Pancreatic Flashcards
Causes of Acute Pancreatitis
GET SMASHED * important
Gallstones *
Ethanol *
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa)
Scorpion venom
Hyperlipidaemia, Hypercalcaemia
ERCP *
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
Presentation of Acute Pancreatitis?
Severe epigastric pain (radiates to back)
Vomiting
Abdo tenderness
Systemically unwell (fever + tachycardia)
Specific signs of Acute Pancreatitis?
Cullens Sign
Grey Turners sign
what is cullens sign
periumbilical discolouration
What is grey-turner’s sign
Flank discolouration
blood Investigations for AP?
Serum amylase >3 times upper limit
Serum lipase (longer half life than amylase so useful for late presentations)
Imaging for AP?
Early US important as aetiology may affect management e.g.g patients with biliary obstruction
What is the Glasgow score
used to assess severity of pancreatitis:
PAO2 <8kPa Age >55 Neutrophils (WBC >15) Calcium <2 uRea >16 Enzymes (LDH >600, AST/ALT >200) Albumin <32 Sugar (glucose >10)
common factors indicating severe pancreatitis include:
age > 55 years hypocalcaemia hyperglycaemia hypoxia neutrophilia elevated LDH and AST
Complications of Acute Pancreatitis?
Necrosis
Infection
Abscess formation (infected pseudocyst) Acute peripancreatic fluid collections
Psuedocysts
Chronic Pancreatitis
How are Pseudocysts formed?
organisation of peripancreatic fluid collection walled by fibrous tisse
typically 4 weeks after acute pancreatitis
treated with cystogastrostomy / aspiration
when would grey turners sign be identified?
Retroperitoneal haemorrhage
Management of acute pancreatitis?
Resus
IV Fluids
Enteral nutrition if severe
Analgesia
Role of surgery in Acute Pancreatitis?
Patients with AP due to gallstones should undergo early cholecystectomy
Pts with obstructed biliary system due to stones should undergo ERCP
Cause of Chronic Pancreatitis?
Alcohol 80%
Ductal obstruction
Features of CP?
Pain worse after meal
Steatorrhoea (pancreatic exocrine insufficiency)
Diabetes mellitus (loss of endocrine function)
Management of CP?
Analgesia
Replacement Pancreatic Enzymes (Creon)
insulin regimes if DM
Signs on investigation of CP?
Abdominal xray shows pancreatic calcification in 30%
CT more sensitive at detecting calcification
What may be used to assess exocrine function if imaging inconclusive of CP?
Faecal elastase
Most common pancreatic tumour?
Adenocarcinoma in the head of the pancreas (80%)
Key presenting feature of Pancreatic Cancer?
Painless obstructive jaundice
OR
rapidly worsening glycaemic control despite good compliance
how does PC cause obstructive jaundice?
tumour at the head of the pancreas compresses the bile ducts, blocking the flow of bile out of the liver
Signs of obstructive jaundice?
yellow skin, sclera
pale stools
dark urine
generalised itching
when to refer for suspected PC?
Over 40 with jaundice = 2 week wait
Over 60 with weight loss + 1 of:
abdo/ back pain, N+V, constipation, new onset DM
= DIRECT ACCESS CT ABDOMEN
what does courvoisiers law state?
palpable gallbladder along with jaundice is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic cancer.
PC tumour marker?
Ca 19.9 (also raised in CCA)
What does a Whipple Procedure remove?
tumour of the head pancreas that has not spread. Involves removal of:
Head of the pancreas Pylorus of the stomach Duodenum Gallbladder Bile duct Relevant lymph nodes
How do patients TYPICALLY present with PC?
Non specific anorexia, weight loss, epigastric pain
Sensible imaging for PC?
ultrasound has 60-90% sensitivity
high resolution CT if diagnosis suspected
DOUBLE DUCT SIGN (presence of simultaneous dilatation of the common bile and pancreatic ducts)
