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year 1 > GI - pancreas > Flashcards

GI - pancreas Flashcards

1
Q

s/s acute pancreatitis

A

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

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2
Q

what would ABGs of acute pancreatitis look like

A

metabolic acidosis

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3
Q

what would be raised in pancreatitis

A

serum amylase and serum lipase (more specific)

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4
Q

what are some causes of acute pancreatitis

A

IGETSMASHED

idiopathic
Gall stones - bile reflux into pancreatic duct
EtOH
Scorpion sting
Mumps
Autoimmune - IgG related
Steroids
Hyperlipidaemia/calcaemia
ERCP
Drugs
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5
Q

aside from gallstones what are some other obstructive causes of pancreatitis

A

pancreatic duct stricture

ampulla/pancreas tumour

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6
Q

what drugs can cause acute pancreatitis

A

azathioprine

corticosteroids

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7
Q

what viruses as well as mumps can cause acute pancreatitis

A

coxsackie B

hepatitis

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8
Q

what are 2 genetic causes of acute pancreatitis

A

CFTR

cationic trypsinogen gene

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9
Q

outline the pathology of acute pancreatitis

A

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

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10
Q

what is seen on an XR of pancreatitis

A

pleural effusion

sentinel loop

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11
Q

all patients with AP get what investigation within 24hours of admission and why

A

U/S of biliary tree

rule out biliary pancreatitis

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12
Q

if the cause is found to be biliary pancreatitis what is the treatment

A

cholecystectomy/ERCP then a CT to assess extent of pancreatitis

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13
Q

what are some investigations of pancreatitis

A

CXR/AXR
AUS
CT
MRI

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14
Q

what is the glasgow prognostic score

A 
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
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15
Q

“focal areas of necrosis in body of pancreas”
“main feature is oedema of the gland”
is what severity

A

mild

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16
Q

“intrapancreatic fat necrosis”
“large amount of Ca bound”
is what severity

A

moderate

17
Q

“complete pancreatic destruction with haemorrhage and fat necrosis”
“organ failure +/- local complications such as pseudocyst, necrosis or abscess”
is what level of severity

A

severe

18
Q

what is the treatment of acute pancreatitis

A

fluids
oxygen
STABs

19
Q

what are some complications of Acute pancreatitis

A

death
pseudocysts
shock
abscess

Hyperglycaemia/Hypocalcaemia
Disseminated intravascular coagulation  (DIC)
ARDS
Multi organ failure 
Necrosis
20
Q

what is a pseudocyst and how is it treated

A

walled off collection of fluid

endoscopic or surgical drainage or cystgastrotomy

21
Q

what is a cystgastrotomy

A

fistula created between pseudocyst and stomach so that its contents drain into the stomach

22
Q

what is chronic pancreatitis

A

progressive and irreversible destruction of pancreatic tissue resulting in permanent loss of exocrine and endocrine function

23
Q

what is the histology of chronic pancreatitis

A

replacement of pancreas by chronic inflammation, fibrosis and scar tissue
destruction of exocrine acini and islets

24
Q

what are some causes of chronic pancreatitis

A 
CF
Alcohol
Malnourishment
Pancreatic duct obstruction e.g. gallstones
Biliary duct obstruction
hyperparathyroidism
familial - A1ATD
idiopathic
autoimmune
25
Q

what is seen in an XR of chronic pancreatitis

A

extensive pancreatic calcification

26
Q

what is seen in a CT of chronic pancreatitis

A

dilated pancreatic duct
calcification
intrapancreatic fluid collection

27
Q

describe the following 5 treatments of chronic pancreatitis

1) lifestyle modification
2) pain relief
3) surgery
4) endocrine function
5) exocrine function

A

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

28
Q

what are 3 surgical procedures used in chronic pancreatitis

A

Pustow
Frey
Beger

29
Q

what are some complications of chronic pancreatitis

A 
Pseudocyst
Pseudoaneurysm
Pancreatic cancer
Pancreatic ascites
Pleural effusion
Obstruction 
diabetes 
death
steatorrhoea
shock
splenic vein thrombosis
abscess
hypocalcaemia

year 1 (45 decks)

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