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gastro > Pancrease > Flashcards

Pancrease Flashcards

1
Q

what is pancreatitis ?

A

inflammation of the pancrease

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2
Q

what are the two types of pancreatitis ?

A

acute
chronic

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3
Q

what is acute pancreatitis ?

A

an inflammatory involving regional tissue and remote organs

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4
Q

what is chronic pancreatitis ?

A

progressive and irreversible damage with loss of endocrine and exocrine function

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5
Q

explain the pathogenesis of acute pancreatitis

A

bile reflux due to duct obstruction
autodigestion of pancreatic acini
release of of lytic pancreatic enzymes proteases and lipases

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6
Q

explain the pathogenesis of chronic pancreatitis

A

replacement of pancreas by chronic inflammation and scar tissue

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7
Q

what causes acute pancreatitis and what is the mnemonic ?

A

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.

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8
Q

what drug can cause pancreatitis ?

A

azathioprine.

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9
Q

what are chronic causes of pancreatitis ?

A

alcohol
obstruction with stones
autoimmune

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10
Q

what are the peaks of pancreatitis ?

A

20-30
50-60

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11
Q

how does acute pancreatitis present ?

A

Acute onset epigastric pain radiating to the back, very severe.
Nausea and vomiting.
Worse in supine position.
Jaundice.
Cause identified.

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12
Q

how does chronic pancreatitis present ?

A

Epigastric pain bores through to the back, relieved by sitting forward or hot water bottle. Bloating, steatorrhoea, weight loss, brittle diabetes.
Relapse and worsen.

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13
Q

how would you investigate for acute pancreatitis ?

A

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.

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14
Q

how would you investigate for chronic pancreatitis ?

A

Imaging - CXR/AXR, US, CT pancreas, MRCP, ERCP.

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15
Q

how would you manage acute pancreatitis ?

A

fluids
correct electrolytes
oxygen
nutrition

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16
Q

how would you manage chronic pancreatitis ?

A

creon as enzyme replacement therapy if pancreatic insufficiency (bloating, pain, loose fatty stools, weight loss).

Diet - no alcohol, low fat may help.

17
Q

what are the complications of pancreatitis ?

A

abscess, pseudocyst and necrosis

18
Q

what types of pancreatic cancer can you get ?

A

exocrine or exocrine tumors

19
Q

what cancer is exocrine in the pancrease?

A

mainly adenocarcinoma (head of pancreas)

20
Q

what can the pancreatic endocrine cancer secrete ?

A

diffrent hormones: gastrin, insulin, glucagon etc.

21
Q

what are risk factors for pancreatic cancer (6) ?

A

smoking
alcohol
charred meat
obesity
T1 and T2 Diabetes
chronic pancreatitis

22
Q

how does pancreatic cancer present ?

A

painless obstructive jaundice
steatorrhoea
dark urine
weight loss
epigastric pain later sign.

23
Q

what are signs of pancreatic cancer ?

A

jaundice, epigastric mass, hepatosplenomegaly, ascites.

24
Q

what is a major sign to look out for in pscreatic cancer ?

A

courvoisiters sign

25
Q

what is Cullens and grey turners sign associated with?

A

Cullens sign - brushing near belly button
grey turners sign - bruising hip dips
acute pancrtitis

26
Q

what is courvoisiters sign?

A

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.

27
Q

how would you investigate for pancreatic cancer?

A

Bloods - cholestatic jaundice. US. CT. MRI. MRCP. 70-80% inoperable.

28
Q

how would you manage inoperable pancreatic cancer ?

A

ERCP or PTC and stent insertion.

gastro (6 decks)

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