Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 final checklist_ SURGERY > Pancreatic conditions > Flashcards

Pancreatic conditions Flashcards

1
Q

Risk factors associated with pancreatic cancer

A
  • increasing age
  • smoking
  • diabetes
  • chronic pancreatitis (alcohol does not appear an independent risk factor though)
  • hereditary non-polyposis colorectal carcinoma
  • multiple endocrine neoplasia
  • BRCA2 gene
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features/presentation of pancreatic cancer

A

Pancreatic cancer is often diagnosed late as it tends to present in a non-specific way

  • classically painless jaundice
  • Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones (however, patients typically present in a non-specific way with anorexia, weight loss, epigastric pain
  • loss of exocrine function (e.g. steatorrhoea)
  • loss of endocrine function (e.g. diabetes mellitus)
  • atypical back pain is often seen
  • migratory thrombophlebitis (Trousseau sign) is more common than with other cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The most common type and location of pancreatic cancer

A
  • 80% of pancreatic tumours are adenocarcinomas
  • typically occur at the head of the pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What’s Courvoisier’s law?

A

Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones → possible head of the pancreas cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Possible signs of pancreatic cancer

A
  • Palpable gallbladder
  • Jaundice
  • Epigastric mass
  • Thrombophlebitis migrans (Trousseau sign)
  • Splenomegaly: PV thrombosis → portal HTN
  • Ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do the bloods may show in pancreatic cancer? (3)

A

Bloods:

  • cholestatic LFTs
  • ↑Ca19-9
  • ↑Ca
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Imaging Ix in pancreatic cancer

A

Imaging

  • high-resolution CT scanning → Ix of choice when pancreatic ca is suspected
  • US: pancreatic mass, dilated ducts, hepatic mets, guide biopsy
  • EUS: better than CT/MRI for staging
  • CXR: mets
  • Laparoscopy: mets, staging
  • ERCP
  • Shows anatomy
  • Allows stenting
  • Biopsy of peri-ampullary lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of Pancreatic cancer

A
  • less than 20% are suitable for surgery at diagnosis
  • a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas
  • adjuvant chemotherapy is usually given following surgery
  • ERCP with stenting is often used for palliation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Side effects of Whipple’s procedure

A

dumping syndrome and peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Prognosis for pancreatic ca

A
  • Mean survival <6mo
  • 5ys = <2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spread of metastasis in pancreatic ca

A

Present late, metastasise early

  • Direct extension to local structures
  • Lymphatics
  • Blood → liver and lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s acute pancreatitis?

A

Autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms of acute pancreatitis

A
  • Severe epigastric pain → back
  • May be relieved by sitting forward

• Vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs of acute pancreatitis

A

↑HR, ↑RR

  • Fever
  • Hypovolaemia → shock
  • Epigastric tenderness
  • Jaundice
  • Ileus → absent bowel sounds
  • Ecchymoses
  • Grey Turners: flank
  • Cullens: periumbilical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of pancreatitis

A

I GET SMASHED

  • Gallstones (45%)
  • Ethanol (25%)
  • Idiopathic (20%): ?microstones
  • Trauma
  • Steroids
  • Mumps + other infections: Coxsackie B
  • Autoimmune: e.g. PAN
  • Scorpion (Trinidadian)
  • Hyperlipidaemia (I and V), ↑Ca, Hypothermia
  • ERCP: 5% risk
  • Drugs: e.g. thiazides, azathioprine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Factors indicating severe pancreatitis

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

* the actual amylase level is not of prognostic value.

17
Q

(3) scoring systems identifying cases of severe pancreatitis

A

cases of severe pancreatitis → may require intensive care management

These include:

  • Ranson score
  • Glasgow score
  • APACHE II
18
Q

Components of Glasgow Criteria

A

Glasgow criteria → to estimate severity of pancreatitis

19
Q

Bloods and urinalysis in acute pancreatitis

A

Bloods

  • FBC: ↑WCC
  • ↑amylase (>1000 / 3x ULN) and ↑lipase (↑ in 80%); returns to normal by 5-7d
  • U+E: dehydration and renal failure
  • LFTs: cholestatic picture, ↑AST, ↑LDH
  • Ca2+: ↓
  • Glucose: ↑
  • CRP: monitor progress, >150 after 48hrs = sev
  • ABG: ↓O2 suggests ARDS

• Urine: glucose, ↑cBR, ↓urobilinogen

20
Q

Imaging in acute pancreatitis

A

Imaging

  • CXR: ARDS, exclude perforated duodenal ulcer
  • AXR: sentinel loop, pancreatic calcification
  • US: Gallstones and dilated ducts, inflammation
  • Contrast CT: Balthazar Severity Score
21
Q

Conservative management of acute pancreatitis

A
  • Manage at appropriate level: e.g. ITU if severe
  • constant reassessment is key
  • Fluid Resuscitation
  • Aggressive fluid resus: keep urine output >30ml/h
  • Catheter ± CVP
  • Pancreatic Rest
  • NBM
  • NGT if vomiting
  • TPN may be required if severe to prevent catabolism
  • Analgesia
  • Pethidine via PCA
  • Or morphine
  • Antibiotics
  • Not routinely given if mild
  • Used if suspicion of infection or before ERCP
  • Penems often used: e.g. meropenem, imipenem
22
Q

Management of complication of acute pancreatitis

A

Mx Complications

  • ARDS: O2 therapy or ventilation
  • ↑ glucose: insulin sliding scale
  • ↑/↓Ca
  • EtOH withdrawal: chlordiazepoxide
23
Q

Interventional management in acute pancreatitis

  • what and when
A

Interventional Mx: ERCP

  • If pancreatitis with dilated ducts secondary to gallstones
  • ERCP + sphincterotomy → ↓ complications
24
Q

Surgical management of acute pancreatitis

  • indications
  • procedures
A

Surgical Mx

Indications:

  • Infected pancreatic necrosis
  • Pseudocyst or abscess
  • Unsure Dx

Operations:

  • Laparotomy + necrosectomy (pancreatic debridement)
  • Laparotomy + peritoneal lavage
  • Laparostomy: abdomen left open with sterile packs in ITU
25
Q

Early complications of acute pancreatitis

  • systemic
  • metabolic
A

Early:

A. Systemic

  • Respiratory: ARDS, pleural effusion
  • Shock: hypovolaemic or septic
  • Renal failure
  • DIC

B.Metabolic

  • ↓ Ca2+
  • ↑ glucose
  • Metabolic acidosis
26
Q

Late complications of acute pancreatitis (4)

A

Late (>1wk):

A. Local

  • Pancreatic necrosis
  • Pancreatic infection
  • Pancreatic abscess
  • May form in pseudocyst or in pancreas
  • Open or percutaneous drainage

B. Bleeding: e.g. from splenic artery

  • May require embolisation

C.Thrombosis

  • Splenic A., GDA or colic branches of SMA
  • May → bowel necrosis
  • Portal vein → portal HTN

D. Fistula formation

  • Pancreato-cutaneous → skin breakdown
27
Q

What’s pancreatic pseudocyst?

A
  • Collection of pancreatic fluid in the lesser sac surrounded by granulation tissue

• Occur in 20% (esp. in EtOH pancreatitis)

28
Q

Symptoms of pancreatic pseudocyst

A
  • 4-6wks after acute attack
  • Persisting abdominal pain
  • Epigastric mass → early satiety
29
Q

Complications of pancreatic pseudocyst

A
  • Infection → abscess
  • Obstruction of duodenum or CBD
30
Q

Ix in pancreatic pseudocyst

A
  • Persistently ↑ amylase ± LFTs
  • US / CT
31
Q

Management of pancreatic pseudocyst

A
  • <6cm: spontaneous resolution
  • >6cm
  • Endoscopic cyst-gastrostomy
  • Percutaneous drainage under US/CT
32
Q

Causes of Chronic Pancreatitis

A

Causes: AGITS

  • Alcohol (70%)
  • Genetic
  • CF
  • haemochromatosis

• Immune

  • Lymphoplasmacytic sclerosing pancreatitis
  • Triglycerides ↑
  • Structural
  • Obstruction by tumour
  • Pancreas divisum
33
Q

Presentation of chronic pancreatitis

A
  • Epigastric pain
  • Bores through to back
  • Relieved by sitting back or hot water bottle → erythema ab igne
  • Exacerbated by fatty food or EtOH
  • Steatorrhoea and wt. loss
  • DM: polyuria, polydipsia
  • Epigastric mass: pseudocyst
34
Q

Investigations in chronic pancreatitis

A
  • ↑ glucose
  • ↓ faecal elastase: ↓ exocrine function
  • US: pseudocyst
  • AXR: speckled pancreatic calcifications
  • CT: pancreatic calcifications
35
Q

Management of chronic pancreatitis

A

Diet

  • No alcohol
  • ↓ fat, ↑ carb

Drugs

  • Analgesia: may need coeliac plexus block
  • Enzyme supplements: pancreatin (Creon)
  • ADEK vitamins
  • DM Rx

Surgery

  • Indications
  • Unremitting pain
  • Wt. loss
  • Duct blockage
  • Procedures
  • Distal pancreatectomy, Whipple’s
  • Pancreaticojejunostomy: drainage
  • Endoscopic stenting
36
Q

Complications of chronic pancreatitis

A

Complications

  • Pseudocyst
  • DM
  • Pancreatic Ca
  • Pancreatic swelling → biliary obstruction
  • Splenic vein thrombosis → splenomegaly
37
Q

What’s that?

A

Multiple small calcific foci projected in the pancreas consistent with chronic pancreatitis

38
Q

What’s that?

A

CT showing an irregular shaped pancreas with the typical calcification of chronic pancreatitis

Y4 final checklist_ SURGERY (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions