Brainscape's Knowledge GenomeTM

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


See full index

R - Yr2 Alimentary (Liam Lennox) > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

Define Acute Pancreatitis

A

Sudden onset inflammation of the pancreas

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

How does acute pancreatitis present?

A
  • Severe Epigastric pain (may radiate to the back)
  • Vomiting/Nausea
  • Pyrexia

Can also cause a number of less common symptoms:

  • Jaundice
  • Acute Renal Failure
  • Tachycardia (hypovolaemic shock)
  • Retroperitoneal haemorrhage
  • Effusions (Ascites/pleural)
  • Paralytic Ileus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do we call the visible signs of retroperitoneal haemorrhage in acute pancreatitis?

A

Grey Turner’s (on the flanks) & Cullen’s (Around the umbilicus) Signs

Both are severe bruising in the subcutaneous fat

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

How do we differentiate mild and severe acute pancreatitis?

A

Severe comes with organ failure or local complications.
Its determined by the modified glasgow criteria, if 3 or more of the criteria are +ve its severe.

A raised CRP also indicates its severe

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

What are the glasgow criteria for acute pancreatitis?

A

PANCREAS

PaO2 (<8)
Age >55yrs
Neutrophilia (Raised WCC)
Calcium (Low)
Renal Function (High Urea)
Enzymes (Raised LDH and AST/ALT Ratio)
Albumin (Low)
Sugar (Blood Glucose raised)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the local complications of acute pancreatitis?

A
  • Fluid Collection
  • Pseudocysts
  • Pancreatic Abscesses or necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common causes of acute pancreatitis?

A
  • Alcohol abuse is the biggest
  • Gallstones
  • Idiopathic

Can also be blunt trauma or post-op.

Rarely drugs/viruses/pancreatic carcinoma/metabolic/auto-immune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do gallstones cause acute pancreatitis?

A

They raise intra-ductal pressure preventing flow of digestive enzymes out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What blood tests do we do for pancreatic disease?

A
  • Serum amylase/lipase (raised)
  • Glucose/U&E (Raised)
  • LFT (Raised AST/ALT)
  • FBC (Raised WCC)
  • Albumin (low)
  • Ca2+ (low)
  • ABG (can be low)
  • Coagulation Screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What imaging can be done for acute pancreatitis?

A

AXR -
CXR - Pleural Effusion
Abdominal US - Gall stones, Pseudocyst, pancreatic oedema
CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What emergency care do we give for an acute pancreatitis case?

A

HDU/ITU:

  • Analgesia
  • IV fluids
  • Transfusion (If necessary)
  • Catheterise
  • NG tube to maintain nutrition
  • O2 (can go into resp. failure)
  • Insulin
  • Ca supplement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do we catheterize an acute pancreatitis patient?

A

We want to monitor urine output in order to monitor Kidney function.
acute pancreatitis can cause kidney failure which show up as small urine volume (Oliguria)

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

How would we treat pancreatic abscess/necrosis as a complication of acute pancreatitis?

A

CT guided fine needle aspiration

Then antibiotics and/or surgery as necessary

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

What is a pseudocyst?

A

A fluid collection without an epithelial lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What would indicate presence of a pseudocyst in acute pancreatitis?

A

Persistantly high serum amylase and/or pain.

Diagnose with US or CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What further problems can a pseudocyst cause?

A

Jaundice
Infection
Haemorrhage
Rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we treat a pseudocyst?

A

Endoscopic drainage or surgery if it doesnt dissapear alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we treat acute pancreatitis?

A
  • Emergency supportive care
  • Treat the complications
  • Treat the underlying causes (e.g. alcohol, abstinence, surgery etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define Chronic Pancreatitis?

A

Continuing inflammatory disease of the pancreas characterized by irreversible glandular destruction and typically causing pain and/or impairment of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What causes Chronic Pancreatitis?

A 
O-A-TIGER
Obstruction - Main Pancreatic duct e.g. Cystic Fibrosis
Autoimmune
Toxin - Alcohol is the biggest cause of CP
Idiopathic
Genetic
Environmental
Recurrent injury

Also can be a congenital anatomical abnormality such as annular pancreas divisum where the ventral/dorsal pancreatic buds fail to fuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name a genetic cause for Chronic Pancreatitis?

A

Hereditary CP

Its a rare autosomal dominant disorder

22
Q

Name an environmental cause of Chronic Pancreatitis?

A

Tropical Chronic Pancreatitis

23
Q

What can cause recurrent pancreatic injury?

A

Hyperlipidaemia or hypercalcaemia

24
Q

What happens to the pancreas in Chronic Pancreatitis?

A
  • Glandular atrophy & fibrous replacement.
  • Ducts become dilated/tortuous/strictured
  • Inspissated secretions can calcify
  • Nerves can become exposed
  • Splenic/Sup Mesenteric/Portal veins can thrombose
25
Q

What does inspissated mean?

A

Thickened in consistency

26
Q

How do nerves become exposed in Chronic Pancreatitis?

A

Perineural cells are lost

27
Q

What is consequence of thrombosis of the portal vein, splenic vein or superior mesenteric vein?

A

Portal hypertension

28
Q

How does Chronic Pancreatitis present?

A

Early CP is often asymptomatic

  • Abdominal pain exacerbated by food or booze
  • Weight loss due to pain/anorexia/malabsorption
  • Exocrine insufficiency
  • Endocrine insuffciency

Also less commonly:
Jaundice/Portal hypertension/GI hemorrhage/Pseudocysts

29
Q

What are the consequences of hormonal insufficiency in Chronic Pancreatitis?

A

Exocrine:

  • Fat Malabsorption -> Steatorrhea
  • Protein Malabsorption -> Weight loss

Endocrine:
- Diabetes

30
Q

How would we investigate suspected Chronic Pancreatitis?

A 
AXR - May see pancreatic calfication
US - Large pancreas, cysts, duct diameter, tumours
Endoscopic US
CT
Bloods
Pancreatic Function Tests
31
Q

What would we see on Chronic Pancreatitis bloods?

A

Low:
Albumin, Ca, Mg, B12
Raised LFTs, prothrombin time, glucose

Raised serum amylase in an acute exacerbation

32
Q

What kind of pancreatic function test are there?

A
  • Faecal/Serum enzymes
  • Diagnostic Enzyme replacement
  • Pancrealauryl test, response of enzymes to stimulus
33
Q

How do we manage Chronic Pancreatitis?

A
  • Pain control
  • Hormonal management
  • Surgery if indicated
34
Q

What kind of pain control is there for Chronic Pancreatitis?

A
  • Avoid alcohol
  • Opiate analgesia
  • Pain clinic referal
  • Endoscopically treat pancreatic duct stones/strictures
  • Some surgeries
  • Coeliac plexus block
35
Q

Explain a coeliac plexus block?

A

Done by injection
Suppresses of destroys coeliac plexus
This prevents pain long term.

36
Q

How do we manage the exocrine/endocrine sides of Chronic Pancreatitis?

A
  • Low Fat Diet

- Pancreatic Enzyme supplements (they may require acid suppression therapies to survive the stomach)

37
Q

What would indicate surgery in Chronic Pancreatitis?

A 
Malignancy
Intractable pain
Complications:
 - Duct/duodenal Stenosis
 - Biliary Obstruction or colonic stricture
 - Cyst/pseudocyst
 - Thrombosis or gastric varices
 - Compression of portal vein
38
Q

What surgical options are there for Chronic Pancreatitis?

A

Depends on the cause and complications.

  • CBD Stent or bypass
  • Endoscopic PD sphincterectomy/dilatation/lithotripsy
  • Cyst drainage
  • Resection
  • Thorascopic Splanchectomy
39
Q

Who is most at risk of pancreatic carcinoma?

A

Westerners in their 60s-80s

40
Q

What are the risk factors for a pancreatic carcinoma?

A 
Smoking
Chronic Pancreatitis
FAP (Familial Adenomatous Polyposis)
Hereditary Pancreatitis
Adult onset diabetes of less than 2 yrs
41
Q

What types of pancreatic carcinoma are there?

A
  • Duct Cell Mucinous Adenocarcinoma - 75% of total (msot are in the head)
  • Carcinosarcoma
  • Cystadenocarcinoma
  • Acinar Cell
42
Q

Whats a cystadenocarcinoma?

A

Basically the malignancy forms a cyst containing retained secretions

43
Q

What are the common clinical features of pancreatic carcinoma?

A
  • Upper Abdominal pain
  • Painless, slow, obstuctive jaundice
  • Weight loss

Also loads of less common stuff like
Anorexia - Fatigue - Steatorrhea - vomiting/nausea - ascites - portal hypertension etc

44
Q

What signs would indicate an unresectable pancreatic carcinoma?

A 
Hepatomegaly
Jaundice
Abdominal mass/tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
45
Q

In what form of pancreatic carcinoma would you feel a palpable gall bladder?

A

An ampullary carcinoma (not technically of the pancreas but related)

46
Q

What investigations could we do for suspected pancreatic carcinoma?

A

(Assuming each test comes up +ve for mass/carcinoma etc this is the suggested progression)

1) Abdominal US +/- CT/EUS

If they’re jaundiced do an ERCP with stent.

2) Then Percutaneous needle biopsy
3) CT/EUS/Laparoscopy/Laparotomy to stage

Bloods, CXR and tumour marker tests are also possible

47
Q

How do we determine if someone is fit for surgery?

A
  • Recieve fully informed consent
  • CXR/ECG/Resp function tests
  • Performance status
48
Q

What surgeries are available for pancreatic carcinoma?

A
  • Pancreatoduodenectomy (whipples procedure)
  • Pylorus Preserving Pancreatic Duodenectomy (PPPD)
  • Stent or cholechoduodenostomy for jaundice
49
Q

How does the whipples procedure work?

A

You remove the duodenum and pylorus.

Then anastomose the stomach, bile duct and pancreas directly to the small intestine

50
Q

How does PPPD work?

A

Remove duodenum and diseased part of pancreas.

Then anastomose the pylorus, bile duct and pancreas directly to the small intestine

51
Q

What is a cholechoduodenostomy?

A

Surgical anastomoses of the bile duct straight to the duodenum

52
Q

What is the prognosis for Pancreatic Cancer??

A

Inoperable - <6months
Operable - 15% survive to 5 yrs

Only 10% are operable by presentation anyway

I.e. no fuckin sunshine an rainbows over here

R - Yr2 Alimentary (Liam Lennox) (37 decks)

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