Pancreatic conditions Flashcards
Causes/risk factors of acute pancreatitis (5)
Alcohol abuse Gallstones blocking main pancreatic duct Trauma ERCP induced Certain drugs
Pathophysiology of acute pancreatitis
Primary insult (i.e. alcohol or gallstones etc) --> release of activated pancreatic enzymes --> autodigestion (pancreas digesting itself)
Symptoms (4) /signs (4) of acute pancreatitis
Epigastric pain - can radiate to back
vomiting,
nausea,
Anorexia
jaundice
Pyrexia,
tachycardia,
Tender/swelling of abdomen
Where can pain radiate to in pancreatitis
Back
Investigations of acute pancreatitis
- bloods (5)
- imaging (2)
AMYLASE (Raised 3x) ,
LIPASE (Raised 3x),
CRP
LFTs - raised AST/ALT suggest gallstone cause
FBC
Haematocrit (ratio of RBCs to volume of blood)
ABG - low O2
AXR
ERCP or EUS if jaundiced - look for gallstones
What Glasgow criteria score indicates severe pancreatitis
> 3
What score system can be used to assess severity of pancreatitis
+ name one criteria (i.e. a finding) of severe pancreatitis
Glasgow criteria score
Blood glucose >10mmol/l
Treatment of acute pancreatitis (5)
+ 3 others which may be used in certain cases
Analgesia IV fluids Nutritional support when symptoms subside \+/- anti-emetics \+/- supplemental oxygen
Antibiotics only given if there’s severe pancreatic necrosis
Cholecystectomy if it was induced by gallstones
Counselling plus alcohol withdrawal prophylaxis if alcohol induced
Complications of acute pancreatitis (3)
Acute renal failure
Pancreatic necrosis
Pancreatic abscess
Pathophysiology of chronic pancreatitis
Continuous inflammatory disease of the pancreas –> irreversible glandular damage –> leading to loss of function
Pancreatic duct obstruction –> abnormal sphincter of oddi function
Chronic pancreatitis usually due to recurrent cases of what
Alcohol related acute pancreatitis
Causes of chronic pancreatitis (OATIGER) + which are the main ones
Obstruction of main pancreatic duct - eg. tumour, trauma Autoimmune Toxins - ALCOHOL, SMOKING Idiopathic GENETIC Environmental Recurrent injuries
Capital = main ones
Symptoms (3) /signs (3) of chronic pancreatitis
Epigastric pain - radiates to back
Nausea/vomiting
Weight loss/malnutrition
Steatorrhoea
Diabetes
Why does chronic pancreatitis cause weight loss/maulnutrition, steatorrhoea and diabetes
Exocrine insufficiency –> fat/ protein malabsorption –> STEATORRHOEA and WEIGHT LOSS respectively
Endocrine insufficiency –> diabetes
Investigations of chronic pancreatitis (6)
- bloods
- imaging (5)
Blood glucose
CT abdo
Abdo USS
AXR
EUS
ERCP
Treatment of chronic pancreatitis (4)
Alcohol/ smoking abstinence
Pancreatic enzyme supplements
Opiate analgesia
Low fat diet
What is the most common pancreatic carcinoma
Primary pancreatic ductal adenocarcinomas (mostly in head of pancreas)
Risk factors of pancreatic cancer (4)
Smoking
Alcohol
Chronic pancreatitis
Inherited
Pathophysiology of pancreatic ductal adenocarcinomas
Pre-invasive pancreatic intraepithelial neoplastic lesions –> invasive ductal adenocarcinoma
Symptoms (2) /signs (2) of pancreatic cancer
Non specific upper abdo pain
Anorexia
PAINLESS OBSTRUCTIVE JAUNDICE
Weight loss
Name 4 causes of obstructive jaundice
gall stone in common bile duct
tumour of common bile duct
stricture of common bile duct
carcinoma head of pancreas
Investigations of pancreatic cancer
- bloods (1)
- imaging (2)
- tumour marker (1)
LFTs - high bilirubin, AlkP, gamma GT
Abdo USS
Pancreas specific CT
Tumour marker – CA19-9
Treatment of pancreatic cancer
- if resectable (stage I-II) (3)
- if locally advanced unresectable (stage III) (3)
If resectable: -pancreaticoduodenectomy (whipple's) OR PPPD - pylorus preserving pancreaticoduodenectomy - + adjuvant chemo
If locally advanced:
- ERCP + stent - to relive jaundice
- chemo or chemoradiotherapy
- analgesia (opiates) + pancreatic enzyme supplements
Gold standard investigation of pancreatic carcinoma
Spiral CT
Surgical treatment of pancreatic cancer
pancreaticoduodenectomy (whipple’s procedure) - for pancreas head tumour
PPPD - pylorus preserving pancreaticoduodenectomy
What therapeutic investigation may follow an abdo USS for pancreatic cancer to relieve jaundice
ERCP + stent - to relieve jaundice
What treatment is done if ERCP +stent not possible (too blocked to stent) in obstructive jaundice due to pancreatic tumour
Palliative bypass/drainage
Surgical treatment of acute pancreatitis
ERCP + ES (endoscopic sphincterotomy) - cutting the muscle between CBD and pancreatic duct
Surgical treatment of chronic pancreatitis (5)
Pylorus preserving pancreatoduodectomy (PPD)
Whipple’s - pancreaticoduodenectomy - if intractable pain + small duct disease
Biliary decompression - if biliary obstruction
Pancreatic ductal decompression - if pancreatic duct obstruction
Coeliac plexus block - if intractable pain + small duct disease
Complications of chronic pancreatitis (5)
Pancreatic pseudocyst Pancreatic exocrine insufficiency Diabetes mellitus Pancreatic calcifications Pancreatic duct obstruction
