Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What % of all malignancy is carcinoma of the pancreas?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Typical prevalence for carcinoma of pancreas

A

> 60 and 60% male (oxford handbook say more female)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for pancreatic carcinoma

A

Smoking
Alcohol
High adiposity - central obesity

Family Hx

Carcinogens
DM
Chronic pancreatitis

Possibly high fat/red meat/processed meat diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of carcinoma is common?

A

Ductal adenocarcinoma

Metastasise early and present late

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Location of pancreatic cancer normally

A

60% in head
25% in body
15% in tail

A few in ampulla of vater or pancreatic islet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Oncogene usually involved in pancreatic cancer

A

95% have KRAS2 activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Features of pancreatic head cancer

A

Painless obstructive jaundice

Obstruction of pancreatic duct can lead to pancreatic damage causing abnormalities in glucose homeostasis and therefore diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of body or tail of pancreas carcinoma

A

Abdominal/epigastric pain - radiates to back and relieved on leaning forward

Also non-specific symptoms such as anorexia, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations in pancreatic cancer

A

Transabdominal ultrasound - less reliable for body or tail cancers because of overlying bowel gas

CEA and Ca 19-9 can be elevated

Contrast CT scan

ERCP - usually for palliative treatment but can be good for cytology if diagnosis is in question

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rarer features of pancreatic cancer

A

Thrombophlebitis migrans
Non-bacterial thrombotic endocarditis
Portal hypertension - splenic vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of cancer of head of pancreas

A

Jaundice and pruritus
Gall bladder may be palpable - Courvoisier’s sign (palpable gall bladder, painless and jaundice = pancreatic malignancy)

Hepatomegaly - mets

Lymphadenopathy

Ascites - mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment for pancreatic cancer

A

Most present with metastatic disease and are not suitable for radical surgery

Can do pancreatoduodenectomy - Whipples - if no mets

Chemotherapy delays progression

Palliation of jaundice and obstruction

Pain - opiates or radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prognosis for pancreatic cancer

A

Poor

5 year survival = 3%, 5-14% with whipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is acute pancreatitis?

A

Self-perpetuating pancreatic inflammation by enzyme-mediated autodigestion - initiated by acute injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of acute pancreatitis?

A

GET SMASHED

Gall Stones
Ethanol
Trauma

Steroids

Mumps and other viruses

Autoimmune - PAN = polyarteritis nodosa

Scorpion venom

Hyperlipidaemia, hypothermia, hypercalcaemia

ERCP and emboli

Drugs
Azathioprine
Sulfonamides
Sulindac
Tetracycline
Valproic acid,
Didanosine
Methyldopa
Estrogens
Furosemide
6-Mercaptopurine
Pentamidine
Corticosteroids
Octreotide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of acute pancreatitis?

A

Gradual/sudden severe epigastric or central abdominal pain

Radiates to back

Relieved by sitting forward

Vomiting

17
Q

Signs of acute pancreatitis

A

May be mild

Tachycardia, fever, hypotension
Jaundice
Shock, ileus (decreased bowel sounds)
Rigid abdomen + tenderness

Periumbilical bruising = Cullen’s sign
Flank bruising = Grey Turner’s sign

18
Q

Blood tests in acute pancreatitis

A

Serum amylase - 3x upper limit of normal if measured within 24 hours of onset of pain - back to normal after 3-5 days

Urinary amylase - remains elevated for longer

Serum lipase - elevated and for longer

CRP - assessing severity and prognosis

19
Q

Imaging in acute pancreatitis

A

Erect chest xray - exclude gastroduodenal perforation (raises serum amylase)

Abdominal ultrasound - gall stone cause of pancreatitis

CT to assess degree of pancreatic necrosis

MRCP - degree of damage and gall stone identification

ERCP - gall stone removal

20
Q

Assessment of severity of pancreatitis

A

PANCREAS

  • PaO2 less than 8
  • Age older than 55
  • Neutrophils > 15 x 109/l
  • Calcium less than 2mmol/L
  • Renal Function Urea > 16mmol/L
  • Enzymes LDH > 600iu/L AST >200iu/L
  • Albumin less than 32g/l
  • Sugar (glucose) >10mmol/L

3 or more positive factors detected within 48hours of onset suggests severe pancreatitis
- Prompt transfer to ITU/HDU

21
Q

Managment of acute pancreatitis

A

NBM - NG tube to decrease pancreatic stimulation
IV fluids
Analgesia - tramadol or morphine

May need debridement of necrotic tissue

Antibiotics

DVT prophylaxis

22
Q

Early complications of acute pancreatitis

A 
Shock or sepsis
ARDS
Renal failure 
Hypocalcaemia 
Hyperglycaemia
23
Q

Late complications of acute pancreatitis

A

Necrosis
Pseudocyst
Abscesses
Bleeding - elastase eroding a major vessel
Thrombosis in SMA - causing bowel necrosis

Recurrent pancreatitis

24
Q

Pathology of chronic pancreatitis

A

Trypsin activation
Increased pancreatic enzyme activity (trypsin) leads to precipitation of proteins within duct lumen - form plugs

Obstruction, hypertension and further damage

25
Q

Presentation of chronic pancreatitis

A

Epigastric pain - through to back, relieved by leaning forward
Hot water bottles chronically on sore areas (epigastrium and back) cause erythema ab igne’s

Bloating 
Steatorrhoea 
Weight loss
Diabetes
Symptoms relapse and worsen
26
Q

Causes of chronic pancreatitis

A 
Alcohol - 70%
Familial (rare)
CF 
Haemochromatosis 
Pancreatic duct obstruction 
high PTH 
Congenital 
Autoimmune
27
Q

Investigations in chronic pancreatitis

A

Amylase and lipase may be elevated

Raised glucose

Ultrasound

CT - shows pancreatic calcification and dilated pancreatic duct

MRCP - more subtle disease diagnosis

Endoscopic ultrasound - doubt about diagnosis

28
Q

DDX of chronic pancreatitis

A

Similar presentation to pancreatic cancer

29
Q

Management of pain in chronic pancreatitis

A

NSAIDs and opiates for short-term flare up

TCA, pregabalin for chronic pain

Coeliac axis block

Many patients become pain free after 6-10 years

Can do surgery in unretractable pain

30
Q

Other management of chronic pancreatitis

A

Fat-soluble vitamins
Lipase
Low fat diet
No alcohol

Treat diabetes

31
Q

Complications in chronic pancreatitis

A

Pseudocysts
Diabetes
Biliary obstruction - ascites, gastric varices
Pancreatic carcinoma

32
Q

What is Trousseau sign of malignancy?

A

Thrombophelbitis migrans - particularly associated with pancreatic and lung cancer

Gastroenterology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions