13. Pancreatitis and Pancreatic Carcinoma Flashcards
What are the causes of pancreatic injury?
I GET SMASHED
Idiopathic
Gallstones, Ethanol, Trauma
Steroids, mumps, autoimmune, scorpion sting, high TAGs/ calcium, ERCP, Drugs
What drugs can injure the pancreas?
Thiazides
What are the symptoms of acute pancreatitis?
Sudden pain radiating to back, relieved when sitting forward
Nausea and vomiting
SIRS
What are the signs of acute pancreatitis?
Dehydration
Epigastric guarding
Tachycardia, tachypnoea, mild pyrexia
What additional signs can be seen if acute pancreatitis is associated with cholangitis?
Jaundice
Pyrexia
RUQ pain
What is Cullen’s sign?
Peri-umbilical bruising
What is Grey Turner’s sign?
Flank bruising
What systems are used to classify acute pancreatitis?
Atlanta classification
Glasgow criteria
Ranson criteria
What are the components of the Glasgow criteria?
PaO2 Age Neutrophilia Calcium Renal function Enzymes Albumin Sugar
What investigations should be done into acute pancreatitis?
FBC, CRP, LFTs, U&Es, calcium, albumin, glucose ABG CXR Ultrasound (gallstones) CT to judge severity
What can be seen on CXR in acute pancreatitis?
Free air under the diaphragm
What should be given in acute pancreatitis for a patient with alcohol withdrawal?
Chlordiazepoxide
Pabrinex
What complications are associated with acute pancreatitis?
Pseudocyst, abscess, intra-abdominal sepsis
Necrotising pancreatitis
ARDS
Acute kidney injury
Pancreatic haemorrhage, chronic pancreatitis
What does necrotising pancreatitis result in?
Erosion of arteries causes haemorrhage
What are the causes of ARDS in acute pancreatitis?
Fluid leak through diaphragm, pleural effusions
SIRS
What are the common causes of mortality in acute pancreatitis?
Week 1-2 die of SIRS
After week 2 die of complications of sepsis
What is the secondary prevention of acute pancreatitis?
Remove gallstones or tumour
Reduce alcohol dependence
Treat high calcium and lipids
What is the pathogenesis of chronic pancreatitis?
Protein precipitates in the pancreatic tubules
Calcium deposits on top and causes obstruction
Patchy fibrosis causes eventual pancreatic failure
What are the causes of chronic pancreatitis?
Recurrent acute pancreatitis Tumours of the head of the pancreas Pancreatic duct strictures Congenital 2 ducts CF Autoimmune disease
What disease does a man with a nobbly liver and 1 eye have?
Malignant melanoma
What is the treatment for chronic pancreatitis?
Treat cause
Reduce fat
Creon enzyme supplements
analgesia
What is the treatment for painful chronic pancreatitis?
Endoscopic therapy
Celiac nerve block
Whipple’s procedure
What is Courvoisier’s law?
Palpable gallbladder in jaundiced patient is unlikely to be due to gallstones
What are the risk factors for pancreatic cancer?
Age
Smoking, alcohol
Diabetes
Chronic pancreatitis
Where is a common location for a secondary nodule from pancreatic cancer?
Umbilicus
What is the management of pancreatic cancer?
Palliative:
Stent through tumour
Gastro-jejunostomy (bypass blockage in duodenum)
Coeliac axis block
What is Whipple’s procedure?
Resect part of the stomach, duodenum, pancreatic head and neck, gall bladder, part of the bile duct and lymph nodes
