Pancreas Stuff Flashcards
What is acute pancreatitis?
Acute inflammation of the pancreas leading to the release of exocrine enzymes which cause auto-digestion of the organ
What are causes of acute pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hyperlipidaemia/Hypercalcaemia ERCO Drugs
Which drugs can cause acute pancreatitis?
Vaproic acid
Azathioprine
L-asparaginase
Corticosteroids
How much alcohol would be considered a risk factor for acute pancreatitis?
> 80g per day
Which other viral conditions besides mumps can cause acute pancreatitis?
Coxsackie B
Hepatitis
During acute pancreatitis, the pancreas releases lytic pancreatic enzymes. What are these and wha tis there effect?
Lipases - intra and peri-pancreatic fat necrosis
Proteases - tissue destruction and haemorrhage
What is the macroscopic appearance of acute pancreatitis?
Focal areas of necrosis in body of the pancreas
What is the macroscopic appearance of moderate acute pancreatitis?
Intrahepatic fat necrosis
What is the macroscopic appearance of severe acute pancreatitis?
Complete pancreatic destruction with haemorrhage and fat necrosis
What is the microscopic appearance of acute pancreatitis?
Fat necrosis
How does acute pancreatitis present?
Sudden severe nose epigastric apin which radiates through to the back Nausea and vomiting pyrexia Tachycardia Indigestion Abdominal tenderness Weight loss jaundice
How would you investigate acute pancreatitis?
Amylase FBC, U&Es, LFTs, PT, CRP AXR/CXR AUS, CT/MRI Glaspow Prognostic score
What would be seen on CXR/AXR for acute pancreatitis?
Pleural effusion
Sentinel loop
What is an AUS used for in acute pancreatitis diagnosis?
Rule out biliary pancreatitis
Gallstones, cholecystitis, CBD diameter, free fluid
What is a CT used for in acute pancreatitis?
Assess severity, interventions, follow-up
What makes up the Glasgow Prognostic Score? (PANCREAS)
PaO2 < 8 kPa (60 mmHg) Age > 55 Neutrophils - WCC > 15 Calcium < 2 Renal - Urea < 16 Enzymes - AST/ALT > 200 or LDH > 600 Sugar - Glucose > 100
How is the Glasgow prognostic score interpreted?
Any score over 3 means acute severe pancreatitis
What are possible complications from acute pancreatitis?
Death Shock Pseudocyst Pancreatic abscess Hypo/hyperglycaemia necrosis +/- infection Fluid Pulmonary oedema Pleural effusion
What can a pancreatic pseudocyst (collection of fluid in typically the lesser sac) cause?
Obstruction of biliary system/gastric outlet
How do you treat a pancreatic pseudocyst?
Endoscopic or surgical drainage (Cystogastrotomy/Cystjejunostomy)
How do you treat an abscess?
CT/US guided drainage
Control sepsis
How do you assess necrosis?
CT
How do you treat pancreatic necrosis?
Necrosectomy + lavage
What are complications of pancreatic necrosis?
Haemorrhage + splenic pseudoaneurysm
What are systemic complications of acute pancreatitis?
Pumonary/renal failure Shock, sepsis metabolic acidosis hyperglycaemia Hypocalcaemia MODS
What does MODS stand for?
Multi-organ dysfunction syndrome
How do you treat mild acute pancreatitis?
Analgesics, IV fluids (NBM)
How do you treat severe acute pancreatitis?
HDU/ITU admission
Abx if infection
NG tube for feeding
What is chronic pancreatitis?
Chronic irreversible inflammation and/or fibrosis of the pancreas resulting in permanent loss of function
Chronic pancreatitis is a _______ which my develop post-?
Relapsing disorder
post-acute
What are causes of chronic pancreatitis?
Alcohol Cholelithiasis CF Hyperparathyroidism FHx/Hereditary Autoimmune Congenital: pancreas divisum
What is the pathophysiology of chronic pancreatitis?
Replacement of pancreas via chronic inflammation by scar tissue
Destruction of exocrine acini and islets
What are macroscopic changes from chronic pancreatitis?
Exocrine pancreas is replaced by chronic inflammation and fibrosis
how does chronic pancreatitis present?
Severe abdominal pain and endocrine or exocrine dysfunction
Nausea/vomiting
Decreased appetite
How do you investigate chronic pancreatitis?
FBC, U&Es, LFTs, creatinine, Calcium, amylase, glucose, HbA1c, secretin stimulation test, CT scan, MRCP, EUS (only very frail)
What are signs on examination of chronic pancreatitis?
Tenderness peritonism mass Ascites Jaundice
How do you treat chronic pancreatitis?
Analgesics
Treat substance misuse
Lipase, Creon (replace pancreatic enzymes), octreotide, surgery(to manage complications)
What is the most common pancreatic cancer?
Exocrine Adenocarcinoma
What are the risk factors for adenocarcinoma of the pancreas?
Smoking Poor diet Obesity Diabetes Alcohol FHx Chronic pancreatitis
How does pancreatic adenocarcinoma present?
Epigastric discomfort or backache Jaundice Acute pancreatitis Unexplained weight loss Anorexia Steatorrhoea epigastric mass Haematemesis Malaena Ascites
What are investigations for pancreatic adenocarcinoma?
FBC, LFTs, serum glucose, CA 19-9, USS, CT
How do you manage pancreatic adenocarcinoma?
Whipple’s procedure (proximal pancreaticoduodenectomy with pylorus preservation), chemotherapy, stenting, analgesics, Creon, domperidone
What are the different types of endocrine tumours of the pancreas?
Insulinoma Gastrinoma Glucagonoma Carcinoid tumour Multiple endocrine neoplasia type 1
What are the signs of insulinoma?
Confusion, sweating, dizziness, weakness, LOC, fasting hypoglycaemia, relief of symptoms after eating or with glucose
What are signs of gastrinoma?
Sever peptic ulceration, abdominal pain, diarrhoea, Zollinger-Ellison syndrome
What are signs of glucagonoma?
Weight loss Diabetes Stomatitis Diarrhoea Necrolytic migratory erythema
What is multiple endocrine neoplasia type 1?
Genetic condition
Includes neoplastic lesions of the pituitary, parathyroid and pancreas
