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Medicine > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

Causes of pancreatitis

A

I idiopathic
G gallstones
E ethanol
T trauma
S steroid
M mumps
A autoimmune eg SLE
S scorpion sting
H hypercalcaemia, hypertriglyceridemia, hypothermia, hyperparathyroidism
E RCP
D drugs (azathioprine, mesalazine, didanosine, pentamidine, steroids, sodium valproate, NSAIDs, or Diuretics)

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2
Q

Clinical presentation of pancreatitis

A

Pain - Sudden onset, Mid-epigastric or LUQ, radiates to the back,worsens with movement, worsens on lying down, some patients find it is eased by taking the fetal position
N&V
Anorexia
Jaundice if gallstone aetiology

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3
Q

Pancreatitis signs

A

tender and distended abdomen with voluntary guarding
haemorraghic pancreatitis can result In bluish discolouration around the umbilicus (Cullen’s sign)
or the flank (Grey-Turner’s sign)
Diminished bowel sounds if an ileus has developed
Signs of Hypovolaemia
Signs of pleural effusion

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4
Q

Glasgow scale of Pancreatitis Severity (PANCREAS)

A 
PaO2< 7.9kPa
Age > 55 years
Neutrophils (WBC > 15)
Calcium < 2 mmol/L
Renal function: Urea > 16 mmol/L
Enzymes LDH > 600IU/L
Albumin < 32g/L (serum)
Sugar (blood glucose) > 10 mmol/L
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5
Q

To diagnose pancreatitis

A

characteristic pain and amylase/ lipase >3 times normal level

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6
Q

Pancreatitis Ix

A

Pulse oximetry
FBC- leukocytosis can indicate the presence of necrotising pancreatitis
Serum lipase or amylase
LFTS- Elevated ALT levels strongly suggest gallstones as the cause

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7
Q

Pancreatitis imaging Ix

A

US - gallstones
AXR -‘sentinal loop sign’ a dilated proximal bowel loop adjacent to the pancreas,calcifications
CXR- pleural effusion/ ARDS/lung ca
CT- diagnostic doubt or failure to improve, can show pancreatic oedema,pseudocysts,necrotizing pancreatitis

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8
Q

Pancreatitis Mx

A

Resuscitation with intravenous fluids
Supplemental oxygen
Pain relief
Abx if infection
Catheterisation to accurately monitor urine output and start a fluid balance chart
Early nutritional support & Nasogastric tube if patient is vomiting profusely
Antiemetic

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9
Q

Pancreatic infected necrosis Mx

A

radiological drainage or surgical necrosectomy

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10
Q

Pancreatitis differentials

A

Perforated peptic ulcer, bowel obstruction, or ischaemic bowel
Ruptured abdominal aortic aneurysm
Myocardial infarction
Biliary colic, acute cholecystitis, or cholangitis
Viral hepatitis
Gastroenteritis

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11
Q

Symptoms of exocrine insufficiency in chronic pancreatitis

A

Weight loss
diarrhoea
Malnutrition/malabsorption
Steatorrhoea

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12
Q

Type 3c (pancreatogenic) diabetes

A

due to endocrine insufficiency secondary to damage to the endocrine tissue the islet of langerhans resulting in failure to produce insulin
needs to be monitored long-term using annual HbA1c measurements

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13
Q

Chronic pancreatitis Ix

A

FBC,LFT,
Amylase may not rise bc pancreas has lost its ability to produce the enzyme
Blood glucose
Faecal elastase level- low in most cases of chronic pancreatitis with exocrine insufficiency

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14
Q

Chronic pancreatitis Imaging Ix

A

US
CT- more sensitive at detecting pancreatic calcification, detects pseudocysts

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15
Q

Chronic pancreatitis Mx

A

can only be managed definitively by treating any reversible underlying cause. This can include alcohol cessation or statin therapy for hyperlipidaemia

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16
Q

Chronic pancreatitis pain relief

A
  1. prescribe paracetamol or a nonsteroidal anti-inflammatory drug (NSAID), for example ibuprofen, first-line.
  2. weak opiod like codeine phosphate
17
Q

Chronic pancreatitis screening

A

Diabetes mellitus- Check serum HbA1c levels every 6 months
Osteoporosis- Offer a dual-energy X-ray absorptiometry (DXA) scan to assess bone density every 2 years

18
Q

Cx chronic pancreatitis

A

Carcinoma occurs in 2-3%
pain
Pseudocyst

19
Q

Pancreatic cancer histology

A

90% are adenocarcinomas of the head of the pancreas

20
Q

The World Health Organisation Performance Status classification

A

0 : able to carry out all normal activity
1: restricted in strenuous activity
2: up and about more than 50% of waking hours
3 : symptomatic and in a chair/bed for greater than 50% of the day but not bedridden
4 : completely disabled

21
Q

pancreatic cancer risk factors

A

Smoking
chronic pancreatitis
hereditary element
Late onset diabetes mellitus
age
Alcohol

22
Q

Courvoisier’s law

A

Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

23
Q

Pancreatic cancer clinical presentation

A

Painless obstructive jaundice
Unintentional weight loss
Pale stools
Steatorrhoea
Dark urine
Palpable mass in epigastric region
Upper Abdominal/back pain

24
Q

Pancreatic cancer clinical presentation

A

Painless obstructive jaundice
Unintentional weight loss
Pale stools
Steatorrhoea
Dark urine
Palpable mass in epigastric region
Upper Abdominal/back pain

25
Q

Pancreatic cancer Ix

A

FBC (anaemia or thrombocytopenia)
LFTs (raised bilirubin, alkaline phosphatase, and gamma-GT, showing an obstructive jaundice picture)
U&E
Clotting screen
Serum vitamin D
CA19-9 tumour marker blood test

26
Q

Pancreatic cancer imaging Ix

A

US- can show pancreatic mass or a dilated biliary tree,hepatic metastases and ascites
CT- dx and stages disease progression

27
Q

Double duct sign

A

Dilation of pancreatic duct and common bile duct on CT

28
Q

Whipple’s procedure

A

pancreaticoduodenectomy

29
Q

Pancreatic cancer typically metastasises to

A

liver, then to peritoneum, lungs and bones

30
Q

pancreatic cancer prognosis

A

5 year survival is 25% for early disease
Overall has a 5-year survival rate of less than 5%

31
Q

Insulinoma Whipple’s triad

A

symptomatic hypoglycaemia, glucose levels of 2.2 or lower and resolution of symptoms with glucose

32
Q

2ww referral pancreatic cancer

A

aged 40 years and over and have jaundice

33
Q

2ww CT/US for pancreatic cancer

A

people aged 60 years and over with weight loss and any of the following:
Diarrhoea.
Back pain.
Abdominal pain.
Nausea.
Vomiting.
Constipation.
New-onset diabetes.

Medicine (72 decks)

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