Pancreas & Spleen Flashcards
___ joins the ___ and terminates at the Ampulla of Vater, which is surrounded by the ___
___ terminates at the minor papilla
main pancreatic duct joins Duct of Wirsung
surrounded by sphincter of Oddi
Duct of Santorini
What hormones do the endocrine cells of the pancreas secrete?
Alpha - glucagon
Beta - insulin
Delta - somatostatin
Gamma - pancreatic polypeptide
Epsilon - ghrelin
What cells make up the exocrine pancreas and what do they produce?
Acinar cells
- pancreatic protease (trypsinogen) activated by enterokinase in duodenum
- pancreatic lipase and amylase
Blood supply of the pancreas
1) Splenic artery
2) Superior pancreaticoduodenal artery (from celiac)
3) Inferior pancreaticoduodenal artery (from SMA)
Diagnosis of acute pancreatitis requires
2 of 3
1) Epigastric pain (acute, persistent, severe, radiates to back)
2) Raised serum lipase/amylase (3x normal)
3) CT/MRI findings
Causes of acute pancreatitis
I GET SMASHED
Gallstone, alcohol (60-80%)
idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion poison
hypertriglyceridemia, hypercalcaemia
ERCP
drugs
others: neoplasm, congenital
Pathophysiology of acute pancreatitis
unregulated activation of trypsin in acinar cells -> auto-digestion -> liquefactive necrosis of pancreatic parenchyma
inflammatory cascade -> SIRS
Cx of acute pancreatitis
Respiratory failure
Renal failure
GIT failure
SIRS/infection: fever +- hypotension
tachycardia
obstructive jaundice
Signs of haemorrhagic pancreatitis
- Grey-Turner sign: flank discolouration (ecchymosis)
- Cullen’s sign: periumbilical ecchymosis
- Fox’s sign: inguinal ecchymosis
Diagnostic lab test for acute pancreatitis
1) Amylase (normal 30-100U/L)
- rises within few hours, normalise in 5 days
- normalises in 5 days
2) Lipase (normal 10-140U/L)
- rises within 4-8 hours, stays elevated 8-14 days
- good for delayed presentation
Antibiotics given in acute pancreatitis
None~
Unless tgt with cholangitis -> give IV Rocephin
Cx of acute pancreatitis
1) Peripancreatic fluid/necrotic collection -> can become infected -> IV abx + drainage
2) Pseudocyst formation
- persistent pain, mass, high amylase/lipase
3) Walled off pancreatic necrosis
- encapsulated collection of pancreatic/extra-pancreatic necrosis w welldefined inflammatory wall
What causes chronic pancreatitis?
Alcohol, smoking
Hypertriglyceridemia
Recurrent severe acute pancreatitis
Autoimmune
Chronic obstruction of pancreatic duct by tumours, scars, stones, cysts
Pathogenesis of chronic pancreatitis
Progressive destruction of pancreas by repeated flareups -> diffuse scarring & strictures of pancreatic duct
Clinical presentation of chronic pancreatitis
Epigastric pain radiating to back
- worse after eating
- can be hours to days
- a/w nausea/vomiting
Pancreatic insufficiency symptoms
- fat malabsorption -> oily, loose stools (difficult to flush) + Vit ADEK,B12 deficiency
- pancreatic diabetes
Diagnosis for chronic pancreatitis
- Calcifications seen on CT
Triad in late advanced disease: calcifications + pancreatic diabetes + steatorrhea
Imaging Ix for chronic pancreatitis
- CT
- *MRCP
- ERCP: chain of lakes of main pancreatic duct
Gold standard for biochemical test for chronic pancreatitis
Pancreatic secretin stimulation test
- secretin given via IV, pancreatic secretions into duodenum are aspirated and analysed over 2 hrs
- chronic pancreatitis -> little secretions
Serum amylase & lipase are used in both acute and chronic pancreatitis. True or false?
False. amylase & lipase usually normal in chronic -> significant fibrosis, decreases these enzymes
What is a Whipple’s procedure?
Removal of pancreatic head, distal stomach, duodenum, proximal jejunum, common bile duct, gall bladder
Majority of pancreatic tumours are ___ that originate from the ___ pancreas
ductal adenocarcinoma
exocrine pancreas
Risk factors for pancreatic cancer
Modifiable: smoking, alcohol, obesity, high fat diet, chlorinated hydrocarbon solvent & asbestos exposure
Un-modifiable: Age, male, family history, DM etc.
DOMINANT RISK FACTORS
- chronic pancreatitis history (family or personal)
- smoking
- family history of pancreatic cancer
Most common site for pancreatic cancer
head of pancreas: tends to present earlier as it obstructs bile duct
tail is rare, presents late
Symptoms of pancreatic cancer
1) Courvoisier’s law
- painless obstructive jaundice w palpable GB
2) Obstructive jaundice +/- pain
- pain is due to invasion of celiac/mesenteric plexus nerves
3) New onset DM in old patients
Signs of advanced pancreatic malignany
1) Virchow’s node: left supraclavicular
2) Sister Mary Joseph nodule: umbilical metastatic lesion via falciform ligament
3) Trousseau’s sign: migratory thrombophlebitis
Tumour markers to test for in pancreatic cancer
Carbohydrate Antigen 19-9 (CA19-9)
- marker for recurrence
- marker for prognosis
Lewis blood group antigen
____ sign on ____ (what scan) is worrying for pancreatic malignancy (esp HOP)
double duct sign - dilated CBD & pancreatic duct
Seen on triphasic pancreatic protocol CT scan
__ of pancreatic cancer pts are not suitable for curative resection
80%
Pls make cards for PNET onwards
:)
