis?
acute = worry about systemic effects - monitor other organs for failure
subacute = local complications - like necrosis, abscess, bleeding etc.
what are the casues of pancreatitis?
“GET SMASHED”
G= gallstones
E = Ethanol
T = Trauma
S= steroids
M= Mumps
A = autoimmune
S= Scorpion
H= hypercalcaemia/hyperlipidaemia
E= ERCP
D = Drugs (thiazides)
what is the “common channel theory” of pancreatitis pathogenesis?
that blockage forces bile up the common pancreatic duct and leads to the activation of trypsinogen = inflammatory reaction ensues
how does Acinar Cell Injury occur in pancreatitis?
1) Trypsinogen is prematurely activated
2) trypsinogen activates lipase, elastase, ribonuclease etc.
3) this leads to acinar cell injury and thus release of cytokine production
4) cytokine production leads to cellular apoptosis and necrosis
What immune cells are the most accurate markers of prognosis in acute pancreatitis patients?
IL6 and IL8
what are the 5 cardinal features of pancreatitis?
- acute inflammation
- proteolytic destruction
- enzymatic destruction of vessel walls
- microvascular damage (oedema)
- Lipolysis - fat necrosis
what are the symptoms of pancreatitis?
pain (severe) - plateau onset - “bandlike pain” - epigastric and through to back - relieved by leaning forwards
nausea/vomiting
what are the signs of pancreatitis?
dehydration
epigastric gaurding
tachycardia
tachypnoea
pyrexia
cullens sign (peri umbilical bruising)
grey turners sign
what lab findings wound you expect wih pancreatitis?
- elevated serum amylase
- elevated WCC
- U&E - urea, albumin, calcium
- CRP
- PaO2
- Glu
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