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GI Year 2 > Acute and chronic Pancreatitis +pancreatic carcinoma > Flashcards

Acute and chronic Pancreatitis +pancreatic carcinoma Flashcards

1
Q

Aetiology of acute pancreatitis

A

Acute inflammation
Primary insult
Release of activated pancreatic enzyme
Auto digestion

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2
Q

RF for acute pancreatitis

A 
Alcohol abuse
Gallstones 
Trauma 
-blunt
-post op
-post ERCP (endoscopy looking at pancreas and bileduct)
Drugs
Viruses
Carcinoma 
Metabolic (Inc. Ca, triglycerides, dec. temp)
Autoimmune
Idiopathic
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3
Q

Ix for acute pancreatitis

A 
Bloods 
-amylase/lipase
-U+E
-LFTs
-ABGs
-AXR and CXR
-abdo US
-CT
Glasgow criteria score >3=acute severe pancreatitis 
CRP>150mg/L
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4
Q

Tx for acute pancreatitis

A 
Analgesia
IV fluids
Blood transfusion if Hb<10g/L
Monitor urine output via catheter 
NG tube 
O2 
May need insulin
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5
Q

If gallstones are present

A

EUS
MRCP
ERCP

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6
Q

If an abscess is present

A

Antibiotics

Drainage

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7
Q

If a psuedocyst is present Tx

A 
Fluid collection without an epithelial lining 
Persistent hyperamylasia and/or pain
Complications
-jaundice 
-infection 
-haemorrhage 
-rupture

If its less than 6cm in diameter then it may resolve spontaneously
Endoscopic drainage or surgery of persistant pain or complications

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8
Q

What is the definition of chronic pancreatitis?

A

Inflammatory disease characterised by irreversible glandular destruction and typically causing pain and or loss of function

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9
Q

The genes associated with pancreatitis

A

PRSS1
SPINK1
CFTR

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10
Q

3 reasons for duct obstructions

A

Calculi
Inflammation
Protein plugs

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11
Q

Causes of abnormal sphincter of Oddi function

A

Spasm=increased pancreatic pressure

Relaxation=reflux of duodenal contents

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12
Q

What do genetic polymorphisms lead to

A

Abnormal trypsin activation

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13
Q

What happens physiologically for chronic pancreatitis

A

Glandular atrophy and replacement by fibrous tissue
Ducts become dilated, torturous and strictured
Inspissated (thickened or congealed) secretions may calcify
Splenic, superior mesenteric veins maybe thrombose>portal hypertension

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14
Q

S+S for chronic pancreatitis

A 
Early disease is asymptomatic 
Abdominal pain
Weight loss
Exocrine insuffiency (fat malabsorption=steatorrhea, dec.fat soluble vitamins=dec.Ca+Mg, protein malabsorption=weight loss, dec B12)
Endocrine insuffiency=diabetes in 30%
Jaundice 
Portal hypertension 
GI haemorrhage 
Pseudocysts 
Pancreatic carcinoma
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15
Q

Ix for chronic pancreatitis

A 
AXR
US
-pancreatic size
-cysts
-duct diameter
-tumours
CT scan
Bloods
-serum amylase increased in acute exacerbations 
-dec. albumin, prothrombin time and glucose
-increased LFTs
Pancreatic function tests (Lundh)
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16
Q

Tx for chronic pancreatitis

A 
Avoid alcohol
Pancreatic enzyme supplements 
Opiate aalgesia
Coeliac plexus block 
Referral to pain clinic/psychologist 
Endoscopic treatment of pancreatic duct stones and strictures 
Surgery maybe
Low fat diet 
Pancreatic enzyme supplements may need acid suppression to prevent hydrolysis in stomach 
Insulin for diabetes
17
Q

4 types of pancreatic carcinomas

A

Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell

18
Q

Symtoms of pancreatic carcinoma

A 
Upper abdominal pain
Painless obstructive jaundice 
Weight loss
Anorexia, fatigue, steatorrhea/diarrhoea, nausea and vomiting 
Tendersubcutaneous fat nodules due to metastatic fat necrosis 
Thrombophlebitis migran (inflammatory process which causes blood to clot in veins which are recurrent and in different places)
Ascites (abnormal fluid in the abdomen)
Portal hypertension
Hepatomegaly/splenomegaly 
Jaundice 
Abdominal mass
Supraclavicular lymphadenopathy
Palpable gallbladder
19
Q

4 RFs for pancreatic carcinoma

A

Smoking
Chronic pancreatitis
Hereditary pancreatitis
Inherited predisposition

20
Q

Ix for pancreatic carcinoma?

A 
Bloods
CXR
USS
ERCP
Laparoscopy 
Patient assessment:
-basic history and exam 
-CXR, ECG
-resp function tests
-physiological scoring 
- -performance status
- -lactate threshold 
- -no test established
21
Q

Two types of surgical Tx for pancreatic carcinoma?

A

Kausch-wipple

PPPD

22
Q

How do you know if acute pancreatitis is mild or severe?

A

Mild=minimal organ dysfunction and an uneventful recovery

Severe=associated with organ failure or local complication

23
Q

4 local complications of acute pancreatitis?

A

Acute fluid collections
Pseudocysts
Pancreatic abscess
Pancreatic necrosis

24
Q

RFs for acute pancreatitis

A

GET SMASHED

Gallstones
Ethanol
Trauma

Scorpion sting
Mumps
Autoimmune
Steroids
Hypercalcemia/hypertriglycerides 
ERCP
Drugs
25
Q

Is NBM enforced after surgery?

A

No, nutrition is vital

26
Q

RFs for chronic pancreatitis?

A

O A TIGER

Obstruction
Autoimmune
Toxin
Idiopathic
Genetic Recurrent injuries

GI Year 2 (22 decks)

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