Pancreas Flashcards
What are the causes of pancreatitis?
What is the Glasgow score for pancreatitis?
Classifies the severity of pancreatitis
0/1= mild
2 = moderate
3+ = severe
What are the criteria for the Glasgow score?
P - PaO2 < 8kPa
A - Age > 55
N - Neutrophils (WBC > 15)
C - Calcium < 2
R - uRea > 16
E - Enzymes (LDH > 600, or AST?ALT > 200)
A - Albumin < 32
S - Sugar (glucose > 20)
What is acute pancreatitis?
Rapid onset of inflammation and symptoms. Usually after an episode of acute pancreatitis, normal pancreatic function will return
What is chronic pancreatitis?
Longer term inflammation of the pancreas. Will see a progressive and permanent deterioration in pancreatic function.
Describe the amylase levels in acute pancreatitis?
3x the upper limit of normal
What are the features of acute pancreatitis?
Severe epigastric pain
Pain can radiate through to back
Associated vomiting
Abdominal tenderness
May see Cullen’s sign and Grey Turners sign
Systemically unwell (e.g. low grade fever and tachycardia)
What sign is this?
Cullen’s sign
What sign is this?
Grey Turner’s sign
What is the management of acute pancreatitis?
Initial resus - ABCDE
IV fluids(crystalloids)
Analgesia
Careful monitoring
Treatment of gallstones if gallstone pancreatitis (cholecystectomy)
Antibiotics if evidence of infection
What are some of the features of chronic pancreatitis?
Chronic epigastric pain which typically worse following a meal
Loss of exocrine and endocrine function - development of DM is common
Formation of pseudocysts and abscesses
What is the management of chronic pancreatitis?
Stop smoking and alcohol
Analgesia
Replacement pancreatic enzymes (e.g. Creon)
Diabetes treatment (e.g. insulin)
ERCP with stenting
Sometimes surgery is required
What type of tumours are a majority of pancreatic cancers?
Adenocarcinomas
What are the features of pancreatic cancer?
Painless jaundice
Courvoisier’s Law
Anorexia, weight loss, epigastric pain
Loss of exo and endocrine function
What sign is seen on imaging of pancreatic cancer?
Double duct sign - presence of simultaneous dilatation of the common bile and pancreatic ducts
What is the NICE guidance for referral of suspected pancreatic cancer?
Over 40 with jaundice - 2 week wait referral
Over 60 with weight loss + one other symptom in keeping with pancreatic cancer - referred for a direct access CT abdomen
What signs are associated with pancreatic cancer?
Courvoisier’s Law
Trousseau’s sign of malignancy
What is Trousseau’s sign of malignancy
Migratory thrombophlebitis - episodes of vessel inflammation due to blood clots which are recurrent and appear in different locations over time
What tumour marker can be raised in pancreatic cancer?
CA 19-9
What is the management of pancreatic cancer?
Palliation - stents to relive obstruction, palliative radio and chemo
Surgery in some cases - Whipple procedure, pancreatectomy
What is a whipple procedure?
Surgery to remove a tumour in the head of the pancreas that has not spread. Involves the removal of
- Head of pancreas
- Pylorus of stomach
- Duodenum
- Gallbladder
- Bile duct
- Relevant lymph nodes
