Gastro - Pancreas and HPB Flashcards
true false acute pancreatitis is common mergency
true - 2nd commonist unusual before the age of 15
what is normal pancreas anatomy
easy access via the stomach
what triggers acute pancreatitis
pancreas produces enzymes
make them in inactive form and are secreted and activated in the bowel
damaged pancreas (e.g. alcohol)
activate increase in calcium in cell which activates the enzymes
how do you diagnose acute pancreatitis
2 of 3 of the following
Typical pancreatic type pain (severe, rapid onset, better leaning forward, radiates to the back in 50% of cases. Maximal onset normally within 20-30 minutes, does not undulate
Radiographic findings of acute pancreatitis
Elevations in blood chemistries (typically amylase and/or lipase >3x ULN)
why test lipase in some instances
Amylase peaks quick and decreases quick – if there is a delay it may be normal
Lipase increases quick and decreases slower (and is specific for pancreatitis) – don’t test first as its more money
top causes of pancreatits
alcohol
gall stones
ischaemia
triglycerides (disorders of lipproteins)
what is the first investigation (imaging)
ultrasound for gall stones
what is mirolithiasis
hundreds of tiny stones that cannot be seen
autosomal dominant hereditary pancreatitis is caused by what
autoativation of trypsinogen due to PRSS!
what drugs cause acute pancreatitis
AIDS— didanosine, pentamidine
Antimicrobial— metronidazole, sulfonamides, tetracycline , INH, dapsone, nitrofurantoin
Diuretics— furosemide, thiazides
Immunosuppressive/antimetabolite— L-asparaginase, azathioprine , 6MP, sorafinib*
Neuropsychiatric— valproic acid
Antiinflammatory— sulindac, sulfasalazine, 5-ASA, salicylates
Others— calcium, estrogen, tamoxifen, Exenatide, TPN, propofol, accutane, vit A –
Through raised Triglycerides
*sorafinib can raise lipase/amylase without pancreatitis
AND azothioprim
what infections can affect the pancreas
Viruses – Mumps, coxsackievirus, hepatitis B, cytomegalovirus, varicella-zoster, herpes simplex, HIV, atypical dengue, Hepatitis E.
Bacteria – Mycoplasma, Legionella, Leptospira, Salmonella, MAI/TB
Fungi – Aspergillus, cryptococcus
Parasites – Toxoplasma, Cryptosporidium, Ascaris, Pneumocystis carinii, Leshmaniasis
what is grey turners sign
retroperitoneal bleeding around he unbilicus due to pancreatitis
what is the scoring system used with 24-48hrs to determine severity
BISAP
SIRS (need 2 of the following)
T >38.5°C or <36.0°C, HR>90,
RR >20 or PaCO2 <32 mm Hg
WBC >12,000, <4000 or >10 percent immature (band) forms
BUN>25 – 7.5 mmol/L
Age>60
Pleural effusion
Altered mental status (glasgow CS < 15)
why is fluid resus important
pancreas is leaking - so fluid is in the 3rd spacing
what is chronic pancreatits
characterized by chronic, progressive pancreatic inflammation and scarring, irreversibly damaging the pancreas, and resulting in loss of exocrine and endocrine function.
what causes chronic pancreatits
Alcohol
Smoking
High Calcium
High Triglycerides
Tropical
Autoimmune
Obstructive
Hereditary - cystic fibrosis
Chronic Renal failure
what imaging do you use for diagnosing pancreatitis
CT
calcification in the parenkia
stones in the gut
atrophy
why use EUS
EUS picks up changes before CT
what is PURT
Pancreatic Enzyme Replacement Therapy
from pigs - no artificial replacement
why assess for osteoporosis
fat soluble vitamins - lack of vit D (and A, E, K)
what are diffuse liver diseases
hereditary
inflammation - hepatits
cholestasis
alcohol
vascular supply
what is haemocromatosis
recessive
iron accumulates in the liver
what is wilsons disease
recessive
copper increases in the blood and liver
alpha trypsin A1
low plasma protease inhibitor
what are acute liver diseases
acute viral hepatitis
acute cholestasis
alcoholic hepatitis
drug induced
bacterial/fungal/parasitic
sepsis
large bile duct obstruction
hepatocytes appear pink in infection they are paler
true
what are chronic liver diseases
chronic hepatitis
NAFLD
ALD
PBC - primary biliary cholangitis
PSC
AI hepatitis
cirrhosis
what does chronic pancreatitis usually cause
cysts
pseudocysts
what are the 3 main classes of steroids
- Peptide/ protein
- Steroids
- Amino acids derivative
what glands/organs produce hormones
how are hormones regulated
how are hormones transported in the blood
what effect has excess hormones have
what effect has reduced hormones have
