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G.I. > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Exocrine system of pancreas - which cells?

A

Acinar cells secrete pancreatic enzymes

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2
Q

Endocrine system - which cells?

A

Islets of Langerhans secrete hormones into the blood

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3
Q

Islets of Langerhans

A

> B cells (insulin)
Alpha cells (glucagon)
Delta cells (somatostatin)
F cells (secrete pancreatic polypeptides)

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4
Q

B cell secrete?

A

Insulin

70% of Islet cells

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5
Q

Alpha cells secrete?

A

Glucagon

20% of islet cells

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6
Q

Delta cells secrete?

A

Somatostatins
Inhibit release of GI hormones
5% of islet cells

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7
Q

F cells secrete?

A

Pancreatic Polypeptides

1% of islet cells

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8
Q

How are pancreatic fluid secretions regulated?

A

By vagus nerve and gastrin levels

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9
Q

Acinar cells secrete?

A

> Protease (trypsin and chymotrypsin)
Pancreatic lipase
Pancreatic amylase

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10
Q

Epithelial cells lining the ducts secrete?

A

> Bicarbonate

> Water

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11
Q

Pancreatitis

A

An acute inflammatory process in the pancreas - involves regional tissues and remote organs

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12
Q

Causes of pancreatitis?

A

I GET SMASHED

Idiopathic
Gallstones***
Ethanol (alcohol)***
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcaemia, hyperthyroidism, hyperlipidaemia
ERCP
Drugs (azathioprine)
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13
Q

Most common causes of pancreatitis?

A

Gallstones and ethanol

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14
Q

Pathophysiology

A

• bile reflux theory
> obstruction of CBD/PD
> Causes reflux of bile into pancreas
> Hyperstimulation of pancreatic acinar cells

> Damage to acinar cells will release activated trypsin —> necrosis, vascular damage, auto digestion of pancreatic tissue

4 main stages

  1. oedema and fluid shifts –>
  2. Autodigestion of blood vessels (retroperitoneal haemorrhage) –>
  3. Infarction due to blood supply (necrosis) –>
    4 Infection (abscesses)
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15
Q

Presentation of pancreatitis

A

Clinical//

  • acute onset epigastric pain radiating to the back
  • double over
  • nausea and vomiting
  • jaundice (sometimes)
  • identify the trigger - GET SMASHED

Examination//

> diffuse upper abdo tenderness
> soft
> normal bowel sounds
> fullness in epigastrium? - pseudocyst
> Can present like peritonitis with guarding and absent BS if severe

> Cullen’s sign (umbilicus)
Grey turner’s sign (flank)
Erythema ab igne

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16
Q

Investigations - pancreatitis

A

> IV access
Bloods - FBC, coat
U/E, LFT, Ca, glucose, CRP, lactate, amylase/lipase

> ABGs - hypoxia and ARDs
> Plain imaging 
> USS
> CT scan
> ERCP
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17
Q

How elevated would amylase be in pancreatitis?

A

3 x ULN

ULN of amylase is 100.

18
Q

What investigation should be used on ALL patients with suspected pancreatitis?

A

Ultrasound Scan

19
Q

What is the CT scan used for?

A

As a follow up investigation

Looking for complications.

20
Q

Prognostic scoring system for pancreatitis?

A

> Glasgow Criteria
Score higher than 3 is severe pancreatitis

pao2< 8kpa
age >55
neutrophils (abc > 15)
calcium < 2
renal function
enzymes
albumin
sugar (glucose > 10mmol/L)

> Ranson’s criteria
– looks at markers on admission and 48 hours later

21
Q

When should you re-score a patient (Glasgow criteria)?

A

24 hours later

22
Q

Complications of pancreatitis?

A

Local//

  • fluid collection
  • pseudocysts
  • abscess
  • necrosis
  • infection
  • ascites
  • pleural effusion

Systemic//

  • pulmonary failure
  • renal failure
  • shcok
  • sepsis
  • metabolic acidosis
  • hyperglycaemia
  • hypocalcaemia
  • MODS
23
Q

Management

A

> Fluid resus, correct electrolytes, careful fluid balance, oxygen, sometimes abx, sometimes nutrition

> Lap chole if due to gallstones

24
Q

Pseudocyst

A

> Complication of acute and chronic pancreatitis
Due ti pancreatic duct communication
Can cause biliary obstruction, gastric outlet obstruction

25
Q

Pseuodcyst - presentation

A

Pain, nausea, vomiting, (jaundice) and weight loss

26
Q

Pseudocysts - Treatment

A

nothin
endoscopic drainage
radiological drainage
surgical drainage

27
Q

Abscesses

A

Drainage to control sepsis

CT/US sided retroperitoneal or transperitoneal drainage

28
Q

Haemorrhage

A

Some pseudocysts can erode into nearby vessels

29
Q

Pancreatic necrosis

  • what investigation would you use?
A 
CT for assessment
sterile or infected?
Fine needle aspiration for microbio
Percutaneous drain
Necrosectomy
30
Q

Chronic pancreatitis

A

Progressive and irreversible damage

Loss of exocrine and endocrine function

31
Q

Chronic pancreatitis - presentation

A

> Can present similarly to acute pancreatitis
Alcohol history, smokers, medications

> Masses, ascites, jaundice O/E

32
Q

Chronic pancreatitis - imaging

A

CXR/AXR, USS, CT pancreas, MRI, ERCP

33
Q

Chronic pancreatitis - causes

A

Main cause is alcohol

Idiopathic

Pancreatic duct obstruction (congenital or acquired)

Autoimmune

Tropical countries

Hereditary (CF, A1AT)

AXR and CT - calcifications and stones in pancreas

34
Q

Management of chronic pancreatitis

A

CREON enzyme therapy
Surgical options

Complications//

Splenic vein thrombosis
Pseudoaneurysm
Splenic artery
Pleural effusions
Ascites
Pancreatic cancer
Pseudocysts
Biliary obstruction
Duodenal obstruction
35
Q

Exocrine tumours

A

Adenocarcinoma (95% of pancreatic tumours)

36
Q

Gastrinoma

A

Endocrine tumour
Produces gastrin
Increases stomach acid

37
Q

Insulinoma

A

Endocrine tumour
Produces insulin
Encourages sugar uptake and storage
Hypoglycaemia

38
Q

Glucagonoma

A

Produces glucagon
Increases serum blood sugars
Hyperglycaemia

39
Q

Symptoms of pancreatic tumours

A 
> Painless jaundice
> Loosepale stools
> Dark urine
> Weight loss
> Back pain
40
Q

Risk factors

A

Smoking
Charred meat
Obesity
Type I and type II DM

41
Q

Initial management - pancreatic tumours

A

inoperable cases//

> ERC or percutaneous drain and stent insertion
decompression of obstructed biliary ducts

operable cases//

> laparoscopy and staging
ercp

42
Q

Treatment

A

TNM staging

Curative vs palliative

Surgery, chemo, radiotherapy

Surgical resection or palliative bypass

POOR PROGNOSIS

G.I. (20 decks)

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