GI Section VI: Pancreatitis Flashcards
What are the most common Etiology of Pancreatitis?
Gallstones and Alcohol combined make up to 80% of the cases
Iatrogenic = ERCP
Medications = Valproic Acid
Trauma = NAT
Pancreatic CA
Infection = Viral in children
Hypercalcemia
Hyperlipidemia
Autoimmune Pancreatitis
Pancreatic divisum
Groove (para-duodenal) pancreatitis,
Tropic
Parasite induced
Prognosis can be estimated with?
Balthazar Score
Think about pancreatitis as
Mild (no necrosis)
Severe (+ necrosis)
Patients with necrosis don’t start doing terrible until =
They get infected - mortality rate is 50-70%
Outcomes are directly correlated with?
Degree of necrosis
Severe acute pancreatitis has a biphasic course.
Pro inflammatory phase (Week 1-2)
Anti-inflammatory periode (Week 3-4)
This is a sterile response in which infection rarely occurs
Pro inflammatory phase (Week 1-2)
the risk o f translocated intestinal flora and the subsequent development of infection increases in this period
Anti-inflammatory period (Week 3-4)
< 4weeks + NO necrosis =
Acute Peripancreatic Fluid Collection
> 4 weeks + NO Necrosis =
Pseudocyst
< 4weeks + NECROSIS =
Acute necrotic Collection
> 4 weeks + NECROSIS =
Walled-off necrosis
Vascular Complications of pancreatitis
- Splenic Vein and Portal Vein Thrombosis (Isolated gastric varices can be seen secondary to splenic vein occlusion)
- Pseudo-aneurysm of the GDA (Gastroduodenal artery) and Splenic Artery
Non-Vascular Complications of pancreatitis
- Abscess, infection
- Gas - sign of infected fluid collection
Inflamed pancreas = hypoechoic (edematous) relative to the liver (opposite of normal)
What are the two ducts of the pancreas?
MAJOR = Wirsung
MINOR = Sontorini
Normal draiaing of the pancreatic ducts:
MAJOR DUCT = INFERIOR PAPILLA
MINOR = SUPERIOR PAPILLA
Santorini = SMALL and SUPERIOR
the most common anatomic variant of the human pancreas
Pancreatic Divisum
Pancreatic Divisum occurs when?
the main portion of the pancreas is drained by the minor or accessory papilla
Main clinical relevence if you see panreatic divisum?
Increased risk of pancreatitis
Chronic Pancreatitis
end result of prolonged inflammatory change = IRREVERSIBLE fibrosis
Acute pancreatitis and chronic pancreatitis are thought of as
Different disease process
Most cases, acute pancreatitis do not result in chronic disease
most common causes of Chronic pancreatitis
Cholithiasis and alcohol (90%)
Alcohol is #1
Imaging findingso of Chronic pancreatitis can be thought as?
Early
or
Late
Balthazar Score
Early Chronic Pancreatitis
- Loss of T1 signal (pancreas is normally the brightest T1 structure in the body)
- Delayed Enhancement
- Dilated Side Branches ~
Late Chronic Pancreatitis
- Commonly small, uniformly atrophic - but can have focal enlargement
- Pseudocyst formation (30%)
- Dilation and beading of the pancreatic duct with calcifications
what is the most characteristic finding of Chronic Pancreatitis?
Dilated and Beaded appearance of the pancreatic duct, with Intraductal Calcifications.
Chronic Pancreatitis
“Chain of LAkes”
Dilated and Beaded appearance of the pancreatic duct, with Intraductal Calcifications.
Chronic Pancreatitis Duct Dilation vs Pancreatic Malignancy Duct Dilation
Chronic Pancreatitis =
Cancer =
Chronic Pancreatitis =
Dilation is Irregular
Duct is < 50% of the AP gland diameter
Cancer =
Dilation is uniform (usually)
Duct is > 50% of the AP gland diameter (obstructive atrophy)
Complications of Chronic Pancreatitis
Pancreatic cancer (20 years o f CP = 6% risk o f Cancer)
