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GIHEP > L13: Pancreatitis and Pancreatic Cancer > Flashcards

L13: Pancreatitis and Pancreatic Cancer Flashcards

1
Q

What is acute pancreatitis? (definition)

A

acute inflammation of the pancreas due to injury

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2
Q

List the causes of pancreatic injury/pancreatitis (remember the mnemonic!)

A

I - Idiopathic

G - Gallstones
E - Ethanol (Alcohol)
T - Trauma

S - Steroids
M - Mumps
A - Autoimmune
S - Scorpion Sting
H - Hypertriglyceridaemia/Hypercalcaemia
E - ERCP
D - Drugs (e.g. thiazides)
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3
Q

List 3 causes which account for 80% of all pancreatic injury (and which can go on to cause pancreatitis)

A
  • Gallstones
  • Alcohol
  • Trauma
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4
Q

Explain the pathogenesis of acute pancreatitis

A
  • trauma/damage to the pancreas lead to intra-pancreatic activation of enzymes
  • the enzymes act on pancreatic tissue
  • causes local and systemic inflammatory response
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5
Q

How can hypercalcaemia cause acute pancreatitis?

A

believed that hypercalcemia leads to accelerated activation of enzymes which causes the pancreatic damage

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6
Q

List the symptoms and signs associated with acute pancreatitis

A

Symptoms:

  • sudden pain (can radiate to back)
  • pain may be relieved by sitting forward
  • fever
  • nausea
  • vomiting
  • dehydration (b/c AP can induce shock)

Signs:

  • epigastric tenderness + guarding
  • tachycardia
  • tachypnoea
  • ± Cullen’s Sign
  • ± Grey Turner’s Sign
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7
Q

List 2 signs that may be seen in haemorrhagic pancreatitis

A
  1. Cullen’s Sign

2. Grey Turner’s Sign

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8
Q

What is Cullen’s Sign - what is it indicative of?

A

Cullen’s Sign: peri-umbilical bruising

- seen in haemorrhagic pancreatitis

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9
Q

What is Grey Turner’s Sign - what is it indicative of?

A

Grey Turner’s Sign: flank bruising

- seen in haemorrhagic pancreatitis

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10
Q

Acute pancreatitis can be classified as mild, moderate or severe. What is considered mild acute pancreatitis?

A
  • NO organ failure

- NO local or systemic complications

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11
Q

Acute pancreatitis can be classified as mild, moderate or severe. What is considered moderate acute pancreatitis?

A
  • transient organ failure (< 48 hours)

- local or systemic complications

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12
Q

Acute pancreatitis can be classified as mild, moderate or severe. What is considered severe acute pancreatitis?

A

persistent organ failure (> 48 hours)

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13
Q

List 2 criteria that can be used to determine the severity of acute pancreatitis

A
  1. Glasgow (IMRIE) Criteria

2. Ranson Criteria

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14
Q

What are the 8 criteria that are present in the Glasgow (IMRIE) criteria?

A 
P - PaO2 < 8kPa
A - Age > 55
N - Neutrophilia (WCC > 15 x 10^9)
C - Calcium < 2 mmol/L
R - Renal Function (Urea > 16 mmol/L)
E - Enzymes (LDH > 600; AST > 200)
A - Albumin (32g/L)
S - Sugar (blood glucose > 10 mmol/L)
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15
Q

List some of the investigations that can be done to diagnose acute pancreatitis

A
  1. Bloods (FBC, CRP, Lipase + Amylase, LFTs, U&E, Calcium, Glucose)
  2. ABG
  3. CXR
  4. Abdominal Ultrasound
  5. CT of Pancreas
  6. MRCP/ERCP
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16
Q

List the treatments/management plan for acute pancreatitis

A
  • IV fluids (to treat dehydration)
  • analgesia
  • assess severity + repeat test at 48 hours
  • antibiotics in pancreatic necrosis
  • try to re-introduce feeding when possible
  • manage systemic + local complications (e.g. anti-thrombotic prophylaxis, alcohol withdrawal)
17
Q

When treating acute pancreatitis, the patient may undergo alcohol withdrawal. Which medications may be given?

A

Chlordiazepoxide + Pabrinex

18
Q

What is Chloridiazepoxide and what is it used for?

A
  • alcohol withdrawal drug
  • for acute pancreatitis pts w/ alcohol withdrawal
  • given with pabrinex (a multi-vitamin)
19
Q

What is Pabrinex and what is it used for?

A
  • multivitamin drug
  • for acute pancreatitis pts w/ alcohol withdrawal
  • given with chlordiazepoxide (an alcohol withdrawal drug)
20
Q

List the complications of acute pancreatitis

A
  • pseudocyst formation
  • pancreatic abscess
  • necrotizing pancreatitis
  • intra-abdominal sepsis
  • necrosis of transverse colon
  • ARDS
  • pancreatic haemorrhage
  • chronic pancreatitis
  • hyperglycaemia (due to loss of insulin)
  • hypocalcaemia (due to fat necrosis + saponification)
  • hypovolaemia; shock
  • SIRS
  • sepsis
  • DIC
21
Q

Necrotizing pancreatitis is a 2-phase disease. What occurs in the first phase (after 1 week)?

A

severe SIRS response

22
Q

Necrotizing pancreatitis is a 2-phase disease. What occurs in the second phase (after 2 weeks)?

A

sepsis-related complications

remember: sepsis is a dysregulated SIRS response

23
Q

Is serum lipase or amylase more important in diagnosing acute pancreatitis?

A

Serum Lipase (should be >3x the upper limit)

24
Q

List some of the cause of chronic pancreatitis

A
  • recurrent acute pancreatitis
  • increased alcohol use
  • due to pancreatic duct obstruction (tumours, cysts, strictures…)
  • autoimmune
  • idiopathic
25
Q

Describe the pathogenesis of chronic pancreatitis and how the pancreas would look

A

Obstruction of Pancreatic Ducts:

  • protein precipitates in pancreatic tubules
  • calcium deposited in precipitates
  • progressive course
  • continuous/episodic pain
  • patchy fibrosis in pancreas
26
Q

What are the possible treatments/managements for chronic pancreatitis?

A
  • stop alcohol
  • cholecystectomy (removing gall bladder)
  • reduce fat
  • enzyme supplementation (creon) [to help digest food]
  • analgesia
  • Whipple’s procedure
27
Q

What is Courvoisier’s Law?

A

a palpable gallbladder in a jaundiced patient is unlikely to be due to gallstones
- so you should think that it is a tumour

28
Q

List some of the risk factors for pancreatic cancer

A
  • age (6th + 7th decades of life)
  • smoking
  • alcoholism
  • diabetes (esp. T2DM)
  • chronic pancreatitis
29
Q

What is the Sister Mary Joseph nodule?

A

nodule on umbilicus

  • metastases from pancreas to the umbilicus
  • secondary tumour
30
Q

List some palliative treatments for pancreatic cancer

A
  • analgesia
  • coeliax axis block (stops nerves from feeling pain)
  • gastro-jejunostomy (to prevent any blockages that may occur)
31
Q

What is Whipple’s Procedure? (explain what is removed)

A

resection of…

  • part of the stomach
  • duodenum
  • pancreatic head + neck
  • gall bladder
  • part of the bile duct
  • draining lymph nodes
32
Q

What is another term for Whipple’s procedure?

A

pancreaticoduodenectomy

33
Q

List 2 indications for Whipple’s procedure

A
  • chronic pancreatitis

- pancreatic cancer (if cancer is resectable - 80% of the time it cannot be resected)

34
Q

What is the Apache II score used for?

A

to determine the mortality of a patient (in this case, with acute pancreatitis)

35
Q

What is the most common indication that a patient with chronic pancreatitis needs surgery (Whipple’s procedure)?

A

intractable pain

GIHEP (24 decks)

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