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Clinical > Inflammation and Tumours of the Pancreas > Flashcards

Inflammation and Tumours of the Pancreas Flashcards

1
Q

4 pancreatic hormones?

A

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide

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2
Q

What is acute pancreatitis?

A

Acute inflammatory process of the pancreas, with variable innolvement of other regional tissues or remote organ systems

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3
Q

Two types of acute pancreatitis?

A

Mild acute pancreatitis - assoc. with minimal organ dysfunction; predominant feature is interstitial oedema of the gland

Severe acute pancreatitis - assoc. with organ failure and/or local complications, such as necrosis (with infection), pseudocysts and abscesses

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4
Q

3 main causes of pancreatitis?

A

Obstructive factors, e.g: biliary disease (gallstones), benign pancreatic duct stricture and tumours of the ampulla/pancreas

Toxic factors, e.g: alcohol and viral infections

Metabolic factors (hyperparathyroidism and hyperlipoproteinaemia)

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5
Q

Other causes of pancreatitis?

A

Genetic defects, e.g: CF

Trauma

Iatrogenic causes

Drug-induced acute pancreatitis

Inflammatory - IgG4-related autoimmune disease

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6
Q

Mnemonic for pancreatitis causes?

A

Iatrogenic

Gallstones
Ethanol
Trauma

Scorpions
Mumps
Autoimmune
Steroids
Hyperlipidaemia / hypercalcaemia / hyperparathyroidism (metabolic disorders)
ERCP
Drugs
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7
Q

Pathophysiology of acute pancreatitis?

A

Causative factors cause pancreatic acinar cell damage; trypsin and lipase become activated

Trypsin causes the activation of other enzymes, which mediate inflammation, vascular damage, haemorrhage and coagulation necrosis; lipase causes fat necrosis

Obstruction of pancreatic duct and inflammation of the parenchyma causes hypoperfusion (necrosis and infection) and pseudocysts

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8
Q

Why do psudocysts form as a result of inflammation of the parenchyma?

A

Peri-pancreatic exudation or pancreatic ductal leakage causes cysts

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9
Q

Blood tests for acute pancreatitis?

A

FBC, U&Es, LFTs, CRP

Amylase (most important measure)

Clotting, glucose and Ca

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10
Q

Imaging for acute pancreatitis?

A

CXR/AXR

AUS - rule out biliary pancreatitis; check for gallstones, cholecystitis, CBD diameter and free fluid

CT pancreas

MRI

ERCP is not a diagnostic tool but is form of treatment for CBD stones with obstructions

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11
Q

What will be found on CXR/AXR with acute pancreatitis?

A

Pleural effusion

Sentinel loop (distended bowel loop specifically due to pancreatitis)

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12
Q

Complications of pancreatitis?

A

Fluid collections

Pancreatic/peri-pancreatic necrosis

Ascites

Bleeding

Abscess

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13
Q

Glasgow prognostic score (1 point for each)?

A

Age >55 years

PaO2 15x10(9) / L

Serum calcium 16 mmol/l

LDH >600 iu/l or AST/ALT >200 iu/l

Albumin 10 mmol/l
Any 3 factors indicated acute severe pancreatitis

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14
Q

Grade of pancreatitis?

A

Grade A - normal gland (0 points)

Grade B - focal or diffuse oedema (1 points)

Grade C - peri-pancreatic inflammation (2 points)

Grade D - single fluid collection (3 points)

Grade E - 2 or more colelctions and/or gas in/adjacent to the pancreas (4 points)

This is added to scores for necrosis:
No necrosis = 0
30% or less =

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15
Q

Symptoms of acute pancreatitis?

A

Epigastric/diffuse abdominal pain +/- radiation to the back (retroperitoneal)

Nausea and vomiting

Indigestion

Abdominal tenderness

Loss of appetite +/- weight loss

Temperature

Jaundice (pain) if there is an obstructive cause

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16
Q

Local complications of acute pancreatitis?

A 
Fluid collection
Pseudocysts and abscess 
Necrosis +/- infection
Ascites
Pleural effusion
17
Q

Systemic complications of acute pancreatitis?

A 
Pulmonary failure
Renal failure
Shock
Sepsis
Metabolic acidosis
Hyperglycaemia
Hypocalcaemia
MODs (maturity-onset diabetes)
18
Q

Prognosis of acute pancreatitis?

A

Prognosis worsens as you move down the list:
Mild pancreatitis

Severe pancreatitis:
Sterile necrosis
Infected necrosis

Severe necrotising pancreatitis (signs of necrosis)

19
Q

What is a pseudocyst?

A

Cystic lesion that may appear as a cyst on scans but lacks epithelial/endothelial cells; can cause biliary obstruction and gastric outlet obstruction

20
Q

Symptoms of pseudocyst?

A

Pain
Nausea and vomiting
Jaundice
Weight loss

21
Q

Treatment of pseudocysts?

A

Endoscopic drainage

Surgical drainage, depends on location of pseudocyst:
Cystgastrostomy
Cystjejunostomy

22
Q

Treatment of pancreatic abscesses?

A

CT scan/ultrasound retroperitoneal drainage; sepsis is controlled and

23
Q

Treatment of necrosis?

A

CT for assessment and determination of whether it is sterile or infected

Interventional drainage

Necrosectomy and lavage

24
Q

What is chronic pancreatitis?

A

Progressive and irreversible destruction of pancreatic tissue; results in permanent loss of endocrine and exocrine function

25
Q

Main causes of chronic pancreatitis?

A

Alcohol abuse

Idiopathic

Pancreatic duct obstruction:
Acquired - stone, stricture, tumour or pseudocyst
Congenital - pancreas divisum

Tropical causes

Autoimmune pancreatitis - increased IgG4 sub-class levels; treatment with steroids

Hereditary chronic pancreatitis

Miscellaneous - hypercalcaemia in hyperparathyroidism and renal failure

26
Q

Blood tests for chronic pancreatitis?

A

FBC, U&ES, LFTs

Clotting and CRP

Glucose and Ca

Amylase

IgG4

Pancreatic function tests

27
Q

AXR and CT scan findings on chronic pancreatitis?

A

Extensive pacreatic calcification

Pancreatic duct dilatation

Intra-pancreatic fluid collection

28
Q

Treatments for chronic pancreatitis?

A

Pustow procedure:

  1. Dilated pancreatic duct is “filleted open”
  2. Jejunum divided
  3. Opened pancreatic duct is anastamosed to the jejunum (pancreaticojejunostomy)
  4. Jejuno-jejunostomy restores continuity of the GI tract

Frey procedure
Beger procedure - duodenum preserving pancreatic
Head resection with reconstruction

29
Q

Complications of chronic pancreatitis?

A

Splenic vein thrombosis

Pseudoaneuryms

Pancreatic cancer

Pseudocyst

Bile duct (oedema due to acute flare-up, calcification or fibrosis and pancreatic head tumour) or duodenal obstruction

Pancreatic ascites

Pleural effusion

30
Q

Treatment of bile duct or duodenal obstruction, due to chronic pancreatitis?

A

Stent, bypass and resection

31
Q

Treatment of pseudocysts?

A

Endoscopic drainage
Surgical drainage
Resection

32
Q

Types of pancreatic cancers?

A

Exocrine pancreatic cancers:
Adenocarcinoma are the majority

Endocrine pancreatic cancer:
Gastrinoma - produces gastrin causing increased stomach acid, leading to gastric/duodenal ulcers

Insulinoma - produces insulin and causes hypoglycemia

Glucagonoma - produces glucagon which causes hyperglycemia

Somatostatinoma

Vipoma

33
Q

How is pancreatic cancer related to age?

A

Incidence increases with age

34
Q

Symptoms of pancreatic cancer?

A

Jaundice - dark urine and light stools

Back pain and abdominal pain

Weight loss along with anorexia, nausea and vomiting

35
Q

Risk factors for pancreatic cancer?

A

Smoking
Charred meat
Obesity and physical inactivity
Diabetes type I and II

36
Q

Staging pancreatic cancer?

A

TNM staging

37
Q

Treatment of pancreatic cancer?

A

Chemotherapy
Radiotherapy
Combinations

Can be curative or palliative

38
Q

What types of surgery are done for pancreatic cancer?

A 
For resectable tumours:
Whipple resection
Total Pancreatectomy
Distal Pancreatectomy
Midsegment Pancreatectomy

For non-resectable tumours:
Biliary bypass
Gastric bypass
Double bypass

Clinical (54 decks)

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