Lesson 3A (Part 4) Flashcards
What is superior to sonography in detecting calcifications and ductal dilation?
CT
What is a hallmark for chronic pancreatitis? (4)
- Ductal dilation
- Calcifications
- Pain
- History of ETOH
- alcohol
What do up to 1/3 of patients with chronic pancreatitis have?
A focal inflammatory mass in the pancreas
What can masses in the head of the pancreas cause?
Dilation of the CBD and pancreatic duct
What is chronic pancreatitis difficult to diagnose from?
Pancreatic carcinoma
What can help rule of malignancy for chronic pancreatitis?
Biopsy
What are the 2 most significant vascular complications in either acute or chronic pancreatitis?
- Pseudoaneurysms
2. Venous thrombosis
What is the most common vascular complication with pancreatitis?
Splenic vein thrombosis
What can splenic vein thrombosis lead to?
Upper GI bleed from gastric varices known as sinistral
Sinistral
Left sided portal hypertension
- occurs in 22% of patients with chronic pancreatitis
How do pseudoaneurysms form?
When enzyme rich peripancreatic fluid, often within a pseudocyst, leads to autodigestion and weakening of the walls of adjacent arteries
What do arteries under go pseudoaneurysms?
Aneurysmal dilatation with the bulge contained within the pseudocyst
How can you rule out an pseudoaneurysm?
But applying colour doppler to the cystic collection
Why does portal and splenic vein thrombosis occur in chronic pancreatitis? (2)
- Intimal injury due to recurrent inflammation
2. Results in chronic fibrosis
What is portal and splenic vein thrombosis caused by?
Pseudocyst compression on the adjacent vessels
Can portal and splenic vein thrombosis can occur simultaneously?
Yes
What do collaterals do?
Convey blood to the liver bypassing the clot
ERCP
Endoscopic retrograde cholangio-pancreatography
Why owuld you use endoscopic retrograde cholangio-pancreatography?
Diagnose or therapeutic reasons
- liver, bile ducts, pancreas or gallbladder
What are the benefits of ERCP? (3)
- Not a painful procedure
- it is uncomfortable - Low incidence of complications
- Provides important information that cannot be obtained by other diagnostic examinations
What therapeutic measures can be performed at the time of ERCP? (2)
- To remove stones in the bile ducts
2. To relieve obstruction of the bile ducts
How is ERCP done? (5)
- The procedure is performed by using a long, flexible, viewing instrument
- a duodenoscope - The fiber optic tip of the endoscope transmits digital video images to a TV screen
- Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the endoscope into the opening of the papilla, and into the bile ducts and/or the pancreatic duct
- Contrast material is then injected
- X-rays are taken of the bile ducts and the pancreatic duct
Why is ERCP used? (4)
- To perform biopsies
- To insert plastic or metal tubing
- stent - To relieve obstruction of the bile ducts or pancreatic duct caused by cancer or scarring
- To perform incisions by using electrocautery
- electric heat
