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Study Notes - Gastroenterology > *Biliary tract and pancreas disorders 3 (Lecture 11) > Flashcards

*Biliary tract and pancreas disorders 3 (Lecture 11) Flashcards

1
Q

What are the 3 main pancreatic diseases?

A

Acute pancreatitis
Chronic pancreatitis
Pancreatic tumours

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2
Q

What are the 5 parts of the pancreas?

A 
Uncinate process
Head
Neck
Body
Tail
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3
Q

What do alpha islet cells release?

A

Glucagon

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4
Q

What do Beta islet cells release?

A

Insulin

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5
Q

What do Delta islet cells release?

A

somatostatin

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6
Q

What do PP cels release?

A

Pancreatic polypeptide

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7
Q

What are the 2 categories of acute pancreatitis?

A

Mild acute

Severe acute

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8
Q

What is the predominant feature of mild acute pancreatitis?

A

interstitial oedema of the gland

Associated with minimal organ dysfunction and an uneventful recovery

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9
Q

What is severe acute pancreatitis?

A

Associated with organ failure and/ or local complications such as necrosis (with infection), pseudocyst or abscess

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10
Q

What viral infections can cause acute pancreatitis?

A

Mumps
Coxsackie B (can cause hand foot and mouth disease)
Viral hepatitis

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11
Q

What other factor can cause acute pancreatitis apart from GET SMASHED?

A

Genetic factors

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12
Q

What genetic factors can cause acute pancreatitis?

A

Cationic trypsinogen gene

CF gene

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13
Q

What drugs can cause pancreatitis? (4)

A

Valproic acid
Azathioprine
L-asparaginase
Corticosteroids

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14
Q

What autoimmune disease can cause pancreatitis?

A

IgG4-related autoimmune disease

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15
Q

What causes necrosis of the pancreas during pancreatitis?

A

Inflammation of the parenchyma causing hypoperfusion

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16
Q

How is acute pancreatitis diagnosed?

A

History (e.g. gallstones, alcohol, drugs, trauma, infection, ERCP)
Examination
Blood tests
Imaging

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17
Q

What is peritonism?

A

having the clinical signs of shock and peritonitis

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18
Q

Possible examination findings for acute pancreatitis? (5)

A 
Tenderness
Peritonism
Distension
Bowel sounds
Skin markings
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19
Q

Blood tests performed to look for acute percents?

A 
FBC
Clotting
U&Es
LFTs
Amylase
CRP
Glucose
Ca
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20
Q

Imaging for acute pancreatitis? (5)

A 
CXR/AXR
AUS
CT pancreas
MRI
ERCP
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21
Q

Findings on AXR suggestive of possible AP? (2)

A

Pleural effusion

Sentinel loop

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22
Q

What is a sentinel loop?

A

dilatation of a segment of small intestine

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23
Q

What is the purpose of carrying out an US for AP?

A 
To rule out biliary pancreatitis
Look for:
Gallstones
Cholecystitis
CBD diameter
Free fluid
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24
Q

What is the purpose of carrying out a CT scan for acute pancreatitis?

A

Assess severity of pancreatitis
Decide on interventions and follow up
Look for complications (e.g. fluid collection, necrosis, ascites, bleeding, abscess)

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25
Q

Use of ERCP in AP?

A

Not as a diagnostic tool!
Used for treatment of CBD stones with obstruction cholangitis as an emergency procedure
Used for treatment of acute biliary pancreatitis (if no index cholecystectomy possible)

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26
Q

What is the glasgow prognostic score?

A

PaO2 less than 8kPa
Age greater than 55 years
Neutrophils greater than 15 X 10^9/L
Calcium less than 2mmol/L
Renal function: urea greater than 16mmol/L
Enzymes (AST/ ALT greater than 200 or LDH greater than 600)
Albumin less than 32 g/L
Sugar (glucose less than 10 mol/L)
*any 3 factors means acute severe pancreatitis

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27
Q

What Glasgow prognostic score = acute severe pancreatitis?

A

3

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28
Q

Apart form the Glasgow prognostic score, what is another scoring system that can be used to acute pancreatitis?

A 
Ranson score (only for alcohol-induced pancreatitis)
Balthazar score - used to assess percentage of necrosis and severity score from a CT scan (CT severity index)
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29
Q

Symptoms of acute pancreatitis? (7)

A 
Epigastric/ diffuse abdominal pain +/- radiation to the back
Nausea and vomiting
Indigesiton
Abdominal tenderness
Loss of appetite +/- weight loss
Temperature
Jaundice (pain)
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30
Q

What type of acute pancreatitis are most pancreatitis?

A

Mild pancreatitis (85% - mortality = 1%)

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31
Q

How long does it take for all necrosis from pancreatitis to show up?

A

4 days

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32
Q

What are the local complications from Acute pancreatitis? (6)

A 
Fluid collection
Pseudocysts
Abscess
Necrosis +/- infection
Ascites
Pleural effusion
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33
Q

What are the systemic complications of acute pancreatitis? (8)

A 
Pulmonary failure
Renal failure
Shock
Sepsis
Metabolic acidosis
Hyperglycaemia
Hypoglycaemia
MODS (multi organ failure)
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34
Q

What problems can pseudocysts cause?

A

They can cause biliary and/ or gastric outlet obstruction

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35
Q

Symptoms of a pseudocyst? 95)

A 
Pain
nausea
Vomiting
Jaundice
Weight loss
36
Q

Treatment of pseudocysts?

A 
Endoscopic drainage
Surgical drainage (open/laparotomy)
(cystgastrostomy or cystjejunostomy can be performed in order to drain the cyst into the stomach or jejunum)
37
Q

Treatment of a pancreatic abscess?

A

CT/US guided retroperitoneal or transpirational drainage

drain abscess, control sepsis

38
Q

Management of necrosis?

A

CT for assessment
Sterile or infected?
If sterile, it should be treated conservatively
May require drainage or necrosectomy and lavage if infected

39
Q

What drugs have been shown to be beneficial for the treatment of acute pancreatitis?

A

no drug therapy has been shown to be beneficial

40
Q

What is chronic pancreatitis?

A

Progressive and irreversible destruction of pancreatic tissue
Results in permanent loss of endocrine and exocrine function

41
Q

What is pancreatic divisum?

A

congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts

42
Q

What are the 5 main causes of chronic pancreatitis?

A 
Familial
Alcohol
Hyperparathyroidism/ hypercalcaemia
CF
Alpha-antitrypsin deficiency
Pancreatic duct obstruction (cholelithiasis, structure, tumour, pseudocyst, pancreas divisum)
Tropical (deficient in methionine and trace elements)
Autoimmune pancreatitis (IgG4 subclass)
43
Q

How is autoimmune chronic pancreatitis treated?

A

Steroids

44
Q

Diagnosis of chronic pancreatitis?

A 
History
Examination
Blood tests
Imagining
*same as for acute pancreatitis except IgG4 and CA 19-9 pancreatic function tests are also performed
45
Q

What are the 2 main imaging signs of chronic pancreatitis?

A

Extensie pancreatic calcification

Pancreatic duct dilation

46
Q

Treatment of chronic pancreatitis?

A

Drugs e.g. analgesics, creon, vitamins, insulin
No alcohol and low fat diet may help
Surgery (pancreatectomy or pancreaticojejunostomy) if unremitting pain/ weight loss

47
Q

What is another name for a pancreaticojejunostomy?
What does this involve?
Other 2 similar procedures?

A

Pustow procedure
Dilated pancreatic duct is filleted open and joined to the jejunum (which is also filleted open)
This allows pancreatic juice to enter the jejunum
(Frey procedure is the same as the pastor procedure although the head of the pancreas gets pulled out a bit more)

48
Q

What type of procedure is used to treat chronic pancreatitis with inflammatory head tumour?

A

Beger procedure

49
Q

Complications of chronic pancreatitis?

A 
Splenic vein thrombosis
Pseudoaneurysms
Pancreatic cancer
pseudocyst
Bile duct or duodenal obstruction
Pancreatic ascites
Pleural effusion
50
Q

Treatment of a biliary obstruction?

A

Stent, bypass, resection

51
Q

Treatment of a duodenal obstruction?

A

Stent, bypass, resection

52
Q

What is the treatment for a pseudocyst?

A

Endoscopic drainage
Surgical drainage
Resection

53
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol (abstinence is associated with a more favourable prognosis)

54
Q

Does stopping smoking have a higher chance of favourable outcomes for chronic pancreatitis?

A

Yes

55
Q

What is the most common type of exocrine pancreatic tumour?

A

Adenocarcinoma (95% of exocrine pancreatic tumours)

56
Q

What are the 5 possible types of endocrine pancreatic cancers?

A 
Gastrinoma
Insulinoma
Glucagonoma
(tends to be smaller and more easily treated than adenocarcinoma)
Somatostatinoma
Vipoma
57
Q

Symptom of a gastroma?

A

Produces gastrin causing increased stomach acid = gastric/ duodenal ulcers

58
Q

Symptom of an insulinoma?

A

Produces insulin, causing the body to store sugar rather than burn it = hypoglycaemia

59
Q

Symptom of a glucagoma?

A

Produces glucagon, increasing blood sugar levels = hyperglycaemia

60
Q

what are symptoms of somatostatinoma?

A

Diabetes

Steatorrhoea

61
Q

Symptoms of vipoma?

A

Severe diarrhoea
Hypokalaemia
Achlorhydria

62
Q

What is achlorhydria

A

Absence of HCl acid in gastric secretions

63
Q

Symptoms of pancreatic cancer?

A

Jaundice (dark urine and light stools)
Back pain
Weight loss (anorexia, nausea, vomiting)

64
Q

Risk factors for pancreatic cancer? (4)

A

Smoking
Diabetes
Familial pancreatitis
Obesity

65
Q

How is pancreatic cancer diagnosed?

A

History
Examination (abdo exam probs won’t tell you anything unless they have metastases)
Blood tests
Imaging

66
Q

How can you diagnose pancreatic cancer from ERCP?

A

Can take brushings = biopsy

67
Q

Staging system for pancreatic cancer?

A

TNM

68
Q

What is Tis for pancreatic cancer?

A

Very early stage, has not had the chance to spread 9carcinoma in situ

69
Q

T1 for pancreatic cancer?

A

The size of the tumour in the pancreas is 2cm or less in any direction

70
Q

T2 for pancreatic cancer?

A

The tumour is more than 2cm across in any direction

71
Q

T3 for pancreatic cancer?

A

The cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or bile duct

72
Q

T4 for pancreatic cancer?

A

The cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels

73
Q

N1 pancreatic cancer?

A

Has spread into lymph nodes (N0 = has not spread)

74
Q

M1 pancreatic cancer?

A

Has spread to distant body parts (M0 = has not)

75
Q

Stage 1 pancreatic cancer?

A

Cancer is confined to the pancreas

76
Q

Stage 2 pancreatic cancer?

A

Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes

77
Q

Stage 3 pancreatic cancer?

A

Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes

78
Q

Stage 4 pancreatic cancer?

A

Cancer has spread to distant sites beyond the pancreas such as the liver, lungs and the peritoneum

79
Q

Treatment for pancreatic cancer?

A

Surgery = only curative method
Chemotherapy
Radiotherapy
Combinations

80
Q

Types of surgery for resectable pancreatic tumours? (4)

A

Whipple resection
Total pancreatectomy
Distal pancreatectomy
Midsegment pancratectomy

81
Q

Types of surgery for non-resectable pancreatic tumours?

A

Biliary bypass
Gastric bypass
Double bypass

82
Q

What is involved in Whipple’s operation?

A

Part of the stomach and the head of the pancreas are removed - remaining stomach and pancreas are joined separately to the small intestines

83
Q

Distal pancreatectomy?

A

Body and tail of the pancreas and usually the spleen are removed

84
Q

Biliary bypass?

A

Rerouting the flow of bile from the common bile duct into the intestine bypassing the pancreas

85
Q

Gastric bypass?

A

Pancreatic tumour can block the duodenum - surgery directly joins the stomach and the small intestine

Study Notes - Gastroenterology (42 decks)

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