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1st Year - Gastroenterology > Liver, etc. 11 - Inflammation adn tumours of Pancreas > Flashcards

Liver, etc. 11 - Inflammation adn tumours of Pancreas Flashcards

1
Q

What are the 3 main pancreatic diseases?

A

Acute pancreatitisChronic pancreatitisPancreatic tumours

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2
Q

What are the 5 parts of the pancreas?

A

Uncinate processHeadNeckBodyTail

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3
Q

What do alpha islet cells release?

A

Glucagon

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4
Q

What do Beta islet cells release?

A

Insulin

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5
Q

What do Delta islet cells release?

A

somatostatin

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6
Q

What do PP cels release?

A

Pancreatic polypeptide

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7
Q

What are the 2 categories of acute pancreatitis?

A

Mild acuteSevere acute

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8
Q

What is the predominant feature of mild acute pancreatitis?

A

interstitial oedema of the glandAssociated with minimal organ dysfunction and an uneventful recovery

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9
Q

What is severe acute pancreatitis?

A

Associated with organ failure and/ or local complications such as necrosis (with infection), pseudocyst or abscess

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10
Q

What viral infections can cause acute pancreatitis?

A

MumpsCoxsackie B (can cause hand foot and mouth disease)Viral hepatitis

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11
Q

What other factor can cause acute pancreatitis apart from GET SMASHED?

A

Genetic factors

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12
Q

What genetic factors can cause acute pancreatitis?

A

Cationic trypsinogen gene CF gene

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13
Q

What drugs can cause pancreatitis? (4)

A

Valproic acidAzathioprineL-asparaginaseCorticosteroids

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14
Q

What autoimmune disease can cause pancreatitis?

A

IgG4-related autoimmune disease

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15
Q

What causes necrosis of the pancreas during pancreatitis?

A

Inflammation of the parenchyma causing hypoperfusion

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16
Q

How is acute pancreatitis diagnosed?

A

History (e.g. gallstones, alcohol, drugs, trauma, infection, ERCP)ExaminationBlood testsImaging

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17
Q

What is peritonism?

A

having the clinical signs of shock and peritonitis

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18
Q

Possible examination findings for acute pancreatitis? (5)

A

TendernessPeritonismDistensionBowel soundsSkin markings

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19
Q

Blood tests performed to look for acute percents?

A

FBCClottingU&EsLFTsAmylaseCRPGlucoseCa

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20
Q

Imaging for acute pancreatitis? (5)

A

CXR/AXRAUSCT pancreasMRIERCP

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21
Q

Findings on AXR suggestive of possible AP? (2)

A

Pleural effusionSentinel loop

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22
Q

What is a sentinel loop?

A

dilatation of a segment of small intestine

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23
Q

What is the purpose of carrying out an US for AP?

A

To rule out biliary pancreatitisLook for:GallstonesCholecystitisCBD diameterFree fluid

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24
Q

What is the purpose of carrying out a CT scan for acute pancreatitis?

A

Assess severity of pancreatitisDecide on interventions and follow upLook for complications (e.g. fluid collection, necrosis, ascites, bleeding, abscess)

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25
Q

Use of ERCP in AP?

A

Not as a diagnostic tool!Used for treatment of CBD stones with obstruction cholangitis as an emergency procedureUsed for treatment of acute biliary pancreatitis (if no index cholecystectomy possible)

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26
Q

What is the glasgow prognostic score?

A

PaO2 less than 8kPaAge greater than 55 yearsNeutrophils greater than 15 X 10^9/LCalcium less than 2mmol/LRenal function: urea greater than 16mmol/LEnzymes (AST/ ALT greater than 200 or LDH greater than 600)Albumin less than 32 g/LSugar (glucose less than 10 mol/L)*any 3 factors means acute severe pancreatitis

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27
Q

What Glasgow prognostic score = acute severe pancreatitis?

A

3

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28
Q

Apart form the Glasgow prognostic score, what is another scoring system that can be used to acute pancreatitis?

A

Ranson score (only for alcohol-induced pancreatitis)Balthazar score - used to assess percentage of necrosis and severity score from a CT scan (CT severity index)

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29
Q

Symptoms of acute pancreatitis? (7)

A

Epigastric/ diffuse abdominal pain +/- radiation to the backNausea and vomitingIndigesitonAbdominal tendernessLoss of appetite +/- weight lossTemperatureJaundice (pain)

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30
Q

What type of acute pancreatitis are most pancreatitis?

A

Mild pancreatitis (85% - mortality = 1%)

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31
Q

How long does it take for all necrosis from pancreatitis to show up?

A

4 days

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32
Q

What are the local complications from Acute pancreatitis? (6)

A

Fluid collectionPseudocystsAbscessNecrosis +/- infectionAscitesPleural effusion

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33
Q

What are the systemic complications of acute pancreatitis? (8)

A

Pulmonary failureRenal failureShockSepsisMetabolic acidosisHyperglycaemiaHypoglycaemiaMODS (multi organ failure)

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34
Q

What problems can pseudocysts cause?

A

They can cause biliary and/ or gastric outlet obstruction

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35
Q

Symptoms of a pseudocyst? 95)

A

PainnauseaVomitingJaundiceWeight loss

36
Q

Treatment of pseudocysts?

A

Endoscopic drainageSurgical drainage (open/laparotomy)(cystgastrostomy or cystjejunostomy can be performed in order to drain the cyst into the stomach or jejunum)

37
Q

Treatment of a pancreatic abscess?

A

CT/US guided retroperitoneal or transpirational drainage drain abscess, control sepsis

38
Q

Management of necrosis?

A

CT for assessmentSterile or infected?If sterile, it should be treated conservatively May require drainage or necrosectomy and lavage if infected

39
Q

What drugs have been shown to be beneficial for the treatment of acute pancreatitis?

A

no drug therapy has been shown to be beneficial

40
Q

What is chronic pancreatitis?

A

Progressive and irreversible destruction of pancreatic tissueResults in permanent loss of endocrine and exocrine function

41
Q

What is pancreatic divisum?

A

congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts

42
Q

What are the 5 main causes of chronic pancreatitis?

A

FamilialAlcoholHyperparathyroidism/ hypercalcaemiaCFAlpha-antitrypsin deficiencyPancreatic duct obstruction (cholelithiasis, structure, tumour, pseudocyst, pancreas divisum)Tropical (deficient in methionine and trace elements)Autoimmune pancreatitis (IgG4 subclass)

43
Q

How is autoimmune chronic pancreatitis treated?

A

Steroids

44
Q

Diagnosis of chronic pancreatitis?

A

HistoryExaminationBlood testsImagining*same as for acute pancreatitis except IgG4 and CA 19-9 pancreatic function tests are also performed

45
Q

What are the 2 main imaging signs of chronic pancreatitis?

A

Extensie pancreatic calcificationPancreatic duct dilation

46
Q

Treatment of chronic pancreatitis?

A

Drugs e.g. analgesics, creon, vitamins, insulinNo alcohol and low fat diet may helpSurgery (pancreatectomy or pancreaticojejunostomy) if unremitting pain/ weight loss

47
Q

What is another name for a pancreaticojejunostomy?What does this involve?Other 2 similar procedures?

A

Pustow procedureDilated pancreatic duct is filleted open and joined to the jejunum (which is also filleted open)This allows pancreatic juice to enter the jejunum(Frey procedure is the same as the pastor procedure although the head of the pancreas gets pulled out a bit more)

48
Q

What type of procedure is used to treat chronic pancreatitis with inflammatory head tumour?

A

Beger procedure

49
Q

Complications of chronic pancreatitis?

A

Splenic vein thrombosisPseudoaneurysmsPancreatic cancerpseudocystBile duct or duodenal obstructionPancreatic ascitesPleural effusion

50
Q

Treatment of a biliary obstruction?

A

Stent, bypass, resection

51
Q

Treatment of a duodenal obstruction?

A

Stent, bypass, resection

52
Q

What is the treatment for a pseudocyst?

A

Endoscopic drainageSurgical drainage Resection

53
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol (abstinence is associated with a more favourable prognosis)

54
Q

Does stopping smoking have a higher chance of favourable outcomes for chronic pancreatitis?

A

Yes

55
Q

What is the most common type of exocrine pancreatic tumour?

A

Adenocarcinoma (95% of exocrine pancreatic tumours)

56
Q

What are the 5 possible types of endocrine pancreatic cancers?

A

GastrinomaInsulinomaGlucagonoma(tends to be smaller and more easily treated than adenocarcinoma)SomatostatinomaVipoma

57
Q

Symptom of a gastroma?

A

Produces gastrin causing increased stomach acid = gastric/ duodenal ulcers

58
Q

Symptom of an insulinoma?

A

Produces insulin, causing the body to store sugar rather than burn it = hypoglycaemia

59
Q

Symptom of a glucagoma?

A

Produces glucagon, increasing blood sugar levels = hyperglycaemia

60
Q

what are symptoms of somatostatinoma?

A

DiabetesSteatorrhoea

61
Q

Symptoms of vipoma?

A

Severe diarrhoeaHypokalaemiaAchlorhydria

62
Q

What is achlorhydria

A

Absence of HCl acid in gastric secretions

63
Q

Symptoms of pancreatic cancer?

A

Jaundice (dark urine and light stools)Back painWeight loss (anorexia, nausea, vomiting)

64
Q

Risk factors for pancreatic cancer? (4)

A

SmokingDiabetesFamilial pancreatitisObesity

65
Q

How is pancreatic cancer diagnosed?

A

HistoryExamination (abdo exam probs won’t tell you anything unless they have metastases)Blood testsImaging

66
Q

How can you diagnose pancreatic cancer from ERCP?

A

Can take brushings = biopsy

67
Q

Staging system for pancreatic cancer?

A

TNM

68
Q

What is Tis for pancreatic cancer?

A

Very early stage, has not had the chance to spread 9carcinoma in situ

69
Q

T1 for pancreatic cancer?

A

The size of the tumour in the pancreas is 2cm or less in any direction

70
Q

T2 for pancreatic cancer?

A

The tumour is more than 2cm across in any direction

71
Q

T3 for pancreatic cancer?

A

The cancer has started to grow into surrounding tissues around the pancreas, in the duodenum or bile duct

72
Q

T4 for pancreatic cancer?

A

The cancer has grown further into the stomach, spleen, large bowel or nearby large blood vessels

73
Q

N1 pancreatic cancer?

A

Has spread into lymph nodes (N0 = has not spread)

74
Q

M1 pancreatic cancer?

A

Has spread to distant body parts (M0 = has not)

75
Q

Stage 1 pancreatic cancer?

A

Cancer is confined to the pancreas

76
Q

Stage 2 pancreatic cancer?

A

Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes

77
Q

Stage 3 pancreatic cancer?

A

Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes

78
Q

Stage 4 pancreatic cancer?

A

Cancer has spread to distant sites beyond the pancreas such as the liver, lungs and the peritoneum

79
Q

Treatment for pancreatic cancer?

A

Surgery = only curative methodChemotherapyRadiotherapyCombinations

80
Q

Types of surgery for resectable pancreatic tumours? (4)

A

Whipple resectionTotal pancreatectomyDistal pancreatectomyMidsegment pancratectomy

81
Q

Types of surgery for non-resectable pancreatic tumours?

A

Biliary bypassGastric bypassDouble bypass

82
Q

What is involved in Whipple’s operation?

A

Part of the stomach and the head of the pancreas are removed - remaining stomach and pancreas are joined separately to the small intestines

83
Q

Distal pancreatectomy?

A

Body and tail of the pancreas and usually the spleen are removed

84
Q

Biliary bypass?

A

Rerouting the flow of bile from the common bile duct into the intestine bypassing the pancreas

85
Q

Gastric bypass?

A

Pancreatic tumour can block the duodenum - surgery directly joins the stomach and the small intestine

1st Year - Gastroenterology (37 decks)

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