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CP3 Surgery > Pancreatic > Flashcards

Pancreatic Flashcards

1
Q

List the causes of acute pancreatitis

A 
Idiopathic*
Gallstones** 
Ethanol **
Trauma*
Steroids
Malignancy / Mumps
Autoimm (SLE, polyarteritis nodosa)
Scorpion venom (tityustoxin)
Hyperlipidaemia / hypercal / hypothermia
ERCP
Drugs (ACEis, NSAIDs, Thiazides, Sulphonamide Abx)
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2
Q

What are the diff (histological) classifications of acute pancreatitis (3) + what are the causes of each

A

Periductal: obstruction (gallstones)
Perilobular: shock / hypothermia (poor perfusion)
Panlobular: E(toxins), M(viruses), H(metab insults), Drugs

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3
Q

What may be seen O/E in acute pancreatitis (7)

A 
Tachycardia (±shock in severe)
Fever
Jaundice (30%)
Cullens / Grey-Turners
Guarding / rigid / tender
Ileus
Dyspnoea (10% L lung tachycardia)
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4
Q

List the investigations done in suspected pancreatitis (7+4)

A 
Bloods:
FBC / CRP
LFTs inc. LDH
U+Es / Gluc / Ca
Amylase / Lipase
ABG

AXR (exclude DDx) / CXR (perforations)
CT
MRCP

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5
Q

What are the variables in Glasgow Prognosis Predictor of Acute Pancreatitis (severity estimation) (8)

A 
PaO2 < 8 
Age >55
Neutrophils; WCC > 15
Ca < 2
Renal; Urea > 16 (third-spacing dehydration)
Enzymes; AST >200 / LDH > 600
Albumin <32
Sugars; Glucose >10
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6
Q

What are some causes of raised amylase (6)

A 
Acute pancreatitis
Acute cholecystitis
Pancreatic pseudocyst
DKA
GI perforations
Mesenteric infarct
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7
Q

Outline the acute management of pancreatitis (10)

A 
A–E plus supportive:
Analgesia
Fluid resus 
Fluid balance (catheterise)
Close monitoring (hrly obs)
NBM + NG

PPI (risk stress ulcer)
Anticoag
Abx if severe
Find/treat cause (e.g. urgent ERCP in gallstones)

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8
Q

List some complications of acute pancreatitis
(6 early + 5 late)
SHHARD

A 
Shock ± septic
Renal failure
Hypocal
Hypergly
ARDS
DIC
Pseudocyst
Abscess
Fistulae
Bleeding
Bowel necrosis (aa thrombosis)
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9
Q

What are the metabolic complications of pancreatitis (4)

A

Hypergly
Hypocal
Hypoalbumin
Malabsorption (↓Vit levels)

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10
Q

How may a pancreatic pseudocyst present? (7)

A 
10d post-pancreatitis
Deep persistent abdo pain
Mass
Jaundice
Anorexia (bowel pressure)
Sepsis
L pleural effusion
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11
Q

What investigations can be done if suspecting a pancreatic pseudocyst? (4)

A

LFTs (if obstrn)
Amylase / lipase

Abdo CT (gold standard)
MRI (ddx necrosis)
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12
Q

What are the indications for drainage of pancreatic pseudocyst? (3)
What are the diff methods of drainage (3)

A

Complications (infection / bleeding)
Symptomatic relief
Malignancy concerns

Percutaneous
Endoscopic (endo USS then ERCP)
Laparoscopic

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13
Q

List some RFs for pancreatic cancer (5)

A 
Age (>60)
Smoking / Alcohol
DM
Genetic
Chronic pancreatitis
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14
Q

How may a head of pancreas tumour present? (3)
How may a pancreas body/tail tumour present? (3)

What conditions could pancreatic cancer present as? (non-specific to area origin) (3)

A

Head (60%):
Painless obstructive jaundice (Courvoisier’s)
Hepatosplenomegaly
Ascites

Body (25%) / Tail (15%):
Asymp (presents late)
B symptoms
Dull abdo pain (radiates back / relief forward)

DM
Acute pancreatitis
Trousseau’s syndrome

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15
Q

What are the tumour markers for pancreatic cancer? (2)

A

CA 19.9

± CEA (non-specific)

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16
Q

What imaging should be done for pancreatic cancer?(2)

What invasive tests (2)

A

USS (duct dilation)
CT

Endoscopic USS / Biopsy
Laparoscopy (staging)

17
Q

What is the histology of most pancreatic neoplasms?

A

Mostly ductal adenocarcinoma

2% islet cell tumours (MEN syndrome)

18
Q

List the diff types of islet cell tumours in pancreatic cancer (5) + their features

A

Insulinoma: symptomatic hypogly / gross wt gain

Glucagonoma: asymp / secondary DM

Gastrinoma: GI ulcers / Oesophagitis / Diarrhoea

VIPoma: profound diarrhoea

Somatostatinoma:
• DM (inhib insulin release)
• Gallstones (inhib CCK release)
• Achlorrhydria (inhib gastrin release)

19
Q

Outline the palliative management of pancreatic cancer

A

Stent (ERCP/PTC)

Control endo/exocrine derangements

20
Q

Features of chronic pancreatitis

A

Epigastric pain
Radiate to back/relief sitting forward
Relapsing/progressive sx

Obstructive jaundice
S/o malnutrition
Brittle DM

21
Q

What drugs can be a cause of acute pancreatitis

A 
ACEis (enalapril)
Thiazides
Sulphonamides
Gliptins
Valproate
Oestrogen-containings
Azathioprine
Tetracyclines
22
Q

List some DDx for acute pancreatitis

A 
Cholangitis
Cholecystitis
MI
Mesenteric ischaemia
Perforated peptic ulcer
DKA
Gastric outlet obstrn
Pancreatic cancer

CP3 Surgery (10 decks)

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