Pancreas

Question 1

What is acute pancreatitis

Answer 1

• Inflammation of the pancreas
• Pancreatic enzymes (amylase / lipase) attack the pancreatic tissue

Diagnosed clinically / by rise in amylase (>3 x normal) / CT scan

Question 2

Why amylase not be raised in an acute exacerbation of chronic pancreatitis

Answer 2

the pancreas has lost it’s ability to produce the enzyme

Question 3

What are the signs and smyptoms of acute pancreatitis

Answer 3

• Severe epigastric pain that radiates to the back
• nausea and vomting
• anorexia

Question 4

Investigations for acute pancreatitis

Answer 4

• amylase

Question 5

What is the glasgow score

Answer 5

Score that indicates the severity of acute pancreatitis
<2: mild
2: moderate
>2: severe
Consider intensive care intervention/review when score is >1

Question 6

What is involved in the ‘Pancreas pneumonic’ for the glasgow score

Answer 6

P – Pa02 < 60
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

Question 7

What are the complications of acute pancreatitis

Answer 7

Pancreatitic necrosis
Infection in necrotic areas
Pseudocysts
Chronic pancreatitis

Question 8

What is the management of acute pancreatitis

Answer 8

Patients can become extremely sick very quickly
Escalate care according to Glascow score
Careful monitoring
IV fluids
Analgesia
Endoscopic drainage of large pseudocysts
Antibiotics only if evidence of infected pancreatic necrosis
Surgery to remove infected pancreatic necrosis

Question 9

What is the most common type of cancer of the pancreas

Answer 9

90% are adenocarincomas of the pancreas head

Typically metastasize early to liver, then to peritoneum, lungs and bones

Question 10

What is the incidence and prognosis of pancreatic cancer

Answer 10

Peak incidence in 70s and 80s
5 year survival is 25% for early disease
Average survival for advanced disease is around 6 months

Question 11

What is the common presentation of pancreatic cancer

Answer 11

• Non-specific upper abdominal/back pain
• Painless obstructive jaundice
• Unintentional weight loss
• Pale stools (due to lack of bile)
• Steatorrhoea
• Dark urine (due to obstructive jaundice)
• Palpable mass in epigastric region

Question 12

What is steatorrhoea

Answer 12

(greasy stools due to malabsorption due to lack of bile)

Question 13

How do you diagnose pancreatic cancer

Answer 13

CA19-9 tumour marker (blood test)
CT scan (including thorax, abdomen and pelvis for staging)
Endoscopic ultrasound with biopsy

Question 14

What is Courvoisier’s law

Answer 14

Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

Question 15

What is a whipples procedure

Answer 15

Requires the patient the be in good baseline health
For tumour of head of pancreas with no spread
Involves removing head of pancreas, gallbladder, duodenum and pylorus
Modified Whipple’s involves leaving the pylorus, and has equal success rates to traditional Whipples

Question 16

What is the management of prancreatic cancer

Answer 16

• Whipples procedure
• Distal pancreatectomy for tumour of body/tail of pancreas
• Adjuvant chemotherapy

Question 17

What is the management of pancreatic cancer

Answer 17

• Whipples procedure
• Distal pancreatectomy for tumour of body/tail of pancreas
• Adjuvant chemotherapy

Question 18

How do you manage end stage pancreatic cancer

Answer 18

Palliative chemotherapy may be offered if fit to attempt to extend life
Palliative stenting of bile ducts to relive obstruction
Palliative care