Pancreatic Disease Flashcards
What does acute pancreatitis cause?
Abdominal pain with an elevated serum amylase
What is the incidence of acute pancreatitis?
Incidence 20-300 cases/million
What is the aetiology of acute pancreatitis?
Alcohol abuse (60-75%) Gallstones (25-40%) Trauma Idiopathic Miscellaneous
What are the investigations for acute pancreatitis?
Bloods Glucose Clotting CXR USS CT ABG
What range of CRP also indicates severe pancreatitis?
> 150mg/l
What does pancreatic necrosis lead to?
A CT guided aspiration resulting in antibiotics and possible surgery
What does gallstones result in?
EUS/MRCP/ERCP or Cholecystectomy
What are the possible complications of acute pancreatitis?
Abscess or Pseudocyst can lead to: Jaundice, Infection, Rupture & Haemorrhage
What precipitating factors of acute pancreatitis must be managed?
Cholelithiasis Alcohol Hyperlidpidaemia Ischaemia Malignancy Anatomical abnormalities Drugs
What are 80% of chronic pancreatitis associated with?
Alcohol
What are the aetiologies for chronic pancreatitis?
CF Diet Congenital anatomical abnormalities Hereditary pancreatitis Hypercalcaemia
What is the pathogenesis of chronic pancreatitis?
Duct obstruction
Abnormal Sphincter of Oddi function
Genetic polymorphisms
What happens during chronic pancreatitis?
Glandular atrophy and replacement by fibrous tissue
What happens to ducts in chronic pancreatitis?
They become dilated, tortuous and strictured
How do nerves become exposed?
The loss of perineural cells
What veins may thrombose to cause portal hypertension?
Splenic vein
Superior mesenteric vein
Hepatic portal vein
Is early disease symptomatic or asymptomatic and what percentage of cases see abdominal pain accompanied with weight loss?
Asymptomatic
85-95%
What insufficiencies are seen in pancreatic disease?
Exocrine leading to steatorrhoea
Endocrine leading to diabetes in 30% of cases
What investigations should be done for chronic pancreatitis?
Plain AXR Ultrasound EUS CT Bloods - Amylase, LFTs, Glucose and Prothrombrin time Pancreatic function tests
What should be done to manage chronic pancreatitis?
Alcohol abstinence Pancreatic enzyme supplements Opiate analgesia Coeliac plexus block Referral to pain clinic/psychologist Endoscopic treatment of pancreatic duct stones and strictures Surgery
How is endocrine insufficiency managed?
Insulin for DM
How is exocrine insufficiency managed?
Low fat diet
Pancreatic enzyme supplements
What is the incidence rate for pancreatic cancer and which sex is it more common in?
11/100,000 pop/year
Males
What types of pancreatic cancer are there?
Duct cell mucinous adenocarcinoma - 75% (60% of cases in the Head, 13% in the Body and 5% in the Tail)
Carcinosarcoma
Cystadenocarcinoma
Acinar cell
What are the features of pancreatic cancer? (12)
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
What are the signs of pancreatic cancer? (8)
Hepatomegaly Jaundice Abdominal mass Abdominal tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder *Top 7 signs indicate an unresectable tumour*
What investigations should be done for pancreatic cancer?
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
What is the management for pancreatic cancer?
For those with advanced disease
What is percentage survival for inoperable cases and operable cases?
Inoperable cases mean survival is
