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GI System > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What does acute pancreatitis cause?

A

Abdominal pain with an elevated serum amylase

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2
Q

What is the incidence of acute pancreatitis?

A

Incidence 20-300 cases/million

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3
Q

What is the aetiology of acute pancreatitis?

A 
Alcohol abuse (60-75%)
Gallstones (25-40%)
Trauma
Idiopathic
Miscellaneous
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4
Q

What are the investigations for acute pancreatitis?

A 
Bloods
Glucose
Clotting
CXR
USS
CT
ABG
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5
Q

What range of CRP also indicates severe pancreatitis?

A

> 150mg/l

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6
Q

What does pancreatic necrosis lead to?

A

A CT guided aspiration resulting in antibiotics and possible surgery

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7
Q

What does gallstones result in?

A

EUS/MRCP/ERCP or Cholecystectomy

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8
Q

What are the possible complications of acute pancreatitis?

A

Abscess or Pseudocyst can lead to: Jaundice, Infection, Rupture & Haemorrhage

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9
Q

What precipitating factors of acute pancreatitis must be managed?

A 
Cholelithiasis 
Alcohol
Hyperlidpidaemia
Ischaemia
Malignancy
Anatomical abnormalities
Drugs
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10
Q

What are 80% of chronic pancreatitis associated with?

A

Alcohol

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11
Q

What are the aetiologies for chronic pancreatitis?

A 
CF
Diet
Congenital anatomical abnormalities
Hereditary pancreatitis
Hypercalcaemia
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12
Q

What is the pathogenesis of chronic pancreatitis?

A

Duct obstruction
Abnormal Sphincter of Oddi function
Genetic polymorphisms

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13
Q

What happens during chronic pancreatitis?

A

Glandular atrophy and replacement by fibrous tissue

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14
Q

What happens to ducts in chronic pancreatitis?

A

They become dilated, tortuous and strictured

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15
Q

How do nerves become exposed?

A

The loss of perineural cells

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16
Q

What veins may thrombose to cause portal hypertension?

A

Splenic vein
Superior mesenteric vein
Hepatic portal vein

17
Q

Is early disease symptomatic or asymptomatic and what percentage of cases see abdominal pain accompanied with weight loss?

A

Asymptomatic

85-95%

18
Q

What insufficiencies are seen in pancreatic disease?

A

Exocrine leading to steatorrhoea

Endocrine leading to diabetes in 30% of cases

19
Q

What investigations should be done for chronic pancreatitis?

A 
Plain AXR
Ultrasound
EUS
CT
Bloods - Amylase, LFTs, Glucose and Prothrombrin time
Pancreatic function tests
20
Q

What should be done to manage chronic pancreatitis?

A 
Alcohol abstinence
Pancreatic enzyme supplements
Opiate analgesia
Coeliac plexus block
Referral to pain clinic/psychologist
Endoscopic treatment of pancreatic duct stones and strictures
Surgery
21
Q

How is endocrine insufficiency managed?

A

Insulin for DM

22
Q

How is exocrine insufficiency managed?

A

Low fat diet

Pancreatic enzyme supplements

23
Q

What is the incidence rate for pancreatic cancer and which sex is it more common in?

A

11/100,000 pop/year

Males

24
Q

What types of pancreatic cancer are there?

A

Duct cell mucinous adenocarcinoma - 75% (60% of cases in the Head, 13% in the Body and 5% in the Tail)
Carcinosarcoma
Cystadenocarcinoma
Acinar cell

25
Q

What are the features of pancreatic cancer? (12)

A 
Upper abdominal pain (75%)
Painless obstructive jaundice
Weight loss (90%)
Anorexia
Fatigue
Diarrhoea/Steatorrhoea
Nausea
Vomiting
Ascites
Portal hypertension
Tender subcutaneous fat nodules
Thrombophlebitis migrans
26
Q

What are the signs of pancreatic cancer? (8)

A 
Hepatomegaly
Jaundice
Abdominal mass
Abdominal tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
Palpable gallbladder
*Top 7 signs indicate an unresectable tumour*
27
Q

What investigations should be done for pancreatic cancer?

A

CT/Ultrasound
Mass without jaundice leads to EUS/Percutaneous needle biopsy and if it is a carcinoma scans are done again to see whethere it is operable or not

28
Q

What is the management for pancreatic cancer?

A

For those with advanced disease

29
Q

What is percentage survival for inoperable cases and operable cases?

A

Inoperable cases mean survival is

GI System (38 decks)

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