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Finals - Gastroenterology > Acute and Chronic Pancreatitis > Flashcards

Acute and Chronic Pancreatitis Flashcards

1
Q

What is acute pancreatitis?

A

Sudden inflammatory process with cascade release of inflammatory cytokines (TNF alpha, IL2, IL4) and pancreatic enzymes (trypsin/lipase ect)

Inflammation and auto-digestion leads to inflammation and haemorrhage of the pancreas

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2
Q

What are the causes of pancreatitis?

A

GET SMASHED

Gallstones (60%, 2:1 cause UK)
Ethanol (30%)
Trauma (or Infection)
Steroids, 
Mumps
Autoimmune pancreatitis
Scorpion sting, 
Hyperlipidemia (hypothermia, hyperparathyroidism)
Endoscopic retrograde cholangiopancreatography (ERCP)
Drugs
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3
Q

What are the clinical features of pancreatitis? (4)

A
  1. Severe epigastric pain, radiating to back
  2. Anorexia, nausea and vomitting
  3. Fever, dehydration, hyrotension, tachycardia (Septic Shock)
  4. Abdominal guarding
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4
Q

What are the classifications of pancreatitis? (3)

A

Oedematous (70%)
Severe/necotising (25%)
Haemorrhagic (5%)

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5
Q

What are the 3 scoring systems of pancreatitis?

A

Abbreviated glasgow scoring system
Ranson criteria
Balthazar score

(APACHE II may be used in intensive care)

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6
Q

What is the management of pancreatitis?

A 
Analgesia!
Catheterise
ABCDE approach to resus/shock
Drainage of collections may be required
Antibiotics (ceftriaxone-metronidazole)
Bowel rest
Nutrition: NG/NJ feed and dietary supplements, potentially TPN
IV infusion and fluid resuscitation
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7
Q

What drugs can cause pancreatitis?

A

Steroids
Azothioprine (DMARD)
Diuretics
NSAIDS

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8
Q

What signs are seen in hemorrhagic pancreatitis?

A

Grey-Turner’s signs (Left flank bruising)

Cullen’s signs (peri-umbilical bruising)

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9
Q

Pancreatitis is diagnosed on the basis of 2 out of 3 of what criteria?

A
  1. Characteristic severe epigastric pain radiating into back.
  2. Serum amylase of >1000U
  3. Abdominal CT scan pathology of pancreas
  4. Abnormality on abdominal x-ray (non-specific, CT more useful)
  5. USS may show gallstones
  6. Serum lipase (more specific)
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10
Q

What makes up the abbreviated glasgow scoring system?

A

8 clinical indicators, if >3 indicates need for ITU or anaesthetic review

PANCREAS

PaO2 <8kPa
Age > 55 years
Neutrophils > 15 x 10^9
Calcium < 2 mmol/l
Raised urea > 15 mmol/l
Elevated enzymes LDH or AST (levels)
Albumin < 32g/l
Serum glucose >15 mmol/l
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11
Q

What does the Ranson Criteria allow you to predict?

A

Risk of mortality

Scores taken at admission and at 48 hours

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12
Q

What does the Balthazar score use to grade?

A

Appearance of CT

Necrosis score

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13
Q

What are the potential complications of pancreatitis?

A

Systemic inflammatory response syndrome (SIRS)
(Pro-inflammatory state that doesn’t include a documented source of infection)

Haemorrhage and hypovolemic shock

Disseminated intravascular coagulation (DIC)

Multiple Organ Dysfunction Syndrome (MODS)

Acute respiratory distress syndrome

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14
Q

What is chronic pancreatitis?

A

Unknown mechanism causes activation of pancreatic enzymes leading to pancreatic tissue necrosis with eventual fibrosis.
(Abnormality of bicarbonate excretion)
Results in irreversible damage

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15
Q

What is the epidemiology of chronic pancreatitis?

A

Worldwide prevalence approx 4-5%

4:1 male:female

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16
Q

What changes are seen with alcohol consumption that leads to chronic pancreatitis?

A

Alcohol causes proteins to precipitate in the ductal structure of the pancreas, leading to dilatation and fibrosis.
No dose-response relationship, patients who drink a ‘normal’ amount can develop it.

17
Q

What is the clinical presentation of chronic pancreatitis?

A

Severe abdominal pain, radiating to back.
Nausea and vomiting
Decreased appetitie
Exocrine dysfunction (malabsorption with weight loss, diarrhoea, steatorrhoea and protein deficiency)
Endocrine dysfuntion (diabetes mellitus)

18
Q

What are the exocrine functions of the pancreas?

A

Releasing digestive enzymes

19
Q

What is the endocrine function of the pancrease?

A

Releasing insulin and glucagon

20
Q

What is autoimmune chronic pancreatits?

A

Chronic pancreatic inflammation resulting from an autoimmune process

High prevalence in Japan

21
Q

What is a clinical identifier of autoimmune chronic pancreatitis?

A

Elevated levels of serum gammaglobulins and immunoglobulin G (IgG)

22
Q

How can auto-immune chronic pancreatitis be treated?

A

Steroids

23
Q

Where is the pancreas located?

A

Epigastric region behind the stomach

24
Q

What cells secrete the exocrine enzymes and what do they secrete?

A

Acinar cells

Trypsinogen

Amylase (Starch)
Protease (Protein)
Lipase (Fat)

25
Q

How does alcohol cause acute pancreatits?

A

Alcohol increases zymogen production
Secretions become thick
Pancreatic duct can become blocked

Also stimulates acinar cells to recrease inflammatory cytokines

26
Q

How do gallstones cause acute pancreatits?

A

Gallstones can become lodged in the spincter of oddi

Blocks the release of pancreatic juices

27
Q

What is a pancreatic pseudocyst?

A

Complication of acute pancreatitis

Occurs when fibrous tissue surrounds the liquefactive necrotic tissue of the pancreas

(Palpable tender mass)

28
Q

What is seen with serum calcium in acute pancreatitis?

A

Hypocalcemia

Fat necrosis consumes calcium

29
Q

What is the difference in the histopathology of acute and chronic pancreatitis?

A

Acute - autodigestion - reversible

Chronic - persistent inflammation - causes by changes to structure (fibrosis, atrophy, calcification) - irreversible

30
Q

What causes of acute pancreatitis often lead to the development of chronic pancreatitis?

A

(Any which remain for a significant amount of time)

Tumours
Trauma
Cystic Fibrosis (Term refers to pancreatic cysts which form)

31
Q

What is the main cause of chronic pancreatitis in children?

A

Cystic Fibrosis

32
Q

What changes to the pancreas are seen in chronic pancreatitis?

A

Ductal dilatation
Fibrosis of tissue
Acinar cell atrophy
(Sometimes calcium deposits)

33
Q

Why is chronic pancreatitis difficult to diagnose?

A

Vague symptoms

Pancreatic enzyme levels may be normal (where raised in acute)

34
Q

How is chronic pancreatitis usually diagnosed?

A

Imaging - Looking or chronic changes

X-rays
CT-scans

ERCP - Endoscopic retrograde cholangiopancreatogrpahy
(or MRCP)

35
Q

What does chronic pancreatitis lead to?

A

Pancreatic insufficiency

Trouble absorbing food and fat
Weight loss
Deficiency in fat-soluble vitamins (ADEK)
Steatorrhoea

+ Development of Diabetes Mellitus

Pancreatic pseudocysts

36
Q

What treatment may be required for chronic pancreatitis (and pancreatic insufficiency)?

A

Control pain
Control risk factors

For pancreatic insufficiency:
Replace digestive enzymes
Nutritional supplements
Insulin therapy

Finals - Gastroenterology (6 decks)

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