pancreatic disease

Question 1

acute panceatitis

Answer 1

acute inflammation of pancreas,
upper abdo pain,
elevation of serum amylase

Question 2

acute panceatitis: aetiology

Answer 2

alcohol abuse, 
gallstones, 
trauma,
drugs: steroids,
inc calcium,
auto-immune

Question 3

acute pancreatitis: pathogenesis

Answer 3

insult –> release of activated pancreatic enzymes –> autodigestion: oedema, fat necorsis, haemorrhage, pro-inflam cytokines

Question 4

acute pancreatitis: clinical features

Answer 4

abdo pain, 
vomiting, 
pyrexia, 
tachycardia, 
oliguia, AKI, 
jaundice, 
hypoxia, 
hypocalcaemia, 
hyperglycameia,
raised amylase, 
effusions

Question 5

acute pancreatitis: ERCP

Answer 5

endoscopic retrograde cholangio-pancreatography

Question 6

acute pancreatitis: Ix

Answer 6

bloods: amylase, FBC, U&Es, ABG, coag,
AXR + CXR,
abdo USS,
CT scan

Question 7

acute pancreatitis: severity scoring

Answer 7

glasgow criteria

Question 8

acute pancreatitis: general MX

Answer 8

analgesia, 
IV fluids, 
monitor UO (catheter), 
oxygen, 
?insulin, 
?blood transfusion

Question 9

acute pancreatitis: Mx if pancreatic necrosis

Answer 9

CT guided aspiration ,

antiboioics +/- surgery

Question 10

acute pancreatitis: Mx if gallstones

Answer 10

EUS/MRCP/ERCP,

cholecystectomy

Question 11

chronic pancreatitis

Answer 11

continuing inflammatory disease of pancreas characterised by irreversible glandular destruction –> pain and/or loss of funcion

Question 12

chronic pancreatitis: aetiology

Answer 12

alcohol
CF
hereditary
hypercalcaemia

Question 13

chronic pancreatitis: pathology

Answer 13

glandular atrophy and fibrosis,

dilated, tortous + strictured ducts,

Question 14

chronic pancreatitis: clinical features

Answer 14

abdo pain , 
weight loss, 
steatorrhoea, 
diabetes, 
jaundice, 
portal htn , 
GI bleed,

Question 15

chronic pancreatitis: ix

Answer 15

AXR,
USS, 
EUS, 
CT ,
amylase,

Question 16

chronic pancreatitis: Mx pain control

Answer 16

avoid alcohol,
enzme supplements,
opiate analhesia,
surgert?

Question 17

pancreatic cancer: histology

Answer 17

75% = duct cell mucinous adenocarcinoma

also,
carcinosarcoma, acinar cell, cystadenocarcinoma

Question 18

pancreatic cancer: clinical features

Answer 18

upper abdo pain, 
painless obstructive jaundice, 
weight loss, 
N+V, 
diarrhoea, 
fatigue, 
tender subcut fat noduels, 
ascites, 
portal htn

Question 19

pancreatic cancer: signs

Answer 19

hepatomegaly, 
jaundice, 
abdo mass,
abdo tenderness, 
ascites, 
splenomegaly, 
lymphadenopathy