Pancreas

Question 1

Anatomical relations of the pancreas?

Answer 1

Lies retroperitoneally; pancreatic head sits in the loop of the duodenum; spleen lies lateral to the pancreas

Question 2

What consequences does the close anatomical relationship between the head of the pancreas and the common bile duct have? (2)

Answer 2

Head of pancreas tumours can present with jaundice; gallstones in the CBD can cause pancreatitis

Question 3

Exocrine secretions of the pancreas? (3)

Answer 3

1-2L of alkaline fluid containing:
Trypinsogen (and other proteolytic enzymes)
Lipase
Amylase

Question 4

Endocrine functions of the pancreas? (4)

Answer 4

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide

Question 5

Causes of acute pancreatitis?

Answer 5

Gallstone pancreatitis
Alcohol-associated
Patients undergoing ERCP
Trauma
Hypercalcaemia
Hyperlipidaemia
Pancreatic cancer

Question 6

Presentation of acute pancreatitis?

Answer 6

Severe epigastric pain +/- radiation to back
Nausea, vomiting
In severe cases- tachycardia, tachypnoea, hypotension
Obstructive jaundice if gallstones

Question 7

Main diagnostic investigation in suspected acute pancreatitis?

Answer 7

Serum amylase- traditionally 3x ULN

Question 8

Radiological investigation for acute pancreatitis is diagnosis in doubt?

Answer 8

Contrast-enhanced CT

Question 9

Which diagnostic test suggests an obstructive aetiology for pancreatitis?

Answer 9

Elevated ALT

Question 10

Management of acute pancreatitis? (3)

Answer 10

Pain relief, usually opiates
Fluid resuscitation
If unable to eat or drink within 48-72 hours- enteral feeding

Question 11

What are the indications for surgery in acute pancreatitis?

Answer 11

Where CT suggests alternative diagnosis
Where gallstones are the cause (and only after acute attack has settled)
Where certain complications develop

Question 12

Possible complications of acute pancreatitis? (5)

Answer 12

Infected pancreatic necrosis
Pancreatic pseudocyst
Pancreatic abscess
Persistent dueodenal ileus
GI bleeding

Question 13

Secondary prevention of acute pancreatitis? (2)

Answer 13

Definitive management of gallstones; advice against alcohol abuse

Question 14

Aetiology of chronic pancreatitis? (3)

Answer 14

Mostly alcohol-related (60-80%)
Genetic associations- trypsinogen gene, CFTR
Cigarette smoking pre-disposes

Question 15

What is chronic pancreatitis characterized by?

Answer 15

Fibrosis and destruction of exocrine pancreatic tissue

Question 16

Clinical features of chronic pancreatitis? (4)

Answer 16

Epigastric pain radiating to back, sometimes exacerbated by eating
Weight loss
Steatorrhoea
Development of diabetes

Question 17

Initial investigations in suspected chronic pancreatitis?

Answer 17

CT showing speckled calcification
MRCP
Secretin stimulation test