Week 122 - Biliary/Pancreatic function Flashcards Preview

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Flashcards in Week 122 - Biliary/Pancreatic function Deck (62)
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1

Week 122 Biliary/Pancreatic Function: What are the main causes of Chronic Pancreatitis?

• Mostly secondary to alcohol abuse in the western world.
• Other causes include hereditary, autoimmune and tropical causes.

2

Week 122 Biliary/Pancreatic Function: How does chronic pancreatitis normally present?

• Severe pain, weight loss, cachexia - this makes it difficult to differentiate from carcinoma.

3

Week 122 Biliary/Pancreatic Function: Which cells produce the exocrine function of the pancreas?

Acinar cells - produce digestive enzymes in the form of pro-enzymes (To protect the pancreas).

4

Week 122 Biliary/Pancreatic Function: What is the exocrine function of the pancreas?

• Pancreatic juice contains the following;
- Bicarbonate, Amylase, Lipase, Tyrpsinogen, Chymotrypsinogen, Phospholipase, Elastase, RNAase, DNAase, Carboxypeptidase.

5

Week 122 Biliary/Pancreatic Function: What causes the secretion of the pancreatic juice?

Pancreatic juice is secreted in response to cholecystokinin, which is produced in response to food entering the duodenum.

6

Week 122 Biliary/Pancreatic Function: What are the endocrine glands of the pancreas?

Islets of Langerhans.

7

Week 122 Biliary/Pancreatic Function: What are the two cell types in the Islets of Langerhans? What do they produce?

• Alpha cells - Glycogen
• Beta cells - Insulin
The Islets also produce somatostatin and pancreatic polypeptide.

8

Week 122 Biliary/Pancreatic Function: What are the two main causes of Acute Pancreatitis? What percentage of cases do these make up?

• Alcohol Abuse
• Gall Stones
• 80%

9

Week 122 Biliary/Pancreatic Function: Aside from Alcohol Abuse and Gallstones, what else can cause Acute Pancreatitis?

• Raised lipids or calcium, hereditary, Viral (mumps, Coxsackie virus), thiazide drugs, shock, trauma, vascular disease, Hypothermia.
• Also a complication of ERCP.

10

Week 122 Biliary/Pancreatic Function: What is the leading cause of Chronic Pancreatitis within the UK?

• Alcohol abuse with recurrent attacks of acute pancreatitis.

11

Week 122 Biliary/Pancreatic Function: Aside from alcohol abuse what other causes of chronic pancreatitis are there?

• Duct obstruction.
• Defective enzyme inhibitors.
• Tropical disease.
• 40% are idiopathic.

12

Week 122 Biliary/Pancreatic Function: What sign of chronic pancreas can make it visible on a radiograph?

The pancreas can calcify.

13

Week 122 Biliary/Pancreatic Function: What are the complications of chronic pancreatitis?

• Failure to produce digestive enzymes.
• Fat absorption is usually the first symptom, producing steatorrhoea and flatulence.
• Loss of endocrine function can finally cause diabetes.

14

Week 122 Biliary/Pancreatic Function: What causes jaundice in terms of pancreatic-biliary systems?

• Excess red cell destruction eg. haemolytic anaemia.
• Common bile duct- stone, stricture, tumour.
• Tumour of Ampulla of Vater
• Tumour Head of pancreas, chronic pancreatitis, stone.

15

Week 122 Biliary/Pancreatic Function: What is the double duct sign?

This is due to a cancer in the head of the pancreas causing strictures which result in dilatation of the common bile duct and the pancreatic duct.

16

Week 122 Biliary/Pancreatic Function: What is the most common type of gallstone?

• 80% are cholesterol or predominantly cholesterol.
• 20% bile pigment stones.

17

Week 122 Biliary/Pancreatic Function: What is the medical term for gallstones?

Cholelithiasis.

18

Week 122 Biliary/Pancreatic Function: What are the risk factors for cholesterol gall stones?

White, Age, High Cholesterol, Female (Fat,female, fair, over forty), Low fibre diet, Diabetes, Gall bladder stasis, Rapid weight reduction.

19

Week 122 Biliary/Pancreatic Function: What is the initial investigation for diagnosis of gallstones?

USS

20

Week 122 Biliary/Pancreatic Function: Describe the natural history of symptomatic gallstones that remain in the gall bladder.

• Acute cholecystitis.
- Which may resolve or develop into chronic cholecystitis.
- Chronic cholecystitis may lead to perforation or gangrene leading to peritonitis.
- Chronic cholecystitis can rarely form into carcinoma.

21

Week 122 Biliary/Pancreatic Function: What are the complications of a gallstone in the bile duct?

• Colic
• Obstructive jaundice
• Pancreatitis

22

Week 122 Biliary/Pancreatic Function: What are the features of biliary colic?

• Usually due to gallstones.
• Sudden onset pain - Epigastric/RUQ
• May radiate to back, inter-scapular
• Nausea, vomiting
• Pain may fluctuate or persist

23

Week 122 Biliary/Pancreatic Function: What would an USS of acute cholecystitis show?

Thickened wall and shadows of gallstones.

24

Week 122 Biliary/Pancreatic Function: What is the treatment for acute cholecystitis?

Opiates and antibiotics.

25

Week 122 Biliary/Pancreatic Function: Describe the pathology of chronic cholecystitis.

• Wall thickens due to infiltration of inflammatory cells.
• Gall bladder becomes rigid and non-distensible.

26

Week 122 Biliary/Pancreatic Function: What is Courvoisiers law?

Jaundice with a palpable gallbladder cannot be due to gallstones (As in chronic cholecystitis the gallbladder becomes rigid and non-distensible.).

27

Week 122 Biliary/Pancreatic Function: Biliary obstruction will alter bowels and bladder in which way?

Pale stools and dark urine.

28

Week 122 Biliary/Pancreatic Function: What is a gall stone ileus?

• The inflamed gall bladder sticks to the bowel.
• A perforation forms and the stones migrate into the bowel.
• Large bowel obstructs the small intestine.

29

Week 122 Biliary/Pancreatic Function: What is the standard surgery for the Gallbladder?

• Endoscopic cholecystectomy
• >95% success.

30

Week 122 Biliary/Pancreatic Function: How does acute pancreatitis present?

• Severe epigastric pain.
• Nausea and vomitting.
• 'Shock'
• Elevation of serum amylase.