Inflammation and Tumours of Pancreas Flashcards
what does the pancreas form from?
dorsal and ventral bud fuse together (if they don’t fuse them together can cause pancreatitis in later life)
what arteries supply the pancreas?
gastroduodenal gives off abranch (ant. and post. superior pancreatiduodenal)
Superior mesenteric gives off ant. and post. inferior pancreatiduodenal
branches off splenic
what islet cells secrete what products?
alpha = glucagon
beta = insulin
delta = somatostatin
….
what regulates secretion of pancreatic fluid?
vagus nerve and gastrin levels
what do acinar cells secrete?
protease (trypsin and chymotrypsin)
pancreatic lipase
pancreatic amylase
other enzymes
how are 80% of acute pancreatitis cases managed?
analgesia and IV fluids
what drugs can cause pancreatits?
azathoprin
what are the 4 stages of pancreatitis due to autodigestion of pancreas by enzymes?
oedema and fluid shifts - hypovolaemic shock
autodigestion of blood vessels - retroperitoneal haemorrhage
infarction due to compromised blood supply - pancreatic necrosis
………
how does pancreatitis present?
acute epigastric pain radiating to back
very severe
nausea and vomiting
jaundice maybe is gallstone obstruction or chronic pancreatitis
pancreatitis on examination?
diffuse upper abdominal tenderness
soft
normal Bowel sounds
fullness in epiastrium due to pseudocyst
what arethe classic signs of pancreatitis?
cullens sign (umbilical) Grey turner's sign (flanks) Erythema abigne (hot water bottle rash)
what are the initial investigations for pancreatitis?
IV access bloods: FBC, coagulation, U&Es, Ca, glucose, amylase/lipase, CRP, lactate ABGs: hypoxia and ARDS Imaging (AXR, AXR, US) can show: - pleural effusion - sentinel loop (buzz word)
what might be seen on US in apncreatitis?
gallstones thickened gallbladder larger CBD cholecystitis free fluid
when is CT used in pancreatitis?
only to stage it or assess complications etc
5 days after onset
what are some possible complications of pancreatitis?
fluid collection (cysts, pseudocysts) necrosis ascites bleeding abscess
what is the Glasgow prognostic criteria (IMREY SCORE)?
PANCREAS PaO2 < 8kPa Age >55 Neutrophils (WBC >15) Calcium < 2 Renal function (urea >16) Enzymes (AST/ALT >....................) ALbumin < 32 Sugar (glucose >10) Score > 3 = sever pancreatitis
what are the principles of aoncreatitis management?
fluid resuscitation correct electrolytes careful fluid balance oxygen antibiotics if sure its an infective cause Nutrition Cholecystectomy
what are pancreatic pseudocysts?
collection of fluid without a lining due to acute/chronic pancreatitis
pain, nausea, vomiting, jaundice, weight loss
can cause obstruction
no real treatment but can drain them
- endoscopic
- radiological
- surgical is chronic (drains into stomach)
how can a cyst cause a haemorrhage?
cyst gets so large that it erodes an artery and artery then bleeds into the cyst
how is pancreatic necrosis managed?
CT for assessment
drain or necrosectomy and lavage
what is chronic pancreatitis?
progressive and irreversible
loss of endocrine and exocrine function
can cause diabetes
how does chronic pancreatitis present?
similar to acute
alcoholic, smoker, medications etc
masses/ascites/jaundice on examination
what diseases can predispose to chronic pancreeatitis?
CF
apha 1 antitrypsin
Autoimmune diseases
how might chronic pancreatitis look on imaging?
stones
calcification
what is Pustow procedure?
encourages drainage of pancreatic fluid from pancreas into ….
Freys procedure is similar
what are some possible complications of chronic pancreatitis?
splenic vein thrombosis pseudoaneurysm Pleural effusion pancreatic cancer ascites pseudocyst biliary obstruction duodenal obstruction
what is the most common pancreatic cancer?
adenocarcinoma (exocrine)
symptoms of pancreatic cancer?
painless jaundice loose pale stools dark urine weight loss back pain
pancreatic tumour risk factors?
diabetes
smoking
obesity
charred meat
inoperable pancreatic tumour?
stent
decompression…..
