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Alimentary System > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What are examples of pancreatic disease?

A

Acute pancreatitis

Chronic pancreatitis

Pancreatic cancer

Neuroendocrine tumours

Cystic fibrosis

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2
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas

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3
Q

Where is the pain usually due to acute pancreatitis?

A

Upper abdominal pain

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4
Q

How does acute pancreatitis change serum levels of amylase?

A

Elevation of serum amylase (4x upper limit of normal)

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5
Q

What can acute pancreatitis be associated with in severe cases?

A

Multi-organ failure

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6
Q

What is the incidence of acute pancreatitis?

A

20-300 cases/million

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7
Q

What is the mortality of acute pancreatitis?

A

6-12/million

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8
Q

What is the aetiology of acute pancreatitis?

A

Alcohol abuse (60-75%)

Gallstones (25-40%)

Trauma (blunt/postoperative/post ERCO)

Miscellaneous (drugs, viruses, pancreatic carcinoma, metabolic, autoimmune)

Idiopathic (about 10%)

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9
Q

What are examples of drugs that can cause acute pancreatitis?

A

Steroids

Azathioprine

Diuretics

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10
Q

What are examples of viruses that can cause acute pancreatitis?

A

Mumps

Coxsackie B4

HIV

CMV

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11
Q

What are metabolic changes that can cause acute pancreatitis?

A

Increased calcium

Increased triaglycerides

Decreased temperature

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12
Q

Explain the pathogenesis of acute pancreatitis?

A

1) Primary insult
2) Release of activated pancreatic enzymes
3) Autodigestion causing pro-inflammatory cytokines, reactive oxygen species, oedema, fat necrosis and haemorrhage

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13
Q

What are the clinical features of acute pancreatitis?

A

Abdominal pain

Vomiting

Pyrexia

Tachycardia

Oliguria

Jaundice

Paralytic ileus

Retroperitoneal haemorrhage

Hypoxia (respiratory failure in most severe cases)

Hypocalcaemia

Hyperglycaemia (occsaionally diabetic coma)

Effusions

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14
Q

What is paralytic ileus?

A

Obstruction of the intestine due to paralysis of the intestinal muscles

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15
Q

What is oligouria?

A

Urine output less than:

1mL/kg/h in infants

0.5mL/kg/h in children

400ml or 500ml per 24 hours in adults

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16
Q

What is strange about ERCP and acute panceatitis?

A

ERCP is a cause and a treatment of acute pancreatitis

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17
Q

What investigations are done for acute pancreatitis?

A

Blood tests

Abdominal and chest x-ray

Abdominal ultrasound

CT scan (contrast enhanced)

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18
Q

What is being looked for in an abdominal ultrasound for acute pancreatitis?

A

Pancreatic oedema

Gallstones

Pseudocyst

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19
Q

What blood tests are done for acute pancreatitis?

A

Amylase

Lipase

FBC

LFTs

Calcium

Glucose

Arterial blood gases

Lipids

Coagulation screen

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20
Q

What is used to assess the severity of acute pancreatitis?

A

Glasgow criteria

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21
Q

Using the glasgow criteria, what is considered to be severe pancreatitis?

A

A score of 3 or more

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22
Q

What is the white cell count for the glasgow criteria?

A

> 15 x 109/L

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23
Q

What is the blood glucose for the glasgow criteria?

A

> 10mmol/L

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24
Q

What is the blood urea for the glasgow criteria?

A

> 16mmol/L

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25
Q

What is the AST for the glasgow criteria?

A

> 200iu/L

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26
Q

What is the LDH for the glasgow criteria?

A

> 600iu/L

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27
Q

What is the serum albumin for the glasgow criteria?

A

<32g/L

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28
Q

What is the serum calcium for the glasgow criteria?

A

<2mmol/L

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29
Q

What is the arterial PO2 for the glasgow criteria?

A

<7.5kPa

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30
Q

What is assessed with the glasgow criteria?

A

White cell count

Blood glucose

Blood urea

AST

LDH

Serum albumin

Serum calcium

Arterial PO2

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31
Q

What is LDH?

A

Lactate dehydrogenase

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32
Q

What does CRP stand for?

A

C-reactive protein

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33
Q

What is another indicator for severe pancreatitis that is not included in the Glasgow criteria?

A

CRP>150mg/L

34
Q

What is the general management for acute pancreatitis?

A

Analgesia

IV fluids

Blood transfusion (Hb<10g/dL)

Monitor urine output (catheter)

Naso-gastric tube

Oxygen

May need insulin

Rarely required calcium supplements

Nutrition (enteral or parenteal) in severe cases

35
Q

What is the specific management for acute pancreatitis if pancreatitic necrosis is occuring?

A

CT guided aspiration

Antibiotics and surgery

36
Q

What is the specific management for acute pancreatitis if gallstones are present?

A

EUS/MRCP/ERCP

Cholecystectomy

37
Q

What are possible complications of acute pancreatitis?

A

Abscess

Pseudocyst

38
Q

What is chronic pancreatitis?

A

Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function

39
Q

What is the prevalence of chronic pancreatitis?

A

Annual incidence of 5- 8 cases
per 100 000 adults
Prevalence of 42-73 cases
per 100 000 adults in the United States.

NHS Grampian ~675 patients

40
Q

where in the world is the highest prevalence of chronic pancreatitis

A

Prevalence rates varying from
36-125 per 100000 population have been reported from Japan, China, and India.

India has the highest prevalence.

41
Q

How does the incidence of chronic pancreatitis compared between males and females?

A

men>women

42
Q

What age group is chronic pancreatitis most common in?

A

30-40

43
Q

What is the aetiology of chronic pancreatitis?

A

Alcohol (80%)
Cystic Fibrosis (CP in 2%)
high frequency of CFTR gene mutations in CP
Congenital anatomical abnormalities
Annular pancreas
Pancreas divisum (failed fusion of dorsal & ventral buds)
Hereditary pancreatitis: rare, autosomal dominant.
Hypercalcaemia
Diet: ?antioxidants ↓ in tropical pancreatitis

44
Q

What are examples of congenital anatomical abnormalities that can cause chronic pancreatitis?

A

Annular pancreas

Pancreas divisum (failed fusion of dorsal & ventral buds)

45
Q

Is hereditary pancreatitis dominant or rescessive?

A

dominant

46
Q

What genes are associated with pancreatitis?

A

PRSS1

SPINK1, CTRC, CASR, and CFTR

47
Q

What are clinical features of chronic pancreatitis?

A

abdominal pain

exocrine and endocrine insufficiency

48
Q

What are abdominal pains due to chronic pancreatitis exacerbated by?

A

Pain in the upper belly that spreads into the back. Pain in the belly that gets worse when you eat or drink alcohol.

49
Q

How does the severity of abdominal pain due to chronic pancreatitis change with time?

A

As chronic pancreatitis progresses, the painful episodes may become more frequent and severe. Although the pain sometimes occurs after eating a meal, there’s often no trigger. Eventually, a constant mild to moderate pain can develop in the abdomen in between episodes of severe pain.

50
Q

What are consequences of weight loss due to chronic pancreatitis?

A

loss of apetite
malnutrition

51
Q

What are consequences of exocrine insufficiency due to chronic pancreatitis?

A

People with EPI don’t have enough pancreatic (digestive) enzymes to break down foods and absorb nutrients. It can lead to malnutrition

52
Q

What is a consequence of endocrine insufficiency due to chronic pancreatitis?

A

impairment of the endocrine function of the pancreas will eventually result in pancreatogenic diabetes (Type 3c diabetes).

reduction in the number of islets of Langerhans, reduced β cells, islet architecture disruption, sclerosis, and amyloid deposit

53
Q

What is steatorrhoea?

A

The definition of steatorrhea is an increase in fat excretion in the stools. Steatorrhea is one of the clinical features of fat malabsorption and noted in many conditions such as exocrine pancreatic insufficiency (EPI), celiac disease, and tropical sprue.

54
Q

What investigations are done by chronic pancreatitis?

A

contrast enhanced CT imaging

MRI with magnetic resonence cholangiopancreatography

endoscopic ultrasound imaging

clinical history assessing risk factors

55
Q

What is being checked in ultrasounds for chronic pancreatitis?

A

If characteristic parenchymal or pancreatic ductal changes found

56
Q

What can be seen in blood tests for chronic pancreatitis?

A

high amylase and lipase levels—digestive enzymes made in your pancreas

high blood glucose, also called blood sugar

high levels of blood fats, called lipids

signs of infection or inflammation of the bile ducts, pancreas, gallbladder, or liver

pancreatic cancer

Stool tests. Your doctor may test a stool sample to find out if a person has fat malabsorption.

57
Q

What does management of chronic pancreatitis involve?

A

medical management
if adequate pain releif is not acheived or there are ductal obstructions from stones or strictures then

endoscopic or surgical management

58
Q

what are pancreatic cysts

A

saclike pockets of fluid on or in your pancreas

59
Q

what has contributed to an increasing detection rate for pancreatic cystic lesions

A

The growing use of cross-sectional imaging modalities such as CT and MRI combined with an ageing population has contributed to an increasing detection rate for pancreatic cystic lesions (PCLs)

60
Q

types of pancreatic cystic lesions

A

SCN - serous cystic neoplasm
IPMN - side branch type
MCN - mucinous cystic neoplasm
Pseudocyst with debris

61
Q

SCN - serous cystic neoplasm

A

Pancreatic serous cystic neoplasms (SCNs) originate from cuboidal epithelial cells full of glycogen-rich components, and are the only benign tumors of the pancreas, accounting for 10-16% of pancreatic cystic neoplasms

62
Q

IPMN

A

Branch duct type (BD-IPMN): These are tumors in smaller ducts that branch out from your main duct. These tumors are usually benign (noncancerous).

63
Q

MCN

A

Mucinous cystic neoplasm (MCN) is an uncommon cystic tumor of pancreas, accounting for about 10% of pancreatic cystic lesions. It occurs almost exclusively in women (male-to-female ratio, 1:9–20), with age at diagnosis being 40 and 60 years. Most such tumors are located in the pancreatic body and tail (93%–95%).

64
Q

epithelial neoplastic cystic lesions of the pancreas

A

intraductal papillary mucinous neoplasms

mucinous cystic neoplasms

serous cystic neoplasms

65
Q

epithelial non-neoplastic cystic lesion types

A

mucinous non-neoplastic cyst….

66
Q

non-epithelial neoplastic

A

benign non epithelial neoplasms (lymphangloma)
malignant non-epithelial neoplasms

67
Q

non epithlial non-neoplastic

A

pancreatitis associated pseudocyst

parasitic cyst

68
Q

what investigations are carried out for pancreatic cysts

A

CT/MRI/MRCP imaging

69
Q

what is done if the CT/MRI/MRCP shows any high risk features

A

urgent HPB and MDT discussion leading to surgery or aspiration and contrast

70
Q

what high risk features could be shown by a patient with a pancreatic cyst

A

jaundice
main PD >10mm
enhancing nodule >5mm within cyst

pancreatitis
main PD>5mm
thick cyst wall
cyst size>30mm
abrupt changed to PD caliber and cyst growth

71
Q

In Radiology for PCLs how accurate is a CT

A

40-81% accuracy

72
Q

In Radiology for PCLs how accurate is a MRI

A

40 - 95% accuracy

MRI preferred method

73
Q

what is the role of endoscopic ultrasound for pancreatic cysts

A

EUS-FNA improves diagnostic accuracy, Mucinous vs non-mucinous, Benign vs. Malignant

Combined analysis of Cyst fluid CEA (> 192, 52-78%, 63-91%), Lipase and cytology –highest accuracy

EUS –FNA should only be performed if it would change management.

Contrast Enhanced-EUS (SONOVUE) is superior : Mural nodules, vascularity, septations

74
Q

what biomarkers are tested for from cyst aspiration

A

DNA markers – GNAS, KRAS
RNA or other protein markers not useful
Carcino Embrionic Antigen (CEA)
Amylase - <250

75
Q

what are clinical features of a pancreatic carcinoma

A

Upper abdominal pain (75%) - Ca body & tail
Painless obstructive jaundice (25%) - Ca head
Weight loss (90%)
Anorexia, fatigue, diarrhoea / steatorrhoea, nausea, vomiting
Tender subcutaneous fat nodules (like erythema nodosum) due to metastatic fat necrosis
Thrombophlebitis migrans
Ascites, portal hypertension

76
Q

what are the investigations carried out following a CT or MRI scan for pancreatic carcinoma

A

most inoperable following staging, clinical trials available endoscopic ultrasound and biopsy

main concern to relive symptoms

77
Q

if a patient is presenting with jaundice and a pancreatic carcinoma that is inoperable what is done

A

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts.

while obtaining biopsy can be done - metal stent can be placed for releif of jaundice

can have radio frequency ablation

78
Q

what is radio frequency ablation

A

Radiofrequency ablation (RFA) uses high-energy radio waves for treatment. A thin, needle-like probe is put through the skin and into the tumor. Placement of the probe is guided by ultrasound or CT scans. The tip of the probe releases a high-frequency electric current which heats the tumor and destroys the cancer cells

after that a metal stent is put in place

79
Q

what can happen to the celiac plexus as a result of pancreatic cancer

A

Cancerous tumors can put pressure on the celiac plexus, causing pain. People with chronic pancreatitis may also need a celiac plexus block to alleviate severe upper abdominal pain or back pain

80
Q

what is a EUS guided coeliac plexus block

A

pass the celiac plexus,
neurolysis needle to the area
of the celiac plexus or the
celiac ganglion,
and then either perform a
blog by just using local
anesthetic and steroid,
or if the pain is severe,
we can also use steroid
And in addition,
100% absolute alcohol to destroy these
neuro fibers
Thereby, improving the pain
in this group of patients.

Alimentary System (44 decks)

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