13. Pancreatitis and Pancreatic Carcinoma

Question 1

What are the causes of pancreatic injury?

Answer 1

I GET SMASHED
Idiopathic
Gallstones, Ethanol, Trauma
Steroids, mumps, autoimmune, scorpion sting, high TAGs/ calcium, ERCP, Drugs

Question 2

What drugs can injure the pancreas?

Answer 2

Thiazides

Question 3

What are the symptoms of acute pancreatitis?

Answer 3

Sudden pain radiating to back, relieved when sitting forward
Nausea and vomiting
SIRS

Question 4

What are the signs of acute pancreatitis?

Answer 4

Dehydration
Epigastric guarding
Tachycardia, tachypnoea, mild pyrexia

Question 5

What additional signs can be seen if acute pancreatitis is associated with cholangitis?

Answer 5

Jaundice
Pyrexia
RUQ pain

Question 6

What is Cullen’s sign?

Answer 6

Peri-umbilical bruising

Question 7

What is Grey Turner’s sign?

Answer 7

Flank bruising

Question 8

What systems are used to classify acute pancreatitis?

Answer 8

Atlanta classification
Glasgow criteria
Ranson criteria

Question 9

What are the components of the Glasgow criteria?

Answer 9

PaO2
Age
Neutrophilia
Calcium
Renal function
Enzymes
Albumin
Sugar

Question 10

What investigations should be done into acute pancreatitis?

Answer 10

FBC, CRP, LFTs, U&Es, calcium, albumin, glucose
ABG
CXR
Ultrasound (gallstones)
CT to judge severity

Question 11

What can be seen on CXR in acute pancreatitis?

Answer 11

Free air under the diaphragm

Question 12

What should be given in acute pancreatitis for a patient with alcohol withdrawal?

Answer 12

Chlordiazepoxide

Pabrinex

Question 13

What complications are associated with acute pancreatitis?

Answer 13

Pseudocyst, abscess, intra-abdominal sepsis
Necrotising pancreatitis
ARDS
Acute kidney injury
Pancreatic haemorrhage, chronic pancreatitis

Question 14

What does necrotising pancreatitis result in?

Answer 14

Erosion of arteries causes haemorrhage

Question 15

What are the causes of ARDS in acute pancreatitis?

Answer 15

Fluid leak through diaphragm, pleural effusions

SIRS

Question 16

What are the common causes of mortality in acute pancreatitis?

Answer 16

Week 1-2 die of SIRS

After week 2 die of complications of sepsis

Question 17

What is the secondary prevention of acute pancreatitis?

Answer 17

Remove gallstones or tumour
Reduce alcohol dependence
Treat high calcium and lipids

Question 18

What is the pathogenesis of chronic pancreatitis?

Answer 18

Protein precipitates in the pancreatic tubules
Calcium deposits on top and causes obstruction
Patchy fibrosis causes eventual pancreatic failure

Question 19

What are the causes of chronic pancreatitis?

Answer 19

Recurrent acute pancreatitis
Tumours of the head of the pancreas
Pancreatic duct strictures
Congenital 2 ducts
CF
Autoimmune disease

Question 20

What disease does a man with a nobbly liver and 1 eye have?

Answer 20

Malignant melanoma

Question 21

What is the treatment for chronic pancreatitis?

Answer 21

Treat cause
Reduce fat
Creon enzyme supplements
analgesia

Question 22

What is the treatment for painful chronic pancreatitis?

Answer 22

Endoscopic therapy
Celiac nerve block
Whipple’s procedure

Question 23

What is Courvoisier’s law?

Answer 23

Palpable gallbladder in jaundiced patient is unlikely to be due to gallstones

Question 24

What are the risk factors for pancreatic cancer?

Answer 24

Age
Smoking, alcohol
Diabetes
Chronic pancreatitis

Question 25

Where is a common location for a secondary nodule from pancreatic cancer?

Answer 25

Umbilicus

Question 26

What is the management of pancreatic cancer?

Answer 26

Palliative:
Stent through tumour
Gastro-jejunostomy (bypass blockage in duodenum)
Coeliac axis block

Question 27

What is Whipple’s procedure?

Answer 27

Resect part of the stomach, duodenum, pancreatic head and neck, gall bladder, part of the bile duct and lymph nodes