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JL Gastrointestinal > Inflammation and Tumours of the Pancreas > Flashcards

Inflammation and Tumours of the Pancreas Flashcards

1
Q

What is an acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems?

A

Acute pancreatitis

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2
Q

What is interstitial oedema a predominant feature of the gland?

A

Mild acute pancreatitis

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3
Q

What is associated with organ failure/and or local complication such as necrosis, pseudocyst or abscess. Most often this is an expression of the development of pancreatic necrosis although patients with oedematous pancreatitis may manifest clinical features of a severe attack?

A

Severe actue pancreatitis

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4
Q

What are three obstructive factors of pancreatitis?

A
  1. Biliary disease
  2. Benign pancreatic duct stricture
  3. Tumours of the ampulla or pancreas
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5
Q

What are 2 toxic factors for pancreatitis?

A
  1. Alcohol

2. Viral infection - mumps, coxsackie B and viral hepatitis

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6
Q

What are two metabolic factors for pancreatitis?

A
  1. Hyperparathyroidism

2. Hyperlipoproteinaemia

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7
Q

What are two genetic defects for pancreatitis?

A
  1. Cationic trypsinogen gene (N29I, RII7H)

2. CF gene (CTFR)

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8
Q

Name an iatrogenic cause of pancreatitis

A

ERCP

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9
Q

What are 4 drugs that can induce acute pancreatitis?

A
  1. Valproic acid
  2. Azathioprine
  3. L-asparaginase
  4. Corticosteroids
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10
Q

Name an inflammatory cause of pancreatitis?

A

IgG4-related autoimmune disease

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11
Q

When inflammation of the parenchyma occurs, what does the resulting peripancreatic exudation or pancreatic ductal leakage cause?

A

Pseudocyst

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12
Q

On examination what does tenderness, peritonism, distention, bowel sounds and skin markings suggest?

A

Pancreatitis

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13
Q

Other than FBC, clotting, U&es, LFTs - what 4 other blood tests would you do for acute pancreatitis?

A
  1. Amylase
  2. CRP
  3. Glucose
  4. Ca
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14
Q

What 5 imaging methods would you use for diagnosing acute pancreatitis?

A
  1. CXR/AXR
  2. US
  3. CT pancreas
  4. MRI
  5. ERCP
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15
Q

With acute pancreatitis, what might you see on an AXR?

A

Sentinel loop

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16
Q

What is an US used for in acute pancreatitis?

A

To rule out biliary pancreatitis

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17
Q

What is a CT scan used for in acute pacnreatitis?

A

To assess severity

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18
Q

What are fluid collections, pancreatic necrosis, ascites, bleeding and abscesses complications of?

A

Acute pancreatitis

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19
Q

What shouldn’t be used as a diagnostic tool, but is used for treatment for CBD stones with obstruction, cholangitis and acute biliary pancreatitis?

A

ERCP

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20
Q

What is the Glasgow Prognostic Score for pancreatitis (3 factors means acute severe)?

A 
PaO2  55
Neutrophils: WBC > 15x109/l
Calcium  16mmol/l)
Enzymes (AST/ALT > 200 or LDH > 600)
Albumin  10mmol/L)
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21
Q

What can be said about pain felt in acute pancreatitis?

A

Epigastric/diffuse abdominal pain with radiation to back

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22
Q

What condition has painful jaundice, temperature, loss of appeitite and weight loss, abdominal tenderness, indigestion and nausea with vomiting, alongside radiating pain to back?

A

Acute pancreatitis

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23
Q

What are pulmonary failure, renal failure, shock, sepsis, metabolic acidosis, hyperglycaemia, hypocalcaemia anad MODS systemic complications of?

A

Acute pancreatitis

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24
Q

What is a complication of acute pancreatitis and chronic pancreatitis, which might have pancreatic duct communication?

A

Pseudocyst

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25
Q

What two things can a pseudo-cyst cause?

A

Biliary obstruction and gastric outlet obstruction

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26
Q

What are the two methods of treating a pseudocyst?

A

Endoscopic drainage and surgical drainage

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27
Q

How are pancreatic abscesses treated?

A

CT/US guided retroperitoneal or transperitoneal drainage, control sepsis

28
Q

How can pancreatic necrosis be assessed?

A

CT

29
Q

With acute biliary pancreatis what is the treatment for the presence of obstruction like acute cholangitis?

A

ERCP with spincteroctomy

30
Q

With acute biliary pancreatitis what is done if there is suspected obstruction?

A

US or MRCP

31
Q

With severe biliary pancreatitis with no obstruction, what is the treatment?

A

Conservative

32
Q

What does chronic pancreatitis result in?

A

Permanent loss of endocrine and exocrine function?

33
Q

What is the main cause of chronic pancreatitis?

A

Alcohol abuse

34
Q

What is a congenital cause of pancreatic duct obstruction leading to chronic pancreatitis?

A

Pancreas divisum

35
Q

What is treatment for autoimmune pancreatitis (increased IgG4)

A

Steroids

36
Q

What class of aetiology does cyanogenetic gluycosides, deficiency in methionine and trace elements zinc and selenium?

A

Tropic causes of chronic pancreatitis

37
Q

What type of pancreatitis has exocrine pancreatic insufficiency and can be present in CF and alpha-antitrypsin deficiency?

A

Hereditary chronic pancreatitis

38
Q

With hereditary chronic pancreatitis, what is there a 53-fold increased risk of?

A

Pancratic ductal adenocarcinoma > 40 years

39
Q

Can high calcium cause chronic pancreatitis?

A

Yes

40
Q

Do alcohol and smoking lead to chronic pancreatitis?

A

Yes

41
Q

With diagnosing chronic pancreatitis, what 3 other blood tests would you do other than FBC, clotting, U&Es, LFTs, amylase, CRP, glucose and Ca?

A
  1. IgG4
  2. CA 19-9
  3. Pancreatic function tests
42
Q

What two things can be seen on AXR with tropical pancreatitis?

A

Calcification and pancreatic duct dilatation

43
Q

What two things can a CT see for chronic pancreatitis?

A

Dilated pancreatic duct and calcification

44
Q

If there is suspected cancer from chronic pancreatitis, what investigation is done?

A

CT guided or endocsopic ultrasound guided biospy

45
Q

What surgical procedure relates to duodenum preserving pancreatic head resection with reconstruction and chronic pancreatitis with inflamamtory head tumour?

A

Beger procedure

46
Q

Is pleural effusion a complication of pancreatitis?

A

Yes

47
Q

What do oedema due to acute flare up, clacification, fibrosis and pancreatic head tumour all cause as a complication of chronic pancreatitis?

A

Common bile duct stenosis

48
Q

What are 3 treatment methods for common bile duct stenosis?

A

Stent, bypass, resection

49
Q

What complication of chronic pancratitis is this: oedema due to acute flare up, fibrosis, pseudocyst, pancreatic head tumour, nasea, vomiting, weight loss, pain?

A

Duodenal/gastric outlet obstruction

50
Q

What are the three methods of treating duodenal/gastric outlet obstruction?

A

Stent, bypass, resection

51
Q

What is the main type of exocrine pancreatic carcinoma, and where is it normally located?

A

Adenocarcinoma (95%)

Located in pancreatic head

52
Q

What are 3 types of endocrine pancreatic cancer?

A

Gastrinoma, insulinoma, glucagonoma

53
Q

What endocrine pancreatic cancer produces gastrin causing increased stomach acid, causing gastric/duodenal ulcers?

A

Gastrinoma

54
Q

What endocrine pancreatic cancer produces insulin, causing the body to store sugar rather than burn it, hypoglycemia?

A

Insulinoma

55
Q

What type of endocrine pancreatic cancer produces glucagon, increases blood sugar levels and leads to hyperglycaemia?

A

Glucagonoma

56
Q

What two features of jaundice are present with pancreatic cancer?

A

Dark urine

Light stools

57
Q

What type of pain is present with pacnreatic cancer?

A

Back pain and abdominal pain

58
Q

Diabetes II and II - are they both risk factors for pancreatic cancer?

A

Yes

59
Q

What is the first investigation for pancreatic cancer suspected, with jaundice?

A

Ultrasound

60
Q

With pancreatic cancer diagnosis, what is done after ultrasound?

A

Triple phase CT scan or MRI/MRCP

61
Q

For inoperable pancreatic cancer, what two methods of managmenet can be done?

A

ERCP/PTC

Biliary stent

62
Q

What is T1 stage of pancreatic cancer?

A

Carcinoma in situ

63
Q

What does N1 and NO mean in pacnreatic cancer stagin?

A

N1 - lymph node spread

N2 - no spread

64
Q

What does M1 and M0 mean in pancreatic cancer staging?

A

M1 - metastases to liver or lungs

M0 - no metastases

65
Q

For staging laparoscopy for pancreatic cancer surgery, what 4 procedures are resectable?

A
  1. Whipple resection
  2. Total pancreatectomy
  3. Distal pancreatectomy
  4. Midsegment pancreatectomy
66
Q

For staging laparaoscopy for pancreatic cancer, what 3 techniques are non resectalbe?

A

Biliary bypass
Gastric bypass
Double bypass

JL Gastrointestinal (33 decks)

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