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Dannys Medicine Finals > Pancreatic > Flashcards

Pancreatic Flashcards

1
Q

Causes of Acute Pancreatitis

A

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)

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2
Q

Presentation of Acute Pancreatitis?

A

Severe epigastric pain (radiates to back)

Vomiting

Abdo tenderness

Systemically unwell (fever + tachycardia)

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3
Q

Specific signs of Acute Pancreatitis?

A

Cullens Sign

Grey Turners sign

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4
Q

what is cullens sign

A

periumbilical discolouration

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5
Q

What is grey-turner’s sign

A

Flank discolouration

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6
Q

blood Investigations for AP?

A

Serum amylase >3 times upper limit

Serum lipase (longer half life than amylase so useful for late presentations)

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7
Q

Imaging for AP?

A

Early US important as aetiology may affect management e.g.g patients with biliary obstruction

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8
Q

What is the Glasgow score

A

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)
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9
Q

common factors indicating severe pancreatitis include:

A 
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
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10
Q

Complications of Acute Pancreatitis?

A

Necrosis
Infection

Abscess formation (infected pseudocyst) 
Acute peripancreatic fluid collections

Psuedocysts
Chronic Pancreatitis

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11
Q

How are Pseudocysts formed?

A

organisation of peripancreatic fluid collection walled by fibrous tisse

typically 4 weeks after acute pancreatitis

treated with cystogastrostomy / aspiration

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12
Q

when would grey turners sign be identified?

A

Retroperitoneal haemorrhage

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13
Q

Management of acute pancreatitis?

A

Resus
IV Fluids
Enteral nutrition if severe
Analgesia

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14
Q

Role of surgery in Acute Pancreatitis?

A

Patients with AP due to gallstones should undergo early cholecystectomy

Pts with obstructed biliary system due to stones should undergo ERCP

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15
Q

Cause of Chronic Pancreatitis?

A

Alcohol 80%

Ductal obstruction

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16
Q

Features of CP?

A

Pain worse after meal

Steatorrhoea (pancreatic exocrine insufficiency)

Diabetes mellitus (loss of endocrine function)

17
Q

Management of CP?

A

Analgesia

Replacement Pancreatic Enzymes (Creon)

insulin regimes if DM

18
Q

Signs on investigation of CP?

A

Abdominal xray shows pancreatic calcification in 30%

CT more sensitive at detecting calcification

19
Q

What may be used to assess exocrine function if imaging inconclusive of CP?

A

Faecal elastase

20
Q

Most common pancreatic tumour?

A

Adenocarcinoma in the head of the pancreas (80%)

21
Q

Key presenting feature of Pancreatic Cancer?

A

Painless obstructive jaundice

OR

rapidly worsening glycaemic control despite good compliance

22
Q

how does PC cause obstructive jaundice?

A

tumour at the head of the pancreas compresses the bile ducts, blocking the flow of bile out of the liver

23
Q

Signs of obstructive jaundice?

A

yellow skin, sclera
pale stools
dark urine
generalised itching

24
Q

when to refer for suspected PC?

A

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

25
Q

what does courvoisiers law state?

A

palpable gallbladder along with jaundice is unlikely to be gallstones. The cause is usually cholangiocarcinoma or pancreatic cancer.

26
Q

PC tumour marker?

A

Ca 19.9 (also raised in CCA)

27
Q

What does a Whipple Procedure remove?

A

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
28
Q

How do patients TYPICALLY present with PC?

A

Non specific anorexia, weight loss, epigastric pain

29
Q

Sensible imaging for PC?

A

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)

Dannys Medicine Finals (9 decks)

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