Pancreas Flashcards
what is the mnemonic to remember causes for acute pancreatitis
‘GETSMASHED’
G - Gallstones
E - excess alcohol
T - trauma
S - steroids
M - mumps
A - autoimmune disease
S - scorpion venom
H - hypercalcaemia
E - Endoscopic retrograde cholangiopancreatography (ERCP)
D - drugs (NSAIDs, azathioprine, diuretics)
what is the pathophysiology of pancreatitis
pancreatic inflammatory response where enzymes are released from the pancreas which then start autodigesting itself
end-stage pancreatitis results in partial or complete necrosis of the pancreas
clinical features of acute pancreatitis
sudden severe epigastric pain that radiates through to the back with associated nausea and vomiting
some less common signs include bruising around the umbilicus and flanks which indicate retroperitoneal haemorrhage
what are the specific blood tests for acute pancreatitis
serum amylase
LFTs - often have raised ALT levels
serum lipase
management of acute pancreatitis
no curative management - treat underlying cause
IV fluids, NG tube, catheter for supportive measures + opioid analgesia
prophylactic abx in cases of necrosis
why is hypocalcaemia a complication of pancreatitis
fat necrosis from released lipases results in the release of free fatty acids which react with serum calcium to form chalky deposits in fatty tissue
lowers levels of free serum calcium in the blood
what are the main causes of chronic pancreatitis
chronic alcohol abuse (60%)
idiopathic (30%)
clinical features of chronic pancreatitis
chronic pain in the epigastrium and back, often associated with nausea and vomiting
patients can also present with malabsorption, weight loss, diarrhoea and steatorrhoea - this is due to the pancreas losing the ability to produce digestive enzymes
patients can also present with diabetes as the pancreas loses its endocrine function and no longer produces insulin
why does chronic pancreatitis often present with malabsorption and significant weight loss
pancreas loses its exocrine function and no longer produces digestive enzymes that enter the GI tract - as a result food isn’t broken down and absorbed
this results in malabsorption and weight loss
how do the stools appear in chronic pancreatitis
pale and fatty stools
due to the fact that pancreas doesn’t produce lipase anymore - fat not broken down in GI tract
all passes out in faeces giving it a pale colour
how do serum amylase and serum lipase appear in chronic pancreatitis patients
often not raised in established disease compared to acute pancreatitis
what investigations would you want to do in a patient with suspected chronic pancreatitis
FBC + CRP
urine dip
serum amylase and lipase (often not raised in established disease)
blood glucose - secondary to endocrine dysfunction
faecal elastase level - often low in cases of chronic pancreatitis
management of chronic pancreatitis
only managed definitively by treating the underlying cause - e.g. alcohol cessation or statin therapy for hyperlipidaemia
analgesia becomes mainstay of management
those with exocrine and endocrine suits require enzyme replacement and nutritional support
what is the most common histological subtype of pancreatic cancer
ductal carcinoma arising from the exocrine portion of the organ
endocrine tumours of the pancreas derive from what cells
islet cells
where is the most common location of pancreatic tumours
the head of the pancreas
risk factors for pancreatic cancer
smoking
chronic pancreatitis
dietary factors; high red meat intake, low fruit and veg intake
family history
diabetes mellitus
clinical features of pancreatic cancer
painless obstructive jaundice - compression of common bile duct
weight loss
abdo pain
what tumour marker is important in pancreatic cancer
CA19-9
imaging in pancreatic cancer
USS first line
CT imaging is gold standard for diagnosis
CT-chest-abdo-pelvis then further needed for staging
management of pancreatic cancer
only curative management is radical resection however at presentation <20% of patients have a resectable tumour
overall 5 year survival rate <5%
what are functional pancreatic endocrine tumours and give examples
tumours that actively secrete hormones with their symptoms being directly related to this
G cells tumour - secrete excess gastrin causing severe peptic ulcers
alpha cell tumour - secrete excess glucagon resulting in increased blood glucose and diabetes
beta cell tumour - secrete excess insulin resulting in decreased blood glucose and hypogylcaemia
what are the broad classifications of pancreatic cysts
mucinous vs non-mucinous
mucinous being higher risk
how do most pancreatic cysts present
incidentally on imaging
clinical features of pancreatic cysts
mostly asymptomatic
high risk features include; obstructive jaundice, recurrent pancreatitis, new onset diabetes
investigations into pancreatic cysts
CT pancreas or MRCP to gain further info
What is the most sensitive blood test for diagnosis of acute pancreatitis?
serum lipase
The serum amylase may rise and fall quite quickly and lead to a false negative result. Should the clinical picture not be concordant with the amylase level then serum lipase or a CT Scan should be performed.
