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GI > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

The endocrine portion of the pancreas is contained where?

A

Pancreatic islets

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2
Q

What is produced by the pancreatic islets?

A

Insulin by beta cells
Glucagon by alpha cells
Somatostatin

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3
Q

The exocrine function of the pancreas is carried out by which cells?

A

Acinar cells forming lobules

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4
Q

Describe connection of acinar lobules to the duodenum

A

Connected individually by ducts, intralobular ducts drain to main pancreatic duct to common bile duct to Sphincter of Oddi, to the duodenum

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5
Q

What is the function of the accessory pancreatic duct?

A

Connected to duodenum, utilised only if other ducts become blocked

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6
Q

What is the function of the exocrine pancreas?

A

Digestion

Secrete bicarbonate and digestive enzymes to pancreatic duct

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7
Q

What are pancreatic zymogens>

A

Inactive form of enzymes, produced in bicarbonate rich medium to prevent autodigestion

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8
Q

What is converted by enterokinase and where>

A

Trypsinogen to trypsin at brush border of duodenal enterocytes

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9
Q

What converts zymogens to active form>

A

Trypsin

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10
Q

Which enzymes are secreted by the pancreas?

A 
Proteases
Nucleases
Elastases
Phospholipases
Lipases
Alpha amylase
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11
Q

What stimulates bicarbonate secretion?

A

Secretin - activated by acid

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12
Q

Zymogen secretion is stimulated by?

A

CCK - released due to fat or amino acid in duodenum

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13
Q

Features of Acute pancreatitis

A

Acute inflammation causing upper abdominal pain
Elevation of serum amylase
Multi-organ failure in severe cases

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14
Q

Aetiology of acute pancreatitis

A 
G- Gallstones
E- Alcohol
T- Trauma
S- steroids
M- Mumps
A- Autoimmune
S- Scorpion 
H- Hypercalcaemia, hypertriglyceridemia, Hypothermia
E- ERCP
D- Drugs; azathioprine, sodium valproate, diuretics
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15
Q

Pathogenesis of acute pancreatitis

A

Primary insult causes release of activated pancreatic enzymes leading to autodigestion
Release of proinflammatory cytokines and ROS

Oedema
Fat necrosis
Haemorrhage

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16
Q

Investigations for acute pancreatitis

A

Blood tests - amylase, lipase, FBC, U&Es, CRP, ABG, lipids, Calcium, LFTs
Abdominal X-ray and Chest X ray
Abdominal US
CT contrast enhanced

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17
Q

Management of acute pancreatitis

A 
Analgesia
IV Fluids
Blood transfusion if required
Monitor urine output
Naso-gastric tube
Oxygen
Insulin
Calcium
Nutrition
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18
Q

Which scoring system is used for severity in acute pancreatitis?

A

Glasgow Criteria

If greater than 3 severe

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19
Q

Treatment for pancreatic necrosis

A

CT guided aspiration - antibiotics and surgery

20
Q

Treatment for gallstones

A

EUS/MRCP/ERCP

Cholecystectomy

21
Q

Complications of treatment in acute pancreatitis

A

Abscess

Pseudocysts

22
Q

Management of abscess and pseudocysts

A

Antibiotics and drainage of abscess

Endoscopic drainage or surgery

23
Q

Indications for US or CT in complications of acute pancreatitis

A

Jaundice
Haemorrhage
Infection
Rupture

24
Q

Which patient group is chronic pancreatitis most common in?

A

Males

Age 35-50

25
Q

Causes of chronic pancreatitis

A 
Alcohol
Cystic fibrosis
Congenital abnormalities - annular pancreas, pancreas, divisium
Hereditary pancreatitis
Hypercalcaemia
Diet
26
Q

Which genetic associations are there to chronic pancreatitis?

A

PRSS1 - trypsinogen mutation
SPINK 1- pancreatic secretory trypsin inhibitor
CFTR

27
Q

Pathogenesis of chronic pancreatitis

A

Duct obstruction - calculi, inflammation, protein plugs
Abnormal sphincter of Oddi - Spasm - intrapancreatic pressure increase, or relaxation - reflux of duodenal contents
Genetic polymorphisms - abnormal trypsin activation

28
Q

Consequence of fibrotic changes in the pancreas in chronic pancreatitis

A

Spleni , Superior mesenteric and portal veins can fibrose leading to portal hypertension

29
Q

Clinical features of chronic pancreatitis

A 
Abdominal pain
Weight loss
Steatorrhoea
Decreased Ca/Mg
Decreased Vitamin B12
Diabetes
Jaundice
Portal HT
 GI haemorrhage
Pseudocysts
Pancreatic carcinoma
30
Q

Investigations of chronic pancreatitis

A 
Abdominal X ray
CT
US
EUS
Bloods - amylase, albumin, LFTs, PT
31
Q

Management of chronic pancreatitis

A 
Avoid alcohol
Pancreatic enzyme supplements
Opiate analgesia
Celiac plexus block
Pain clinic
Endoscopic treatment of strictures and stones
Surgery
Low fat diet
Vitamin supplements
Diabetic management
32
Q

Complications of chronic pancreatitis

A 
Acute on chronic attacks
Cardiac complications of diabetes
Associated cirrhosis
Drug dependance
Suicide
33
Q

Most common tumour of the pancreas

A

Duct cell mucinous adenocarcinoma

Carcinosarcoma
Cystoadenocarcinoma
Acinar cell

34
Q

Clinical features of pancreatic cancer

A 
Painless obstructive jaundice
Upper abdominal pain
Weight loss
Anorexia, fatigue, diarrhoea, steatorrhoea, nausea, vomiting
Tender subcutaneous fat nodules - metastatic fat necrosis
Thrombophlebitis migrans
Asvites
Portal hypertension
35
Q

Signs on examination for pancreatic cancer

A 
Hepatomegaly
Jaundice
Abdominal mass, tenderness
Ascites
Palpable gallbladder - ampullary carcinoma
Splenomegaly
Supracvlavicular lymphadenotpahty
36
Q

Investigations for pancreatic cancer

A 
Abdominal US
CT
EUS
Jaundice and mass - ERCP and stent
Mass no jaundice - EUS percutaneous needle biopsy -
Laparoscopy/Laparotomy
37
Q

Management of pancreatic cancer

A

Radical surgery - pancreatoduodenectomy - Whipple’s
Palliation of jaundice - stent, cholechoduodenostomy
Pain control - opiates, coeliac plexus block, radiotherapy
Chemotherapy

38
Q

Prognosis for inoperable pancreatic cancer

A

Less than 6 months

39
Q

Prognosis for operable pancreatic cancer

A

15% 5 year survival

Ampullary 30-50% 5 year survival

40
Q

Differentials for acute pancreatitis - pain radiating to the back

A 
AAA
Renal calculi
Chronic pancreatitis
Aortic dissection
Peptic ulcer disease
41
Q

When is serum amylase diagnostic of acute pancreatitis?

A

When 3x normal upper limit

42
Q

Other causes of raised serum amylase

A

Bowel perforation
Ectopic pregnancy
Diabetic ketoacidosis

43
Q

What is included within the Glasgow score?

A 
PANCREAS
PO2
Age over 55
Neutrophils over 15
Calcium less than 2
Renal function - Urea greater than 16
Enzymes - LDH
Ablumin /AST
Sugar - Blood glucose greater than 10
44
Q

Systemic complications of acute pancreatitis

A

Acute Respiratory Distress Syndrome
Disseminated Intravascular Coagulation
Hypocalcaemia

Hyperglycaemia

45
Q

Local complications of acute pancreatitis

A

Pancreatic necrosis

Pseudocysts

46
Q

Management of pseudocysts

A

Surgical debridement

Endoscopic drainage

GI (8 decks)

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