GI - pancreas Flashcards
s/s acute pancreatitis
Pain in epigastric area that radiates to back
Anorexia
Nausea
Grey Turner’s sign - flank bruising, lumbar redness
Cullen’s sign - periumbilical bruising, umbilical redness
weight loss, temperature, jaundice, indigestion
what would ABGs of acute pancreatitis look like
metabolic acidosis
what would be raised in pancreatitis
serum amylase and serum lipase (more specific)
what are some causes of acute pancreatitis
IGETSMASHED
idiopathic Gall stones - bile reflux into pancreatic duct EtOH Scorpion sting Mumps Autoimmune - IgG related Steroids Hyperlipidaemia/calcaemia ERCP Drugs
aside from gallstones what are some other obstructive causes of pancreatitis
pancreatic duct stricture
ampulla/pancreas tumour
what drugs can cause acute pancreatitis
azathioprine
corticosteroids
what viruses as well as mumps can cause acute pancreatitis
coxsackie B
hepatitis
what are 2 genetic causes of acute pancreatitis
CFTR
cationic trypsinogen gene
outline the pathology of acute pancreatitis
1) inflammation of acinar cells
2) premature activation of trypsin
3) activation of other pancreatic enzymes
4) auto digestion of pancreatic acini due to lytic enzymes and loss of protective barrier
5) lipase - intra and peri pancreatic fat necrosis
protease - tissue destruction and BV digestion causing haemorrhage
what is seen on an XR of pancreatitis
pleural effusion
sentinel loop
all patients with AP get what investigation within 24hours of admission and why
U/S of biliary tree
rule out biliary pancreatitis
if the cause is found to be biliary pancreatitis what is the treatment
cholecystectomy/ERCP then a CT to assess extent of pancreatitis
what are some investigations of pancreatitis
CXR/AXR
AUS
CT
MRI
what is the glasgow prognostic score
PANCREAS - any 3 factors = acute pancreatitis P - PaO2 < 8 A - Age > 55 N - Neutrophils C - Calcium <2 R - Renal function (urea > 16) E - Enzymes - AST/ALT > 200, or LDH 600 A - Albumin < 32g/l S - sugar - glucose > 10
“focal areas of necrosis in body of pancreas”
“main feature is oedema of the gland”
is what severity
mild
“intrapancreatic fat necrosis”
“large amount of Ca bound”
is what severity
moderate
“complete pancreatic destruction with haemorrhage and fat necrosis”
“organ failure +/- local complications such as pseudocyst, necrosis or abscess”
is what level of severity
severe
what is the treatment of acute pancreatitis
fluids
oxygen
STABs
what are some complications of Acute pancreatitis
death
pseudocysts
shock
abscess
Hyperglycaemia/Hypocalcaemia Disseminated intravascular coagulation (DIC) ARDS Multi organ failure Necrosis
what is a pseudocyst and how is it treated
walled off collection of fluid
endoscopic or surgical drainage or cystgastrotomy
what is a cystgastrotomy
fistula created between pseudocyst and stomach so that its contents drain into the stomach
what is chronic pancreatitis
progressive and irreversible destruction of pancreatic tissue resulting in permanent loss of exocrine and endocrine function
what is the histology of chronic pancreatitis
replacement of pancreas by chronic inflammation, fibrosis and scar tissue
destruction of exocrine acini and islets
what are some causes of chronic pancreatitis
CF Alcohol Malnourishment Pancreatic duct obstruction e.g. gallstones Biliary duct obstruction hyperparathyroidism familial - A1ATD idiopathic autoimmune
what is seen in an XR of chronic pancreatitis
extensive pancreatic calcification
what is seen in a CT of chronic pancreatitis
dilated pancreatic duct
calcification
intrapancreatic fluid collection
describe the following 5 treatments of chronic pancreatitis
1) lifestyle modification
2) pain relief
3) surgery
4) endocrine function
5) exocrine function
1) stop smoking/drinking
2) opioids, paracetamol, NSAIDs
3) duodenum/jejunum joined to pancreas to enable pancreatic juice to flow
4) address diabetes
5) enzyme supplements e.g. CREON
what are 3 surgical procedures used in chronic pancreatitis
Pustow
Frey
Beger
what are some complications of chronic pancreatitis
Pseudocyst Pseudoaneurysm Pancreatic cancer Pancreatic ascites Pleural effusion Obstruction diabetes death steatorrhoea shock splenic vein thrombosis abscess hypocalcaemia
