Lesson 3A (Part 4)

Question 1

What is superior to sonography in detecting calcifications and ductal dilation?

Answer 1

CT

Question 2

What is a hallmark for chronic pancreatitis? (4)

Answer 2

1. Ductal dilation
2. Calcifications
3. Pain
4. History of ETOH
   - alcohol

Question 3

What do up to 1/3 of patients with chronic pancreatitis have?

Answer 3

A focal inflammatory mass in the pancreas

Question 4

What can masses in the head of the pancreas cause?

Answer 4

Dilation of the CBD and pancreatic duct

Question 5

What is chronic pancreatitis difficult to diagnose from?

Answer 5

Pancreatic carcinoma

Question 6

What can help rule of malignancy for chronic pancreatitis?

Answer 6

Biopsy

Question 7

What are the 2 most significant vascular complications in either acute or chronic pancreatitis?

Answer 7

1. Pseudoaneurysms

2. Venous thrombosis

Question 8

What is the most common vascular complication with pancreatitis?

Answer 8

Splenic vein thrombosis

Question 9

What can splenic vein thrombosis lead to?

Answer 9

Upper GI bleed from gastric varices known as sinistral

Question 10

Sinistral

Answer 10

Left sided portal hypertension

- occurs in 22% of patients with chronic pancreatitis

Question 11

How do pseudoaneurysms form?

Answer 11

When enzyme rich peripancreatic fluid, often within a pseudocyst, leads to autodigestion and weakening of the walls of adjacent arteries

Question 12

What do arteries under go pseudoaneurysms?

Answer 12

Aneurysmal dilatation with the bulge contained within the pseudocyst

Question 13

How can you rule out an pseudoaneurysm?

Answer 13

But applying colour doppler to the cystic collection

Question 14

Why does portal and splenic vein thrombosis occur in chronic pancreatitis? (2)

Answer 14

1. Intimal injury due to recurrent inflammation

2. Results in chronic fibrosis

Question 15

What is portal and splenic vein thrombosis caused by?

Answer 15

Pseudocyst compression on the adjacent vessels

Question 16

Can portal and splenic vein thrombosis can occur simultaneously?

Answer 16

Yes

Question 17

What do collaterals do?

Answer 17

Convey blood to the liver bypassing the clot

Question 18

ERCP

Answer 18

Endoscopic retrograde cholangio-pancreatography

Question 19

Why owuld you use endoscopic retrograde cholangio-pancreatography?

Answer 19

Diagnose or therapeutic reasons

- liver, bile ducts, pancreas or gallbladder

Question 20

What are the benefits of ERCP? (3)

Answer 20

1. Not a painful procedure
   - it is uncomfortable
2. Low incidence of complications
3. Provides important information that cannot be obtained by other diagnostic examinations

Question 21

What therapeutic measures can be performed at the time of ERCP? (2)

Answer 21

1. To remove stones in the bile ducts

2. To relieve obstruction of the bile ducts

Question 22

How is ERCP done? (5)

Answer 22

1. The procedure is performed by using a long, flexible, viewing instrument
   - a duodenoscope
2. The fiber optic tip of the endoscope transmits digital video images to a TV screen
3. 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
4. Contrast material is then injected
5. X-rays are taken of the bile ducts and the pancreatic duct

Question 23

Why is ERCP used? (4)

Answer 23

1. To perform biopsies
2. To insert plastic or metal tubing
   - stent
3. To relieve obstruction of the bile ducts or pancreatic duct caused by cancer or scarring
4. To perform incisions by using electrocautery
   - electric heat