Gastro - Chronic pancreatitis. Pancreatic cancer Flashcards
Acute and chronic pancreatitis definition? Difference?
Acute pancreatitis is rapid onset of inflammation and symptoms. It is caused by autodigestion and is reversible.
Chronic is longer term inflammation and symptoms with progressive and irreversible deterioration of pancreatic function.
It results from persistent inflammation caused by changes to structure of pancreas (such as by fibrosis, atrophy, and calcification)
Causes of chronic pancreatitis?
Alcohol - most common
Genetic – Cystic fibrosis (CF main cause in children)
Ductal obstruction
Autoimmune
Tumours
Trauma
Idiopathic
Roles of pancreas?
Exocrine function: producing digestive enzymes to break down carbs, fats and proteins (amylase, lipase, trypsin)
Endocrine function: alpha and beta cells secrete hormones Insulin and glucagon to control blood sugar
Can acute pancreatitis become chronic?
Yes, each bout of acute pancreatitis has a chance for ductal dilatation and stellate cells can cause fibrosis of tissue which causes stenosis of ducts.
Alcoholic acute pancreatitis also can cause calcium to deposit on protein plugs obstructing ducts.
chronic pancreatitis Sx?
Upper abdo pain\ tender mass
Sudden weight loss
Steatorrhea
Diabetes
Deficiency in fat soluble vitamins (ADEK)
chronic pancreatitis ddx?
Pancreatic, ampullary cancer
Cholangitis
Crohn’s
Chronic gastritis
Bowel perforation
Mesenteric ischemia
chronic pancreatitis Dx:
Elevated Lipase and amylase suggests acute. But in chronic may not be enough healthy tissue to produce sufficient amounts
US
Xray CT – can show calcifications.
Endoscopic retrograde cholangiopancreatography
Fluoroscopy showing ‘chain of lakes’ pattern of alternating stenosis and dilation.
Magnetic resonance cholangio-pancreatography
Chronic pancreatitis complications?
DM – inflammation of alpha and beta cells stops productions of insulin
Pseudocyst or abscess formation
Pancreatic ductal adenocarcinoma
Splenic vein thrombosis
Pancreatic ascites or pleural effusion
Chronic pancreatitis tx?
Control risk factors: Stop alcohol and smoking. Less meat. Weight loss
Analgesia
Replacement pancreatis enzymes particularly lipase
Insulin injections to treat DM
ERCP with stenting
Surgery: ductal drainage,
pancreatic-jejunostomy, pancreatectomy
Pancreatic cancer definition?
Cancer of pancreas which is highly invasive and usually are adenocarcinomas. Most often occur at head (60%) of the pancreas. Can also occur on the body (15%) and tail.
Pancreatic cancer sx?
MOST IMP: Painless obstructive jaundice – tumor large enough to compress bile duct.
Pale stools
Dark urine
Generalised itching
Weight loss
Epigastric mass
New onset diabetes or worsening of type 2
What is the ddx of painless obstructive jaundice?
Pancreatic cancer or cholangiocarcinoma
Pancreatic cancer metastasis?
Liver
Lungs
Peritoneum
Bones
When should you refer a pt when query pancreatic cancer?
> 40 with jaundice – 2 week wait referral
60 weight loss plus addional sx like diarrhea, back pain, abdo pain, new onset diabetes
They should get a CT done
Dx of pancreatic cancer?
Courvoisier’s law – palpable gallbladder along with jaundice
Trousseau’s sign of malignancy - migratory thrombophlebitis
Dx needs imaging and histology for!!
CT – staging
Biopsy – histology
Ca19-9 tumour marker
Magnetic resonance cholangio-pancreatography
Endoscopic retrograde cholangio-pancreatography
