Inflammation and Tumours of the Pancreas Flashcards
what cells are found in the exocrine pancreas?
acinar cells
what does the exocrine pancreas secrete?
pancreatic digestive enzymes
what cells are found in the endocrine pancreas?
islets of langerhans
what does the endocrine pancreas secrete?
hormones
name the four different types of islets
beta cells
alpha cells
delta cells
F cells
what do beta cells secrete?
insulin
what do alpha cells secrete?
glucagon
what do delta cells secrete?
somatostatin
what do F cells secrete?
pancreatic polypeptide
what two things regulate pancreatic secretions?
the vagus nerve
gastrin levels
what three things are secreted from the acinar cells?
proteases
lipase
amylase
name two proteases secreted by the pancreas?
trypsin
chymotrypsin
what do proteases do?
breakdown polypeptides into peptides
what does lipase do?
breakdown triglycerides
what does amylase do?
breaks down carbohydrates into di/monosaccharides
what two things are secreted from the epithelial cells lining ducts in the pancreas?
bicarbonate
water
what is acute pancreatitis?
an acute inflammatory process in the pancreas
what mnemonic is used to remember the causes of acute pancreatitis?
I GET SMASHED
name all of the causes of acute pancreatitis
idiopathic gallstones ethanol trauma steroids mumps autoimmune scorpion bite hypercalcaemia and hyperlipidaemia ERCP drugs
name a drug that can cause acute pancreatitis
azathioprine
where does pain from pancreatitis present?
the epigastrium
where does pain from pancreatitis radiate to?
the back
what can be associated with the pain from pancreatitis?
nausea
vomiting
jaundice
what are bowel sounds like in pancreatitis?
normal
what does fullness in the epigastrium in a patient with pancreatitis suggest?
a pseudocyst
name three classic signs of acute pancreatitis
erythema ab igne
cullen’s sign
grey turner’s sign
name four initial investigations for acute pancreatitis
bloods
ABG
USS
CT
what blood result is diagnostic of acute pancreatitis?
amylase more than three times the upper limit of normal
what is USS used for in patients with acute pancreatitis?
gallstones
CBD size
cholecystitis
what is CT used for in patients with acute pancreatitis?
as follow up to assess the severity and to look for any complications
when is the best time to do a CT in a patient with acute pancreatitis?
around 5 days after the onset of symptoms
name five possible complications of acute pancreatitis
fluid collections necrosis ascites bleeding abscess
what should not be used to diagnose acute pancreatitis?
ERCP
what can ERCP be used for?
treating gallstones
what score on the glasgow criteria is considered to be severe pancreatitis?
more than 3
how is acute pancreatitis managed initially?
fluid resuscitation
oxygen
antibiotics if needed
what can pancreatic pseudocysts cause?
biliary and gastric outlet obstruction
how does a pancreatic pseudocyst present?
pain
nausea & vomiting
jaundice
weight loss
how is a pancreatic pseudocyst treated?
drainage or resection
what three methods of drainage can be used on a pancreatic pseudocyst?
endoscopic
radiological
surgical
why are pancreatic abscesses drained?
to control sepsis
how is a pancreatic abscess drained?
using CT/US guided retro/transperitoneal drainage
what imaging can be used to assess pancreatic necrosis?
CT
what two states can pancreatic necrosis be in?
sterile
infected
what is chronic pancreatitis?
progressive and irreversible damage causing a loss of exocrine and/or endocrine function
how does chronic pancreatitis present?
same as acute, with masses, ascites or jaundice on examination
name five investigations that can be done for chronic pancreatitis?
x-ray ultrasound CT MRI ERCP
name five causes of chronic pancreatitis
alcohol idiopathic pancreatic duct obstruction autoimmune hereditary
what should be used to treat pancreatitis if there is pancreatic insufficiency?
creon as enzyme replacement
what do surgical procedures can be done to treat chronic pancreatitis?
pustow procedure
frey procedure
name an exocrine tumour of the pancreas
adenocarcinoma
name three endocrine tumours of the pancreas
gastrinoma
insulinoma
glucagonoma
what does a gastrinoma do?
produces gastrin and increases stomach acid
what does an insulinoma do?
produces insulin and causes hypoglycaemia
what does a glucagonoma do?
produces glucagon, causing hyperglycaemia
what investigations can be done for pancreatic cancers?
ultrasound
CT
MRI
MRCP
