pancreas Flashcards
pathogenesis appendicitis
lymphoid hyperplasia or faecolith -> obstruction –> infection –> oedema, ischaemia, perforation
common symptoms appendicitis
general abdo pain –> RIF // pain on coughing + speed bumps // mild N+V // temp 37.5-38 // anorexia
o/e appendicitis
redbound tenderness // PR = boggy + right sided tenderness // Rosvings = palpate LIF –> pain RIF // psoas = pain extending hip
invx appendicitis
raised inflammation // neutrophil raised WCC // thin male = clinical // USS = women
mx appendicitis
lap appendicectomy // IV abx
pathophysiology pancreatitis
auto digestion pancreas
causes pancreatitis
(gallstone or alcohol) // GET SMASHED // Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoiumme, Scorpion, H , ECRP, Drugs
H causes pancreatitis
hypertriglyciders // hyperCa // hypothermia
drug causes pancreatitis
azathioprine, mesalazine!!, bendroflumethiazide, furosemide, steroids, valproate
features pancreatitis
severe epigastric pain –> back // vomiting // low fever
o/e pancreatitis
tender // Cullens sign - periumbilical discolouration // grey-turner = flank discolouraition
rare symptom pancreatitis
ischaemic retinopathy –> blindness
invx pancreatitis (not imaging)
amylase >3x limit // lipase // diagnosis if symptoms + raised lipase or amylase >3x limit
imaging pancreatitis
USS
scoring systems pancreatitis
ranson, glasgow, apache II
signs severe pancreatitis
> 55 // hypoCa // hyperglycaemic // hypoxic // neutrophilic // elevated LDH + AST
when is lipase particularly useful pancreatitis
late presentation - long half life
local complications pancreatitis
fluid collection // pseudocysts // necrosis // abscess // haemorrhage
peripancreatic fluid collection mx
aspirate + drain
invx pseudocysts pancreatitis
CT, ECRP, MRI
mx pseudocysts pancreatitis
observe 12 weeks –> aspiration
systemic complication pancreatitis
ARDS
mild pancreatitis
no organ failure or complications
moderate pancreatitis
transient organ failure <48hrs + possible local complications
severe pancreatitis
organ failure >48hrs + possible complications
mx pancreatitis
IV cytsalloids // IV opioids // PO or enteral nutrition // NO abx
causes chronic pancreatitis
alcoho!!l // CF, haemochromatosis // duct obstruction
features chronic pancreatitis
pain worse just after a meal // steatorrhoea // DM (20 years later)
invx chronic pancreatitis
CT // abdo Xray // faecal elastase
mx chronic pancreatitis
enzyme supplements // analgesia
RF pancreatic cancer
smoking // diabetes // chronic pancreatitis // hereditary NPCC // MEN // BRCA
features pancreatic cancer
painless jaundice (pale stool, dark urine, itch) // hepatomegaly, gallbladder mass, epgastric mass // vague symptoms eg anorexia, weigh loss // DM
courvoisers law
painless obstructive jaundice + palpable bladder = NOT gallstones
invx pancreatic cancer
raised ca199 // CT - double duct // USS
mx pancreatic cancer
whipples (pancreaticoduodenectomy) + chemo // palliative = ERCP
SE whipples
dumping syndrome + peptic ulcer
