69. Pancreatic Disorders

Question 1

Describe the presentation of chronic pancreatitis?

Answer 1

Long term inflammation in the pancreas, relapsing and remitting disease.

Epigastric pain, steatorrhoea, weight loss, brittle diabetes.

Question 2

How can you test for chronic pancreatitis?

Answer 2

Ultrasound/CT- pancreatic calcification
MRCP/AXP
Faecal elastase

Question 3

What is the treatment of chronic pancreatitis?

Answer 3

Analgesia
Lipase (creon)
Insulin?

Diet: no alcohol, low fat. Medium chain triglycerides.
Surgery for unremitting pain

Question 4

What are the complications of chronic pancreatitis?

Answer 4

Pseudocyst, 
Diabetes
Biliary obstruction
Local arterial aneursym 
Splenic vein thrombosis 
Gastric varices 
Pancreatic carcinoma

Question 5

What are the risk factors for pancreatic cancer?

Answer 5

Smoking, 
Alcohol
Carcinogens
DM
Chronic pancreatitis
Increased weight circumference
High fat/red meat diet

Question 6

What genetic mutations are associated with pancreatic cancer?

Answer 6

KRAS2 gene

Question 7

Describe the pathology of pancreatitis?

Answer 7

Majority are ductal adenocarcinomas

60% head 25% body 15% tail

Question 8

How does a patient with pancreatic cancer present?

Answer 8

Painless jaundice 
Epigastric pain
Anorexia
Weight loss
Diabetes
Acute pancreatitis 

(Rare features- thrombophlebitis, increased calcium, portal hypertension)

Question 9

What are the clinical signs of pancreatic carcinomas?

Answer 9

Jaundice and palpable gallbladder
Epigastric mass
Hepatomegaly
Splenomegaly 
Lymphadenopathy
Ascites

Question 10

What are the treatments for pancreatic cancer?

Answer 10

Surgical resection: pancreatoduodenectomy, whipple’s
Laparoscopic excision
Post-op chemo
Palliation of jaundice- percutanoues stent insertion
Pain- opiates