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Gastrointestinal > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

Causes of Acute Pancreatitis? (11)

A 
Idiopathic, 
Gallstones 
Ethanol (alcohol) 
Trauma
Steroids 
Mumps 
Autoimmune
Scorpio sting 
Hypercholesterolaemia/ hyperlipidaemia 
ERCP 
Drugs (Azathioprine, NSAIDs, Diuretics)
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2
Q

What happens when the pancreatic enzymes are activated in acute pancreatitis?

A

Causes inflammation that increases vascular permeability, causing it to enter the systemic circulation. The enzymes causes a break down in blood vessels and fat cells, leading to haemorrhage and fatty necrosis, respectively.

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3
Q

Clinical features of acute pancreatitis? (4)

A
  1. LUQ/epigastric pain radiating to the back
  2. nausea/vomiting
  3. jaundice
  4. systemically unwell, fever
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4
Q

2 signs that can be seen in Acute Pancreatitis? Where are they found?

A
  1. Grey-Turners sign (flanks)

2. Cullen’s sign (periumbilical region)

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5
Q

Investigation for Acute pancreatitis? (TIP: remember Glasgow score)

A
  1. Bloods - FBC, LFTs, CRP, amylase/lipase, bone profile, ABG, U&E, blood glucose
  2. Imaging - CT Abdomen/Pelvis (shows complications), Abdo USS/MRCP (show gallstones)
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6
Q

How raised does the amylase/lipase be in Acute Pancreatitis? (X times above the upper limit)

A

3 times above the upper limit of normal

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7
Q

Which one is more reliable/specific for Acute Pancreatitis - amylase or lipase?

A

Lipase - remains elevated for longer, but is more expensive to do/ not available in all hospitals.

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8
Q

Mainstay of management of Acute pancreatitis? What does it include? (4)

A

Supportive:

  1. analgesia
  2. antiemetics
  3. IV fluids
  4. Catheterise (fluid balance)
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9
Q

When should Abx be given for Acute Pancreatitis?

A

Septic picture, pancreatic necrosis

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10
Q

How do gallstones cause Acute Pancreatitis?

A

Becomes occluded in the Ampulla of Vater, causing an obstruction for the drainage of pancreatic enzymes.

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11
Q

What can a CT scan show in Acute pancreatitis?

A

Mainly complications of pancreatitis (e.g. necrotic tissue, pseudocyst, fluid, abscess)

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12
Q

Management option if gallstones was found to be the cause of Acute Pancreatitis?

A

Laparoscopic Cholecystectomy, CBD clearance (ERCP) (+ the usual supportive management)

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13
Q

Local complications of Acute Pancreatitis? (2)

A
  1. Pancreatic Pseudocyst

2. Pancreatic necrosis

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14
Q

Systemic complications of Acute Pancreatitis? (5)

A
  1. ARDS
  2. DIC
  3. Sepsis
  4. Hypocalcaemia
  5. Hyperglycaemia
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15
Q

Causes of Chronic Pancreatitis? (6)

A
  1. Idiopathic
  2. Alcohol
  3. Malignancy
  4. Hyperlipidaemia
  5. Autoimmune pancreatitis
  6. High Ca2+
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16
Q

Clinical presentation of chronic pancreatitis?

A
  1. LUQ/epigastric pain radiating to the back. Worst lying down.
  2. nausea and vomitting
  3. Exocrine insufficiency - weight loss, cachexia, ssteatorhoea
  4. Endocrine insufficiency - impaired glucose regulation/ Type 3c diabetes
  5. Biliary obstruction/GOO due to pseudocyst
17
Q

Investigations for Chronic Pancreatitis

A
  1. Bloods - FBC, CRP, ALP, bilirubin, GGT, Lipase/Amylase, Faecal Elastase, BM
  2. CT (or USS)- show atrophy, calcification, pseudocysts, malignancies, congenital abnormalities
18
Q

How will these markers be in Chronic Pancreatitis?

  1. FBC
  2. CRP
  3. ALP, bilirubin, GGT
  4. Lipase/Amylase
  5. Faecal Elastase
  6. Blood glucose
A
  1. FBC = WBC raised if infection
  2. CRP = raised
  3. ALP, bilirubin, GGT = raised in obstruction (pseudocyst, pancreatic head tumour)
  4. Lipase/Amylase = often not raised in established disease
  5. Faecal Elastase = decreased
  6. Blood glucose = raised
19
Q

Medical management of Chronic Pancreatitis (4)

A
  1. Pancreatic enzyme replacement (Pancreatin/Creon)
  2. Vitamin supplements (DAKE)
  3. Insulin
  4. Supportive - analgesia, antiemetics, alcohol/smoking cessation
20
Q

Surgical management of Chronic Pancreatitis

A
  1. Pancreaticoduodenectomy (Whipples Procedure)

2. Pancreaticojejunostomy (Frey’s procedure)

21
Q

Complication of Chronic Pancreatitis?

A

Pancreatic Cancer

22
Q

Most common type of pancreatic cancer?

A

Ductal carcinoma of the pancreatic head

23
Q

Pancreatic cancer can arise in the pancreatic head or the…?

A

Pancreatic body and tail

24
Q

Clinical presentation of pancreatic cancer?

A
  • weight loss, cachexia
  • head: obstructive jaundice (Courvoisier’s law)
  • body/tail: LUQ/epigastric pain
25
Q

Risk factors of pancreatic cancer? (6)

A
  • late onset diabetes
  • smoking
  • alcohol
  • red meat
  • chronic pancreatitis
  • family history
26
Q

What is Courvoisier’s law?

A

Obstructive jaundice and palpable gallbladder is biliary/pancreatic cancer until proven otherwise

27
Q

What is Trousseau’s sign?

A

Migratory thrombophlebitis due to a hyper-coagulable state in Pancreatic cancer

28
Q

Investigations for pancreatic cancer

A

Bloods - FBC (anaemia, thrombocytopenia), LFTs (raised ALP, Bili, GGT)
Imaging - USS (pancreatic mass, dilate biliary tree), CT TAP (diagnosis and staging), PET (if CT inconclusive), EUS (biopsy)

29
Q

Definitive management for Pancreatic cancer (if resectable)? (2)

A
  1. Resection using Whipple’s procedure (pancreaticoduodenectomy) with regional lymphadenectomy.
  2. Adjuvant Chemo
30
Q

What is CA19-9 used for in Pancreatic cancer?

A

monitoring treatment

31
Q

Marker used to monitor Pancreatic cancer? (CA__ -_)

A

CA19-9

32
Q

What percentage of patients have a resectable pancreatic tumour at diagnosis?

A

20%

33
Q

Management of pancreatic cancer if non-resectable?

A
  • ERCP +/- Stent (Relieve jaundice/obstruction)
  • Pancreatic enzymes
  • Analgesia, anti-emetics
  • Palliative Chemo (FOLFIRINOX regime)
34
Q

What makes a pancreatic cancer non-resectable? (2)

A

Advanced disease or metastasis

35
Q

Which tumours are diagnosed earlier - head or body/tail?

A

Head (presents with obstructive symptoms)

Gastrointestinal (9 decks)

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