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Alimentary System > Lecture 19 Pancreatic Disease > Flashcards

Lecture 19 Pancreatic Disease Flashcards

1
Q

Define acute pancreatitis

A

Acute inflammation of the pancreas

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2
Q

Aetiology of acute pancreatitis

A 
Alcohol abuse
Gallstones
Blunt trauma
Postoperative
Post ERCP
Drugs
Viruses
Carcinoma
Metabolic
Idiopathic
Autoimmune
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3
Q

Pathogenesis of acute pancreatic

A 
Primary insult
Release of activated pancreatic enzymes
Autodigestion: oedema, fat necrosis, haemorrhage 
Pro-inflammatory cytokines
Reactive oxygen species
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4
Q

Clinical Features of acute pancreatitis

A
  • Abdominal pain (may radiate to back)
  • Vomiting
  • Pyrexia
  • Tachycardia, hypovolaemic shock
  • Oliguria, acute renal failure (low urine output)
  • Jaundice
  • Paralytic ileus (Obstruction of the intestine due to paralysis of the intestinal muscles)
  • Retroperitoneal haemorrhage (Grey Turner’s & Cullen’s signs)
  • Hypoxia (respiratory failure in severe cases)
  • Hypocalcaemia (tetany rare)
  • Hyperglycaemia (occasionally diabetic coma)
  • Effusions (ascitic & pleural; high amylase
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5
Q

Investigations of acute pancreatitis

A
  • Endoscopic Ultra-Sound
  • Blood tests: amylase/lipase, FBC, U&Es, LFTs, Ca2+, glucose, arterial blood gases, lipids, coagulation screen
  • AXR (ileus) & CXR (pleural effusion)
  • Abdominal ultrasound (pancreatic oedema, gallstones, pseudocyst)
  • CT scan (contrast enhanced)
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6
Q

General Management of acute pancreatitis

A
  • Analgesia (pethidine, indomethacin)
  • Intravenous fluids
  • Blood transfusion (Hb <10 g/dl)
  • Monitor urine output (catheter)
  • Naso-gastric tube
  • Oxygen
  • May need insulin
  • Rarely require calcium supplements
  • Nutrition (enteral or parenteral) in severe cases
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7
Q

Specific Management for pancreatic necrosis

A

CT guided aspiration, antibiotics + surgery

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8
Q

Specific Management of gallstones

A

EUS/MRCP/ERCP

Cholecystectomy

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9
Q

Management of abscess in acute pancreatitis

A

Anti-biotics and drainage

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10
Q

Management of pseudocyst in acute pancreatitis

A

US/CT scan

Endoscopic drainage or surgery if persistent pain or complications

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11
Q

What is a pseudocyst

A

fluid collection without an epithelial lining

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12
Q

Define chronic pancreatitis

A

• Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function’

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13
Q

Aetiology of Chronic Pancreatitis

A 
Alcohol
Cystic Fibrosis
Annular pancreatitis 
Pancreas 
Hereditary
Hypercalcaemia
Diet
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14
Q

What genes are associated with pancreatitis

A

PRSS1

  • SPINK1
  • CFTR
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15
Q

Describe the pathogenesis of chronic pancreatitis

A

Duct obstruction
Abnormal sphincter of Oddi
Genetic polymorphism

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16
Q

Pathology of chronic pancreatitis

A 
Glandular atrophy
Ducts become dilated, tortuous and strictured
Secretions may calcify
Exposed nerves
Portal hypertension
17
Q

Presentation of chronic pancreatitis

A 
Abdominal pain
Weight loss 
Pain anorexia
Malabsorption (fat and protein)
Exocrine and endocrine insufficiency 
Jaundice
Portal hypertension
GI haemorrhage 
Pseudocysts
18
Q

Investigations for chronic pancreatitis

A 
Plain AXR
US
EUS
CT scan
Blood test: serum amylase, albumin, calcium and magnesium, LfT, PT (vit k), glucose 
Pancreatic function test
19
Q

Management of pain control of chronic pancreatitis

A
  • avoid alcohol
  • pancreatic enzyme supplements
  • opiate analgesia (dihydrocodeine, pethidine)
  • Coeliac plexus block
  • referral to pain clinic/psychologist
  • Endoscopic treatment of pancreatic duct stones and strictures
  • Surgery in selected cases
20
Q

Management of endocrine and exocrine problem

A
  • Low-fat diet (30-40 g/day)
  • Pancreatic enzyme supplements (eg. Creon, Pancrex); may need acid suppression to prevent hydrolysis in stomach
  • Vitamin supplements usually not required
  • Insulin for diabetes mellitus (oral hypoglycaemics usually ineffective)
21
Q

Whats the most common type fo pancreatic cancer

A

Duct cell mucinous adenocarcinoma

22
Q

Where do majority of duct cell mucinous adenocarcinoma

A

Head

23
Q

Clinical features of carcinoma of the pancreas

A 
Upper abdominal pain
Painless obstructive jaundice
Weight loss
Anorexia
fatigue
Diarrhoea 
Steatorrhoea
Nausea
Vomiting
Tender subcutaneous fat nodules
Thrombophlebitis migraines
Ascites
Portal hypertension
24
Q

Physical signs of pancreatic cancer

A 
Hepatomegaly
Jaundice
Abdominal mass
Abdominal tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
25
Q

Investigation for pancreatic cancer

A

USS
CT
MRI
EUS

26
Q

Management of pancreatic cancer

A

Radical surgery-pancreatoduodenectomy
• Palliation of jaundice
stent, palliative surgery - cholechoduodenostomy
• Pain control (opiates, coeliac plexus block, radiotherapy)
• Chemotherapy only in controlled trials

Alimentary System (39 decks)

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