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Gastrointestinal Conditions (JBR) > Pancreas Stuff > Flashcards

Pancreas Stuff Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas leading to the release of exocrine enzymes which cause auto-digestion of the organ

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2
Q

What are causes of acute pancreatitis?

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps 
Autoimmune 
Scorpion stings
Hyperlipidaemia/Hypercalcaemia
ERCO
Drugs
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3
Q

Which drugs can cause acute pancreatitis?

A

Vaproic acid
Azathioprine
L-asparaginase
Corticosteroids

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4
Q

How much alcohol would be considered a risk factor for acute pancreatitis?

A

> 80g per day

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5
Q

Which other viral conditions besides mumps can cause acute pancreatitis?

A

Coxsackie B

Hepatitis

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6
Q

During acute pancreatitis, the pancreas releases lytic pancreatic enzymes. What are these and wha tis there effect?

A

Lipases - intra and peri-pancreatic fat necrosis

Proteases - tissue destruction and haemorrhage

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7
Q

What is the macroscopic appearance of acute pancreatitis?

A

Focal areas of necrosis in body of the pancreas

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8
Q

What is the macroscopic appearance of moderate acute pancreatitis?

A

Intrahepatic fat necrosis

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9
Q

What is the macroscopic appearance of severe acute pancreatitis?

A

Complete pancreatic destruction with haemorrhage and fat necrosis

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10
Q

What is the microscopic appearance of acute pancreatitis?

A

Fat necrosis

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11
Q

How does acute pancreatitis present?

A 
Sudden severe nose epigastric apin which radiates through to the back
Nausea and vomiting 
pyrexia 
Tachycardia
Indigestion
Abdominal tenderness
Weight loss
jaundice
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12
Q

How would you investigate acute pancreatitis?

A 
Amylase
FBC, U&Es, LFTs, PT, CRP
AXR/CXR
AUS, CT/MRI
Glaspow Prognostic score
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13
Q

What would be seen on CXR/AXR for acute pancreatitis?

A

Pleural effusion

Sentinel loop

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14
Q

What is an AUS used for in acute pancreatitis diagnosis?

A

Rule out biliary pancreatitis

Gallstones, cholecystitis, CBD diameter, free fluid

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15
Q

What is a CT used for in acute pancreatitis?

A

Assess severity, interventions, follow-up

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16
Q

What makes up the Glasgow Prognostic Score? (PANCREAS)

A 
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
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17
Q

How is the Glasgow prognostic score interpreted?

A

Any score over 3 means acute severe pancreatitis

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18
Q

What are possible complications from acute pancreatitis?

A 
Death
Shock
Pseudocyst 
Pancreatic abscess
Hypo/hyperglycaemia 
necrosis +/- infection
Fluid 
Pulmonary oedema 
Pleural effusion
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19
Q

What can a pancreatic pseudocyst (collection of fluid in typically the lesser sac) cause?

A

Obstruction of biliary system/gastric outlet

20
Q

How do you treat a pancreatic pseudocyst?

A

Endoscopic or surgical drainage (Cystogastrotomy/Cystjejunostomy)

21
Q

How do you treat an abscess?

A

CT/US guided drainage

Control sepsis

22
Q

How do you assess necrosis?

A

CT

23
Q

How do you treat pancreatic necrosis?

A

Necrosectomy + lavage

24
Q

What are complications of pancreatic necrosis?

A

Haemorrhage + splenic pseudoaneurysm

25
Q

What are systemic complications of acute pancreatitis?

A 
Pumonary/renal failure
Shock, sepsis 
metabolic acidosis
hyperglycaemia
Hypocalcaemia 
MODS
26
Q

What does MODS stand for?

A

Multi-organ dysfunction syndrome

27
Q

How do you treat mild acute pancreatitis?

A

Analgesics, IV fluids (NBM)

28
Q

How do you treat severe acute pancreatitis?

A

HDU/ITU admission
Abx if infection
NG tube for feeding

29
Q

What is chronic pancreatitis?

A

Chronic irreversible inflammation and/or fibrosis of the pancreas resulting in permanent loss of function

30
Q

Chronic pancreatitis is a _______ which my develop post-?

A

Relapsing disorder

post-acute

31
Q

What are causes of chronic pancreatitis?

A 
Alcohol
Cholelithiasis
CF
Hyperparathyroidism 
FHx/Hereditary
Autoimmune 
Congenital: pancreas divisum
32
Q

What is the pathophysiology of chronic pancreatitis?

A

Replacement of pancreas via chronic inflammation by scar tissue
Destruction of exocrine acini and islets

33
Q

What are macroscopic changes from chronic pancreatitis?

A

Exocrine pancreas is replaced by chronic inflammation and fibrosis

34
Q

how does chronic pancreatitis present?

A

Severe abdominal pain and endocrine or exocrine dysfunction
Nausea/vomiting
Decreased appetite

35
Q

How do you investigate chronic pancreatitis?

A

FBC, U&Es, LFTs, creatinine, Calcium, amylase, glucose, HbA1c, secretin stimulation test, CT scan, MRCP, EUS (only very frail)

36
Q

What are signs on examination of chronic pancreatitis?

A 
Tenderness
peritonism
mass
Ascites
Jaundice
37
Q

How do you treat chronic pancreatitis?

A

Analgesics
Treat substance misuse
Lipase, Creon (replace pancreatic enzymes), octreotide, surgery(to manage complications)

38
Q

What is the most common pancreatic cancer?

A

Exocrine Adenocarcinoma

39
Q

What are the risk factors for adenocarcinoma of the pancreas?

A 
Smoking 
Poor diet
Obesity
Diabetes
Alcohol
FHx
Chronic pancreatitis
40
Q

How does pancreatic adenocarcinoma present?

A 
Epigastric discomfort or backache 
Jaundice
Acute pancreatitis
Unexplained weight loss
Anorexia
Steatorrhoea
epigastric mass
Haematemesis
Malaena
Ascites
41
Q

What are investigations for pancreatic adenocarcinoma?

A

FBC, LFTs, serum glucose, CA 19-9, USS, CT

42
Q

How do you manage pancreatic adenocarcinoma?

A

Whipple’s procedure (proximal pancreaticoduodenectomy with pylorus preservation), chemotherapy, stenting, analgesics, Creon, domperidone

43
Q

What are the different types of endocrine tumours of the pancreas?

A 
Insulinoma
Gastrinoma
Glucagonoma
Carcinoid tumour
Multiple endocrine neoplasia type 1
44
Q

What are the signs of insulinoma?

A

Confusion, sweating, dizziness, weakness, LOC, fasting hypoglycaemia, relief of symptoms after eating or with glucose

45
Q

What are signs of gastrinoma?

A

Sever peptic ulceration, abdominal pain, diarrhoea, Zollinger-Ellison syndrome

46
Q

What are signs of glucagonoma?

A 
Weight loss
Diabetes
Stomatitis
Diarrhoea
Necrolytic migratory erythema
47
Q

What is multiple endocrine neoplasia type 1?

A

Genetic condition

Includes neoplastic lesions of the pituitary, parathyroid and pancreas

Gastrointestinal Conditions (JBR) (33 decks)

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