Inflammation and Tumours of Pancreas Flashcards
exocrine pancreas function
acing cells secrete pancreatic enzymes
endocrine pancreas function
islets of langerhans secrete hormones into blood
islet’s of langerhan’s cells
beta
alpha
delta
F
what do beta cells secrete
insulin
what do alpha cells secrete
glucagon
what do delta cells secrete
somatostatin
what do F cell secrete
pancreatic polypeptide
how is secretion of pancreatic fluid regulated
via vagus nerve and gastrin leaves
what is secreted from acinar cells
protease
pancreatic lipase
pancreatic amylase
other enzymes
function of protease
digests polypeptides to peptides
function of pancreatic lipase
digests triglycerides into fatty acids and monoglycerides
function of pancreatic amylase
digests carbohydrate into disaccharides/monosaccharides
what is secreted from epithelial cells lining pancreatic duct
bicarbonate
water
role of bicarbonate in pancreas
neutralises acidic gastric juice
what is pancreatitis
acute inflammatory process in the pancreas
involving regional tissues and remote organs
aetiology of pancreatitis
I GET SMASHED; idiopathic gallstone ethanol (alcohol) trauma steroids mumps (+hepatitis) autoimmune scorpion bite hypercalcaemia, hyperparathyroidism, hyperlipidaemia ERCP drugs (azathorpine)
pathophysiology of pancreatitis
bile reflux theory
hyperstimulation of pancreatic acinar cells with cholecystokinin - auto digestion of the pancreas
bile reflux theory
obstruction of common bile duct/pancreatic duct causing reflux of bile into pancreas
4 stages of auto-digestion of pancreas
1. hypovolaemic shock hypocalcaemia 2. retroperitoneal haemorrhage 3. pancreatic necrosis 4. abscess formation
clinical presentation of pancreatitis
acute onset epigastric pain - very severe
nausea and vomiting
jaundice
peritonitis - severe
describe radiation of epigastric pain in pancreatitis
radiates to back
signs of pancreatitis
erythema abigne
Cullen’s sign
grey turner’s sign
elevated serum amylase
tests for pancreatitis
FBC coagulation U&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
