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Gastrointestinal MD2 > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What are the 2 functions of the pancreas?

A

Endocrine - Islet Cells

Exocrine - Acinar and ducts

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2
Q

What are the 3 types of endocrine cells and what do they secrete?

A

Alpha cells: glucagon
Beta cells: insulin
Delta cells: somatostatin

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3
Q

What are the RF for acute pancreatitis?

A 
Idiopathic 
Gallstones
Ethanol 
Trauma 
Steroids
Mumps/malignancy 
Autimmune 
Scorpion/spider bite 
Hyperlipidemia/hypercalcemia 
ERCP 
Drugs
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4
Q

What would you expect on history for acute pancreatitis?

A

Nausea and vomiting

Pain starting in epigastrium penetrating quality and radiates to the back

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5
Q

What would you expect on examination for acute pancreatitis?

A
  • Tachycardia, fever
  • Epigastric tenderness, abdominal distension
  • Severe cases can get Turner Sign and Cullen Sign
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6
Q

What is Turner’s Sign? What is Cullen’s Sign?

A

Turner: bruising in the flanks
Cullen: Superficial edema and bruising in the subcutaneous fat around umbilicus

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7
Q

Differential diagnosis for acute sharp pain in epigastric region

A
  • Perforated peptid ulcer
  • Choledocholithiasis
  • Cholecystitis
  • Cholangitis
  • Intestinal Obstruction
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8
Q

What tests are done to confirm acute pancreatitis?

A
  • Amylase and LIPASE: super high
  • Hypocalcaemia
  • Serum glucose goes down
  • AST/ALT: if > 3 times upper normal limit then predicts gallstone disease
  • X-ray to rule out other causes
  • CT/MRI
  • MRCP:
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9
Q

What is the advantage of MRCP?

A

MRCP has the advantage of not requiring IV contrast or radiation. In addition, MRCP allows better visualisation of common bile duct stones and the pancreatic duct.

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10
Q

What is the treatment of Pancreatitis

A
  • Initial resuscitation
  • Analgesia and antiemetic
  • Nutritional support
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11
Q

Acute pancreatitis complications?

A
  • Pancreatic pseudocyst
  • Infection: pancreatic abscess
  • Pancreatic ascites
  • Hemorrhage
  • Hypocalcemia
  • Shock
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12
Q

What is chronic pancreatitis?

A

Progressive injury to the pancreas resulting in scarring and loss of function.

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13
Q

What happens in the late stages of chronic pancreaitits?

A
  • the endocrine parenchyma is also affected
  • malabsorption
  • diabetes
  • pancreatic calcification
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14
Q

what would be your differential for chronic pancreatitis?

A
  • Pancreatic cancer
  • Acute pancreatitis
  • Biliary colic
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15
Q

What ix would you do for chronic pancreatitis?

A
  • Blood glucose may be elevated
  • Lipase and amylase
  • Pancreatic calcification on Xray
  • CT to evaluate the size and texture of the pancreas
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16
Q

Complications of chronic pancreaitits?

A
  • Pancreatic insufficiency
  • Diabetes
  • Pancreatic calcification
  • Opiod addiction
17
Q

What is the most common type of exocrine tumour o of the pancreas?

A

duct cell adenocarcinoma

18
Q

What are the signs and symptoms pancreatic cancer?

A
  • Jaundice
  • Weight loss
  • Abdominal pain
19
Q

What ix would you over for pancreatic cancer?

A
  • LFT: high bilirubin and ALP
  • Blood tumour markers: CEA and C19-9
  • CT constrast
  • Trans-abdominal contrast
20
Q

What is the function of C19-9?

A
  • Progressive increase in over time is diagnostic
  • Monitor response to treatment
  • high sensitivity but high false positive rate too
21
Q

What is Whipple procedure?

A

Treatment for pancreatic cancer

22
Q

How does Whipple procedure work?

A

○ Remove head of pancreas, duodenum, gallbladder and distal part of the stomach
○ Bring the bile duct down by the liver

23
Q

What are the 3 types of benign, pre-cancerous tumours?

A
  • Intraductal papillary mucinous neoplasm
  • Pancreatic Epithelial Neoplasm
  • Mucinous cystic neoplasm
24
Q

What does Intraductal papillary mucinous neoplasm affect?

A
  • Affects pancreatic ducts or branches
  • Can be benign, borderline, malignant non-invasive or malignant invasive
  • Produces multiloculated cystic lesions
  • make mucin, and they can sometimes become cancer
  • No relationship to duct
25
Q

How common are endocrine tumours of the pancreas?

A

rare with an incidence of 5 in 1 million

26
Q

Types of endocrine tumours

A
  • Insulinoma
  • Gastrinoma (Zollinger Ellison Syndrome)
  • Glucagonoma
  • (VIOPoma)
  • Somatostatinoma - rare
  • Non-functional islet cell tumor
27
Q

what is the commonest type of endocrine tumour

A

Insulinoma

28
Q

Are LN mets common in endocrine cancer of pancreas?

A

Yes

29
Q

Where are the sites of metastases in endocrine pancreas cancer

A

liver
lung
skin
brain

30
Q

findings on History and examination for endocrine cancer of pancreas?

A
  • Painless jaundice
  • Abdominal discomfort
  • Weight loss
31
Q

What ix need for pancreas cancer?

A
  • Abdominal US
  • LFT
  • CA 19-9 biomarker
  • Pancreas CT
  • ERCP
32
Q

Management of endocrine pancreas cancer?

A 
• Pancreatic resection 
	○ Whipple procedure 
• Pancreatic enzyme 
• Adjuvent chemotherapy and chemoradiotherapy	• Pain management 
• Palliative care

Gastrointestinal MD2 (1 decks)

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