Pancreatic Disease Flashcards
Causes of Acute Pancreatitis? (11)
Idiopathic, Gallstones Ethanol (alcohol) Trauma Steroids Mumps Autoimmune Scorpio sting Hypercholesterolaemia/ hyperlipidaemia ERCP Drugs (Azathioprine, NSAIDs, Diuretics)
What happens when the pancreatic enzymes are activated in acute pancreatitis?
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.
Clinical features of acute pancreatitis? (4)
- LUQ/epigastric pain radiating to the back
- nausea/vomiting
- jaundice
- systemically unwell, fever
2 signs that can be seen in Acute Pancreatitis? Where are they found?
- Grey-Turners sign (flanks)
2. Cullen’s sign (periumbilical region)
Investigation for Acute pancreatitis? (TIP: remember Glasgow score)
- Bloods - FBC, LFTs, CRP, amylase/lipase, bone profile, ABG, U&E, blood glucose
- Imaging - CT Abdomen/Pelvis (shows complications), Abdo USS/MRCP (show gallstones)
How raised does the amylase/lipase be in Acute Pancreatitis? (X times above the upper limit)
3 times above the upper limit of normal
Which one is more reliable/specific for Acute Pancreatitis - amylase or lipase?
Lipase - remains elevated for longer, but is more expensive to do/ not available in all hospitals.
Mainstay of management of Acute pancreatitis? What does it include? (4)
Supportive:
- analgesia
- antiemetics
- IV fluids
- Catheterise (fluid balance)
When should Abx be given for Acute Pancreatitis?
Septic picture, pancreatic necrosis
How do gallstones cause Acute Pancreatitis?
Becomes occluded in the Ampulla of Vater, causing an obstruction for the drainage of pancreatic enzymes.
What can a CT scan show in Acute pancreatitis?
Mainly complications of pancreatitis (e.g. necrotic tissue, pseudocyst, fluid, abscess)
Management option if gallstones was found to be the cause of Acute Pancreatitis?
Laparoscopic Cholecystectomy, CBD clearance (ERCP) (+ the usual supportive management)
Local complications of Acute Pancreatitis? (2)
- Pancreatic Pseudocyst
2. Pancreatic necrosis
Systemic complications of Acute Pancreatitis? (5)
- ARDS
- DIC
- Sepsis
- Hypocalcaemia
- Hyperglycaemia
Causes of Chronic Pancreatitis? (6)
- Idiopathic
- Alcohol
- Malignancy
- Hyperlipidaemia
- Autoimmune pancreatitis
- High Ca2+
Clinical presentation of chronic pancreatitis?
- LUQ/epigastric pain radiating to the back. Worst lying down.
- nausea and vomitting
- Exocrine insufficiency - weight loss, cachexia, ssteatorhoea
- Endocrine insufficiency - impaired glucose regulation/ Type 3c diabetes
- Biliary obstruction/GOO due to pseudocyst
Investigations for Chronic Pancreatitis
- Bloods - FBC, CRP, ALP, bilirubin, GGT, Lipase/Amylase, Faecal Elastase, BM
- CT (or USS)- show atrophy, calcification, pseudocysts, malignancies, congenital abnormalities
How will these markers be in Chronic Pancreatitis?
- FBC
- CRP
- ALP, bilirubin, GGT
- Lipase/Amylase
- Faecal Elastase
- Blood glucose
- FBC = WBC raised if infection
- CRP = raised
- ALP, bilirubin, GGT = raised in obstruction (pseudocyst, pancreatic head tumour)
- Lipase/Amylase = often not raised in established disease
- Faecal Elastase = decreased
- Blood glucose = raised
Medical management of Chronic Pancreatitis (4)
- Pancreatic enzyme replacement (Pancreatin/Creon)
- Vitamin supplements (DAKE)
- Insulin
- Supportive - analgesia, antiemetics, alcohol/smoking cessation
Surgical management of Chronic Pancreatitis
- Pancreaticoduodenectomy (Whipples Procedure)
2. Pancreaticojejunostomy (Frey’s procedure)
Complication of Chronic Pancreatitis?
Pancreatic Cancer
Most common type of pancreatic cancer?
Ductal carcinoma of the pancreatic head
Pancreatic cancer can arise in the pancreatic head or the…?
Pancreatic body and tail
Clinical presentation of pancreatic cancer?
- weight loss, cachexia
- head: obstructive jaundice (Courvoisier’s law)
- body/tail: LUQ/epigastric pain
