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Medicine Gastrointestinal > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Parts of the pancreas

A

Uncinate process, head, neck, body, tail

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2
Q

Functions of the pancreas

A

Exocrine - acinar cells secrete pancreatic enzymes

Endocrine - Islets of Langerhans secrete hormones into blood

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3
Q

Cells that make up the Islets of Langerhans and what these cells secrete

A 
Beta cells (74%) - secrete insulin
Alpha cells (19%) - secrete glucagon
Delta cells (5%) - secrete somatostatin
F cells (1%) - secrete pancreatic polypeptide
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4
Q

What are secretions of pancreatic fluid regulated by?

A

Vagus nerve and gastrin levels

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5
Q

Secretions from acinar cells

A

Protease, pancreatic lipase, pancreatic amylase, other enzymes e.g. nuclease, deoxyribonuclease, gelatinase and elastase

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6
Q

What does protease do?

A

Converts polypeptides to peptides

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7
Q

What does pancreatic lipase do?

A

Converts triglycerides into fatty acids and monoglycerides

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8
Q

What does pancreatic amylase do?

A

Turns carbohydrates into dissacharides/monosaccharides

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9
Q

What do the epithelial cells lining the ducts secrete?

A

Bicarbonate and water

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10
Q

Pancreatitis

A

Acute inflammatory process in the pancreas which involves regional tissues and remote organs

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11
Q

Aetiology of pancreatitis - I GET SMASHED

A 
I = idiopathic
G = gallstones
E = ethanol
T = traums
S = steroids
M = mumps
A = autoimmune
S = scorpion bite
H = hypercalcaemia, hyperparathyroidism, hyperlopidaeia
E = ERCP
D = drugs
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12
Q

Clinical presentation of acute pancreatitis

A

Acute onset epigastric pain radiating to the back, very severe - patient doubling over. Nausea and vomiting, jaundice

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13
Q

Examination findings of acute pancreatitis

A

Diffuse upper abdominal tenderness, soft abdomen, fullness in epigastrium, normal bowel sounds, erythema ab igne, Cullen’s sign, Grey turner’s sign

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14
Q

Erythema ab igne

A

Hot water bottle rash. Caused by long-term exposure to heat

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15
Q

Cullen’s sign

A

Superficial oedema and bruising in subcutaneous fatty tissue around umbilicus

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16
Q

Grey turner’s sign

A

Bruising of the flanks

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17
Q

Investigations for pancreatitis

A

Blood tests - FBC and coagulation, U&Es, LFTs, calcium, glucose, amylase/lipase, CRP lactate
Arterial blood gas
CXR, AXR, ultrasound, CT

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18
Q

Diagnostic level of serum amylase in pancreatitis

A

3x upper limit of normal

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19
Q

What may a CXR show in pancreatitis?

A

Pleural effusion

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20
Q

What may an AXR show in pancreatitis?

A

Sentinel loop

21
Q

What may an ultrasound show in pancreatitis?

A

Gallstones, common bile duct size, free fluid, cholecystitis

22
Q

What may a CT scan show in pancreatitis?

A

Fluid collections, ascites, bleeding, abscess, pancreatic/peripancreatic necrosis

23
Q

What 2 criteria options are there for diagnosing severe pancreatitis?

A

Glasgow criteria and Ranson’s criteria

24
Q

Glasgow criteria - PANCREAS

A

More than 3 of the following is severe pancreatitis and critical care should be considered:

  • P = PaO2 <8kPa (60mmHg)
  • A = age >55 years
  • N = neutrophils (WBC >15 x 109/l)
  • C = calcium <2mmol/l
  • R = renal function (urea>16mmol/l)
  • E = enzymes (AST/ALT >200iu/L or LDH > 600iu/L)
  • A = albumin <32g/l
  • S = sugar (glucose >10mmol/L)
25
Q

Ranson’s criteria

A 
A score of 3 or more indicates severe pancreatitis:
-At admission
o>55 years old
o	Blood glucose >11mmol/l)
o	Serum LDH >500iu/L
o	AST >200iu/l
o	WCC >16
-At 48 hours from admission
o	HCT fall >10%
o	Blood urea >16 mmol/L
o	Serum calcium <2mmol/l
o	Arterial PO2 <8 kPA
o	Base defecit <4mmol/l
26
Q

Four main stages in pathophysiology of pancreatitis

A 
1 = Oedema and fluid shifts can result in hypovolaemic shock, fluids and enzymes in the peritoneal cavity autodigest fats affecting Ca++ binding and can result in hypocalcaemia
2 = Autodigestion of blood vessels leading to retroperitoneal haemorrhage
3 = Infarction due to compromised blood supply leading to pancreatic necrosis
4 = Necrotic tissue becomes infected leading to abscess formation
27
Q

Local complications of pancreatitis

A

Fluid collection, pseudocysts, abscess, necrosis +/- infection, ascites, pleural effusion

28
Q

Systemic complications of pancreatitis

A

Pulmonary failure, renal failure, shock, sepsis, metabolic acidosis, hyperglycaemia, hypoglycaemia, MODS

29
Q

Pancreatic pseudocysts:

  • What is it?
  • Symptoms
  • Treatment
A
  • Complication of acute and chronic pancreatitis
  • Pain, nausea, vomiting, weight loss, jaundice
  • Nothing, endoscopic drainage, radiological drainage, surgical drainage
30
Q

How are pancreatic abscesses drained?

A

CT/US guided retroperitoneal or transperitoneal drainage

31
Q

Pancreatic necrosis - which investigations are required?

A

CT for assessment, fine needle aspiration for micro

32
Q

Treatment for pancreatic necrosis

A

Percutaneous drain, necrosectomy and lavage

33
Q

Aetiology of chronic pancreatitis

A

Alcohol, idiopathic, pancreatic duct obstruction, autoimmune, hereditary

34
Q

Management of chronic pancreatitis

A

Manage acute episodes appropriately, creon as enzyme replacement therapy if pancreatic insufficiency, Puestow procedure, Frey procedure

35
Q

Complications of chronic pancreatitis

A

Splenic vein thrombosis, pseudoaneurysm, pleural effusions, ascites, pancreatic cancer, pseudocysts, biliary obstruction, duodenal obstruction

36
Q

Management of duodenal obstruction

A

Stent, bypass, resection

37
Q

Pancreatic tumours:

  • Exocrine
  • Endocrine
A 
Exocrine = adenocarcinoma
Endocrine = gastrinoma, insulinoma, glucagonoma
38
Q

Symptoms of pancreatic insufficiency

A

Bloating, pain, loose fatty pale stools, weight loss, increased stool frequency

39
Q

Symptoms of pancreatic cancer

A

Jaundice, weight loss, back pain

40
Q

Risk factors for pancreatic cancer

A

Smoking, charred meat, obesity, diabetes

41
Q

Investigations for pancreatic cancer

A

Ultrasound, triple phase CT, MRI and MRCP

42
Q

Initial management of inoperable pancreatic cancer

A

ERCP or PTC and stent insertion, decompression of obstructed biliary ducts

43
Q

Initial management of operable pancreatic cancer

A

Laparoscopy and staging, ERCP stent, resection or palliative bypass

44
Q

Treatment for pancreatic cancer

A

Surgery, chemotherapy, radiotherapy

45
Q

Procedures for resectable pancreatic tumours

A

Whipples procedure, distal pancreatectomy, total pancreatectomy

46
Q

Procedures for non-resectable pancreatic tumours

A

Biliary bypass, gastric bypass, double bypass

47
Q

Survival time for stage I/II pancreatic cancer

A

11-22 months post resection, 7-25% 5 year survival

48
Q

Survival time for stage III pancreatic cancer

A

6-11 months

49
Q

Survival time for stage IV pancreatic cancer

A

2-6 months

Medicine Gastrointestinal (24 decks)

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