CHRONIC PANCREATITIS & PANCREATIC CANCER

Question 1

What is the main symptom of chronic pancreatitis?

Answer 1

Chronic abdominal pain

May wax and wane, worse after meals

Question 2

Pancreatitis can cause thrombosis in which vein? What will this cause? How does this present?

Answer 2

Splenic vein

obstruct drainage of blood from spleen → dilates vessels between left gastric vein and splenic vein

♦ Presents as UGI bleed with enlarged spleen and gastric varices

Question 3

What three things seen on the patient results from pancreatic insufficiency?

Answer 3

• Fat malabsorption and steatorrhoea
• Fat soluble vitamin deficiencies
• Diabetes

Question 4

What is the classic presentation of pancreatic cancer?

Answer 4

Painless jaundice

May also complained of abdominal pain, weight loss, tiredness

Question 5

A classic physical exam finding for pancreatic cancer is Courvoisier’s sign. Explain what this is

Answer 5

States that presence of a palpably enlarged gallbladder which is non-tender and accompanied by painless jaundice → unlikely to be caused by gallstones

Question 6

What is Trousseou’s syndrome?

Answer 6

Migratory thrombophlebitis (inflammation of vein due to blood clot)

Question 7

What are the two strongest risk factors for pancreatic cancer?

Answer 7

• Age >50
• Smoking
• Diabetes and chronic pancreatitis (over 20 yrs)

♦ not strongly associated with alcohol

Question 8

If an Ashkenazi Jew is diagnosed with pancreatic cancer what screening should be done for the rest of the family?

Answer 8

BRCA2 mutation (DNA repair protein)

Question 9

What is the most frequently mutated gene and pancreatic cancer?

Answer 9

K-RAS

Question 10

What is the classic surgical procedure carried out in pancreatic cancer?

Answer 10

Whipple procedure

Question 11

What does this CT show?

Answer 11

Calcified pancreas: classic finding of chronic pancreatitis. Presents with pancreatic insufficiency