Inflammation and Tumours of Pancreas Flashcards by Alyx McGregor

exocrine pancreas function

acing cells secrete pancreatic enzymes

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endocrine pancreas function

islets of langerhans secrete hormones into blood

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islet’s of langerhan’s cells

beta
alpha
delta
F

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what do beta cells secrete

insulin

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what do alpha cells secrete

glucagon

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what do delta cells secrete

somatostatin

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what do F cell secrete

pancreatic polypeptide

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how is secretion of pancreatic fluid regulated

via vagus nerve and gastrin leaves

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what is secreted from acinar cells

protease
pancreatic lipase
pancreatic amylase
other enzymes

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function of protease

digests polypeptides to peptides

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function of pancreatic lipase

digests triglycerides into fatty acids and monoglycerides

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function of pancreatic amylase

digests carbohydrate into disaccharides/monosaccharides

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what is secreted from epithelial cells lining pancreatic duct

bicarbonate

water

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role of bicarbonate in pancreas

neutralises acidic gastric juice

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what is pancreatitis

acute inflammatory process in the pancreas

involving regional tissues and remote organs

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aetiology of pancreatitis

I GET SMASHED;
idiopathic 
gallstone 
ethanol (alcohol)
trauma 
steroids
mumps (+hepatitis)
autoimmune 
scorpion bite 
hypercalcaemia, hyperparathyroidism, hyperlipidaemia 
ERCP
drugs (azathorpine)

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pathophysiology of pancreatitis

bile reflux theory

hyperstimulation of pancreatic acinar cells with cholecystokinin - auto digestion of the pancreas

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bile reflux theory

obstruction of common bile duct/pancreatic duct causing reflux of bile into pancreas

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4 stages of auto-digestion of pancreas

1. hypovolaemic shock 
hypocalcaemia 
2. retroperitoneal haemorrhage 
3. pancreatic necrosis 
4. abscess formation

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clinical presentation of pancreatitis

acute onset epigastric pain - very severe
nausea and vomiting
jaundice
peritonitis - severe

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describe radiation of epigastric pain in pancreatitis

radiates to back

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signs of pancreatitis

erythema abigne
Cullen’s sign
grey turner’s sign
elevated serum amylase

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tests for pancreatitis

FBC
coagulation 
U&amp;E
LFTs
calcium
glucose 
amylase/lipase
CRP
lactate

arterial blood gases 
AXR
CXR
ultrasound 
CT

presentation of CXR in pancreatitis

evaluates complications

pleural effusion

presentation of AXR in pancreatitis

evaluates complications | sentinel loop

prognostic criteria for pancreatitis

glasgow criteria | ranson's criteria

local complications of pancreatitis

``` fluid collection pseudocysts abscess necrosis +/- infection ascites pleural effusion ```

systemic complications of pancreatitis

``` pulmonary failure renal failure shock sepsis metabolic acidosis hyperglycaemia hypocalcaemia MODS ```

treatment for pancreatitis

conservative analgesia IV fluids ERCP - removal of common bile duct stones with obstruction

conservative treatment in pancreatitis

``` fluid restriction electrolytes fluid balance oxygen antibiotics if necessary nutrition if necessary ```

consequences of pancreatic pseudocysts

biliary obstruction | gastric outlet obstruction

clinical features of pancreatic pseudocysts

``` pain nausea vomiting jaundice weight loss ```

treatment of pancreatic pseudocysts

nothing endoscopic/radiological/surgical drainage resection

treatment of pancreatic abscess

CT/ultrasound guided retroperitoneal or trans-peritoneal drainage to control sepsis

describe chronic pancreatitis

progressive and irreversible damage of pancreas | loss of exocrine +/- endocrine function

clinical features of chronic pancreatitis

``` similar to acute pancreatitis masses ascites jaundice calcifications on imaging ```

risk factors for chronic pancreatitis

alcohol hx smokers medications

tests for chronic pancreatitis

``` CXR AXR ultrasound CT MRI ERCP ```

aetiology of chronic pancreatitis

alcohol idiopathic Pancreatic duct obstruction - congenital or acquired autoimmune tropical counties hereditary - cystic fibrosis and alpha-1-anti-trypsin deficiency

treatment for chronic pancreatitis

manage acute episodes as appropriate creon - enzyme replacement therapy surgery

surgery for chronic pancreatitis

pustow procedure | frey procedure

complications of chronic pacreaitits

``` splenic vein thrombosis pseduoaneurysm - splenic artery pleural effusion ascites pancreatic cancer pseudocysts biliary obstruction duodenal obstruction ```

describe duodenal obstruction

oedema due to acute flare up fibrosis and pancreatic head tumour pseudocysts

treatment for duodenal obstruction

stent bypass resection

exocrine tumours

adenocarcinoma - most common

endocrine tumours

gastrinoma insulinoma glucagonoma

describe gastrinoma

produces gastric increases stomach acid history of peptic ulcer disease

describe insulinoma

produces insulin encourages sugar uptake and storage hypoglycaemia

describe glucoagonoma

produces glucagon increases serum blood sugars hyperglycaemia

symptoms of pancreatic tumours

``` jaundice steatorrhoea dark urine weight loss back pain ```

risk factors for pancreatic tumours

smoking charred meat obesity diabetes (type 2 more at risk)

tests for pancreatic tumours

``` blood tests ultrasund CT MRI ERCP ```

treatment for pancreatic tumours - inoperable cases

ERCP or PTC or stent insertion decompression of obstructed biliary ducts chemo-/radiotherapy

treatment for pancreatic tumours - operable cases

laparoscopy and staging ERCP stent resection or palliative biliary bypass chemo-/radiotherapy

surgery for pancreatic tumours

whipple distal pancreatectomy total pancreatectomy