Pancrease Flashcards
what is pancreatitis ?
inflammation of the pancrease
what are the two types of pancreatitis ?
acute
chronic
what is acute pancreatitis ?
an inflammatory involving regional tissue and remote organs
what is chronic pancreatitis ?
progressive and irreversible damage with loss of endocrine and exocrine function
explain the pathogenesis of acute pancreatitis
bile reflux due to duct obstruction
autodigestion of pancreatic acini
release of of lytic pancreatic enzymes proteases and lipases
explain the pathogenesis of chronic pancreatitis
replacement of pancreas by chronic inflammation and scar tissue
what causes acute pancreatitis and what is the mnemonic ?
Causes = ‘I GET SMASHED’: Acute
I - idiopathic.
G - gallstones (common).
E - ethanol.
T - trauma.
S - steroids.
M - mumps.
A - autoimmune.
S - scorpion venom (NOT COMMON).
H - hypercalcaemia, hyperparathyroidism,
E - ERCP.
D - drugs eg azathioprine.
what drug can cause pancreatitis ?
azathioprine.
what are chronic causes of pancreatitis ?
alcohol
obstruction with stones
autoimmune
what are the peaks of pancreatitis ?
20-30
50-60
how does acute pancreatitis present ?
Acute onset epigastric pain radiating to the back, very severe.
Nausea and vomiting.
Worse in supine position.
Jaundice.
Cause identified.
how does chronic pancreatitis present ?
Epigastric pain bores through to the back, relieved by sitting forward or hot water bottle. Bloating, steatorrhoea, weight loss, brittle diabetes.
Relapse and worsen.
how would you investigate for acute pancreatitis ?
IV access. Bloods - FBC, coag, U&Es, LFTs, calcium, glucose, amylase, CRP, lactate.
Imaging - Ultra Sound: look for cause of pancreatitis - gallstones, CBD size, cholecystitis, free fluid
CT - to assess severity, day 5 from onset of symptoms. Fat stranding.
ERCP - used as diagnostic tool, treatment for CBD stones with obstruction.
how would you investigate for chronic pancreatitis ?
Imaging - CXR/AXR, US, CT pancreas, MRCP, ERCP.
how would you manage acute pancreatitis ?
fluids
correct electrolytes
oxygen
nutrition
how would you manage chronic pancreatitis ?
creon as enzyme replacement therapy if pancreatic insufficiency (bloating, pain, loose fatty stools, weight loss).
Diet - no alcohol, low fat may help.
what are the complications of pancreatitis ?
abscess, pseudocyst and necrosis
what types of pancreatic cancer can you get ?
exocrine or exocrine tumors
what cancer is exocrine in the pancrease?
mainly adenocarcinoma (head of pancreas)
what can the pancreatic endocrine cancer secrete ?
diffrent hormones: gastrin, insulin, glucagon etc.
what are risk factors for pancreatic cancer (6) ?
smoking
alcohol
charred meat
obesity
T1 and T2 Diabetes
chronic pancreatitis
how does pancreatic cancer present ?
painless obstructive jaundice
steatorrhoea
dark urine
weight loss
epigastric pain later sign.
what are signs of pancreatic cancer ?
jaundice, epigastric mass, hepatosplenomegaly, ascites.
what is a major sign to look out for in pscreatic cancer ?
courvoisiters sign
what is Cullens and grey turners sign associated with?
Cullens sign - brushing near belly button
grey turners sign - bruising hip dips
acute pancrtitis
what is courvoisiters sign?
painless jaundice and an enlarged gallbladder, the cause is unlikely to be gallstones and therefore presumes the cause to be an obstructing pancreatic or biliary neoplasm until proven otherwise.
how would you investigate for pancreatic cancer?
Bloods - cholestatic jaundice. US. CT. MRI. MRCP. 70-80% inoperable.
how would you manage inoperable pancreatic cancer ?
ERCP or PTC and stent insertion.
