Disorders of the exocrine pancreas Flashcards
Causes of non-gallstone pancreatitis
Alcohol Infection Trauma Azathioprine, sodium valproate, diuretics Hypothermia Hypercalcaemia Hyperlipidaemia Post ERCP
I GET SMASHED acute pancreatitis
Idiopathic Gall stones Ethanol (alcohol) Trauma Steroids Mumps Autoimmune Scorpion bites Hyperlipidaemia/hypothermia ERCP Drugs (azathioprine, diuretics)
Typical presentation of acute pancreatitis
Severe abdominal pain of sudden onset, radiate to the back
Nausea
Vomiting
Upper abdomen is usually tender to palpation
Diagnosis of acute pancreatitis
Serum amylase is greatly elevated (5X or more)
Acute pancreatitis Treatment
Kept ‘nil by mouth’
IV water and electrolyte replacement
Opiate analgesia (not morphine)
Complications of acute pancreatitis
Formation of pseudocyst Renal failure due to shock DIC relapses Diabetes mellitus Severe--> necrosis
Causes of Chronic pancreatitis
Alcohol Idiopathic- associated with PVD Trauma-obstruction of the main duct Hypercalcaemia- calcified plugs block pancreatic duct Cystic fibrosis Hereditary
Clinical Features of Chronic Pancreatitis
Chronic epigastric pain radiating to the back
Steatorrhoea
Secondary diabetes mellitus (destruction of pancreatic islet cells)
Diagnosis of Chronic Pancreatitis
Serum amylase-normal
CT scan with EUS or MRI
Speckled calcification of the pancreas (binding of calcium ions binding to necrosed fat)
Treatment of Chronic Pancreatitis
Stopping alcohol
Analgesia
Surgery in those committed to stopping alcohol
Pancreatic enzyme supplements
Low fat diet
DM- insulin or diet control and oral hypoglycaemic agents
What are pseudocysts?
Localised collections of serosanguinous fluid found 6 weeks after the onset of an acute pancreatic attack
Description of the pseudocyst:
Solitary, 5-10cm in diameter and lie in the lesser sac
Clinical Feature of pseudocyst
Chronic pain
Persistent raised serum amylase levels
