12 Abdominal Pain and Pancreatitis Flashcards
Q: What are the 2 functions of the pancreas?
A: Endocrine
Islet cells of Langerhans
Exocrine
1.5 L of pancreatic juice, enzyme rich for digestion of fats, carbohydrates and proteins
Q: What is acute pancreatitis defined as?
A: ICD-10
An acute inflammatory process that leads to necrosis of the pancreatic parenchyma.
Q: What are the signs and symptoms of pancreatitis? (6) Pulse? BP?
A: severe abdominal pain, -> starts at front and go through to back
nausea, vomiting, -> really close to stomach and duodenum -> can cause degree of obstruction
diarrhoea, -> food stops being digested properly
fever, -> severe inflammatory response
and shock. -> body can’t provide enough oxygen to tissues it needs (end stage of severe inflammatory response)
- high pulse
- low bp
Q: What tests should you do with suspected pancreatitis? (5)
A: the simple ones
BLOOD TESTS COMPLEX BLOOD TEST SIMPLE IMAGING (chest/abdo Xray, CT, ultrasound, MRCP) CROSS SECTIONAL (COMPLEX) IMAGING INVASIVE TEST
Q: What invasive test should you do with suspected pancreatitis?
A: ERCP
Endoscopic Retrograde Cholangio-Pancreatography
put in endoscope and put wire into ampulla vater-> insert dye and see result
Q: What scoring systems are used for pancreatitis? (3)
A: Ranson’s criteria
APACHE II
SIRS
Q: What are the risk factors for pancreatitis severity? (5)
A: Necrosis vs non necrosis Organ failure Age Co morbidities Alcohol
Q: What causes pancreatitis?
A: Gallstones
Ethanol (alcohol)
Trauma => top 3 most common
Steroids Mumps Autoimmune Scorpion bite (trinidad) Hyperlipidaemia/ Hypercalcaemia/Hypothermia ERCP Drugs (azathioprine, valproate)
Q: What are systemic complications of acute pancreatitis? (6)
A: Hypovolaemia Hypoxia Hypocalcaemia Hyperglycaemia Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body blocking small blood vessels Multiple organ failure
Q: What localised complications of acute pancreatitis? (4)
A: Pancreatic necrosis
Fluid collections – mature into pseduocysts
Splenic vein thrombosis/pseudoaneurysm
Chronic Pancreatitis
Q: What kind of treatment is given for acute pancreatitis? Examples. (5)
A: Supportive (can’t remove)
Fluids Painkillers Nutrition Organ Support Management of complications
Q: Define chronic pancreatitis.
A: progressive fibroinflammatory process of the pancreas that results in permanent structural damage, which leads to impairment of exocrine and endocrine function
Q: What are the physiological results of chronic pancreatitis? (3)
A: Malabsorption (=diarrhoea)
Loss of 90% exocrine function -> below
Fat soluble vitamin malabsorption (A, D, E, K)
Q: 3 exams for chronic pancreatitis?
A: Plain Xray
CT scan
Faecal elastase
Q: 4 management steps for chronic pancreatitis.
A: Stop alcohol and smoking
Small meals with low fat (tries to prevent chronic gastric pain)
PPI and pancreatic supplements (need to counteract stomach acid as well to make sure they work)
Analgesia
