Pancreas

Question 1

What can cause acute pancreatitis?

Answer 1

Gallstones
Ethanol
Trauma

Steroids 
Mumps 
Autoimmune e.g. SLE 
Scorpion venom
Hypercalcaemia 
ERCP 
Drugs e.g. azathioprine

Question 2

What are the clinical features of acute pancreatitis?

Answer 2

severe epigastric pain, radiates to back
N+V

O/E:
epigastric tenderness
signs of shock
periumbilical bruising

Question 3

How is acute pancreatitis investigated?

Answer 3

bloods

• serum amylase and lipase
• cholestatic LFTs
• hypocalcaemia

imaging

• abdo USS
• contrast CT

Question 4

How is acute pancreatitis managed?

Answer 4

treat underlying cause e.g. gallstones
opiod analgesia and antiemetic
IV fluid resus
broad spectrum antibiotics - to decrease change of infection in necrosis

Question 5

What are systemic complications of acute pancreatitis?

Answer 5

ARDS
DIC
hyperglycaemia (destruction of Islets)

Question 6

What are local complications of acute pancreatitis?

Answer 6

pancreatic necrosis (from ongoing inflammation)
pancreatic pseudocyst

Question 7

What is chronic pancreatitis?

Answer 7

chronic

progressive and irreversible damage to pancreatic parenchyma

Question 8

What are the clinical features of chronic pancreatitis?

Answer 8

chronic epigastric pain, radiates to back
nausea and vomiting

diabetes, malabsorption, steatorrhea

Question 9

What accounts for majority of pancreatic cancer?

Answer 9

ductal adenocarcinoma

Question 10

What are the more rare forms of pancreatic cancer?

Answer 10

neuroendocrine tumours

e.g. gastrinoma (peptic ulcer disease), insulinoma (hypos), glucagonoma (diabetes)

Question 11

What are risk factors for pancreatic cancer?

Answer 11

smoking

chronic pancreatitis

Question 12

How does pancreatic cancer present?

Answer 12

vague and non specific symptoms (until advanced disease)
painless obstructive jaundice
weight loss, loss of appetite

Question 13

How is pancreatic cancer diagnosed?

Answer 13

cholestatic LFTs
CA19.9 tumour marker

imaging:
abdo USS (pancreatic mass, dilated biliary tree)
CT staging
ERCP

Question 14

How is pancreatic cancer managed?

Answer 14

radical surgical resection - Whipple’s (pancreaticoduodenectomy) or distal pancreatectomy (for tumours of body/tail)

post-op chemo

palliative

• most patients
• biliary stent
• palliative chemo
• enzyme replacement - creon

Question 15

What is a pancreaticoduodenectomy?

Answer 15

remove head of pancreas, antrum of stomach, 1st and 2nd parts of duodenum, CBD and gall bladder

tail of pancreas and hepatic duct attached to jejunum (bile and pancreatic juices drain into gut)

stomach anastomosed to jejenum