Pancreatic Disease Flashcards
What is acute pancreatitis?
Inflammation of the pancreas
What are the causes of acute pancreatitis?
Alcohol abuse Gallstones Idiopathic Trauma Drugs (steroids, diuretics, azathioprine)
What are the symptoms of acute pancreatitis?
Upper abdominal pain
Jaundice
Sudden onset
Grey Turner’s/ Cullen’s signs
What are the clinical signs of acute pancreatitis?
Elevated serum amylase levels
What are the investigations used to diagnose acute pancreatitis?
Bloods
AXR and CXR
Abdominal ultrasound
CT
How is the severity of acute pancreatitis accessed?
Glasgow criteria, score above 3 is considered severe
What is the general management strategy for acute pancreatitis?
Analgesia Oxygen Naso gastric tube IV fluids Blood transfusion Monitor urine output May need insulin
What is the management of acute pancreatitis caused by pancreatic necrosis?
CT guided aspiration followed by antibiotics and surgery
What is the management of acute pancreatitis caused by gallstones?
EUS/MRCP/ERCP
Cholecystectomy
What is the management of acute pancreatitis caused by abscess?
Antibiotics and drainage
What is a pseudocyst?
Fluid collection without an epithelial lining
What is the clinical sign of a pseudocyst?
Persistent hyperamylasaemia and/or pain
How is a pseudocyst diagnosed?
Ultrasound or CT
What are the complications of a pseudocyst?
Jaundice
Infection
Haemorrhage
Rupture
What is the treatment for a pseudocyst?
Endoscopic drainage or surgery
What is chronic pancreatitis?
Continuing inflammation of pancreas by irreversible glandular destruction, typically causing pain and permanent loss of function
What are the causes of chronic pancreatitis?
Alcohol
Cystic fibrosis
Hereditary pancreatitis
Hypercalcaemia
What is the pathogenesis of chronic pancreatitis?
Duct obstruction (calculi, inflammation, protein plugs) Abnormal sphincter of Oddi function Genetic polymorphism
What is the pathology of chronic pancreatitis?
Glandular atrophy and replacement by fibrous tissue
Ducts become dilated, tortuous and strictured
Inspissated secretions may calcify
Splenic, superior mesenteric and portal veins may thrombose
What are the clinical features of chronic pancreatitis?
Abdominal pain Weight loss Steatorrhoea Jaundice Portal hypertension GI haemorrhage
What are the investigations for chronic pancreatitis?
AXR Ultrasound EUS CT Bloods Pancreatic function tests
What is the management of chronic pancreatitis?
Avoid alcohol Opiate analgesia Coeliac plexus block Pancreatic enzyme supplements Surgery in selected cases
What is the endocrine/exocrine management of chronic pancreatitis?
Low fat diet
Pancreatic enzyme supplements
Vitamin supplements
Insulin for diabetes
What is the most common carcinoma of the pancreas?
Duct cell mucinous adenocarcinoma
