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Systems: Alimentary AB > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

Acute Pancreatitis

A

-Acute inflammation of the pancreas resulting in upper abdominal pain and elevation of serum amylase (>4x upper limit of normal) and can be associated with multi-organ failure in severe cases

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2
Q

What is the epidemiology of acute pancreatitis?

A
  • Incidence 20-300 cases/million

- Mortality 6-12/million

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3
Q

What is the aetiology of acute pancreatitis?

A
  • Alcohol abuse
  • Gallstones
  • Trauma
  • Miscellaneous
  • Idiopathic
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4
Q

What falls into the miscellaneaos category of acute pancreatitis aetiology?

A
  • Drugs (steroids, azathioprine, diuretics)
  • Viruses (mumps, coxsackie B4, HIV, CMV)
  • Pancreatic carcinoma
  • Metabolic (increased CA, increased triglycerides, decreased temp)
  • Auto-immune
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5
Q

What is the pathogenesis of acute pancreatitis?

A
  • Primary insult
  • Release of activated pancreatic enzymes
  • Autodigestion
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6
Q

What are the 2 pathways that can occur as a result of autodigestion?

A
  • Pro-inflammatory cytokines and reactive oxygen species

- Oedema, fat necrosis and haemorrhage

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7
Q

What are the clinical features of acute pancreatitis?

A
  • Abdominal pain
  • Vomiting
  • Pyrexia
  • Tachycardia, hypovolemic shock
  • Oliguria, acute renal failure
  • Jaundice
  • Paralytic ileus
  • Retroperitoneal haemorrhage
  • Hypoxia
  • Hypocalcaemia
  • Hyperglycaemia
  • Effusions
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8
Q

ERCP

A

Endoscopic retrograde cholangio-pancreatography

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9
Q

What blood tests should be carried out in acute pancreatitis?

A
  • Amylase, lipase
  • FBC
  • U+Es
  • LFTs
  • Ca
  • Glucose
  • ABG
  • Lipids
  • Coagulation screen
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10
Q

What X-rays should be carried out in acute pancreatitis?

A
  • Abdominal X-ray for ileus

- Chest X-ray for effusion

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11
Q

What are you looking for on an abdominal ultrasound in acute pancreatitis?

A
  • Pancreatic oedema
  • Gallstones
  • Pseudocysts
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12
Q

What type of CT should be carried out in acute pancreatitis?

A

Contrast enhanced

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13
Q

What criteria is used to assess the severity of acute pancreatitis?

A

Glasgow criteria

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14
Q

What indicates severe acute pancreatitis within 24hrs of admission?

A
  • Glasgow criteria score >3

- CRP>150mg/l

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15
Q

What are the points in the Glasgow criteria assessment?

A

-WCC >15x10^9/l
-Blood glucose >10mmol/l
-Blood urea>16mmol/l
-AST>200iu/l
-LDH>600iu/l
-Serum albumin <32g/l
-Serum calcium<2mmol/l
Arterial PO2 <7.5kPa

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16
Q

What is the general management for acute pancreatitis?

A
  • Analgesia
  • IV fluids
  • Blood transfusion if Hb<10g/dl
  • Monitor urine output
  • NG tube
  • Oxygen
  • Insulin if required
  • Nutrition-
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17
Q

What is the specific management of acute pancreatitis if there is pancreatic necrosis?

A
  • CT guided aspiration
  • Antibiotics
  • Surgery if required
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18
Q

What is the specific management of acute pancreatitis if there is gallstones?

A
  • EUS/MRCP/ERCP

- Cholecystectomy

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19
Q

What is the specific management of acute pancreatitis if there is an abscess?

A
  • Antibiotics

- Drainage

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20
Q

Pseudocyst

A

Fluid collection without an epithelial lining resulting in persistent hyperamylasaemia with or without pain

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21
Q

How is a pseudocyst diagnosed?

A
  • Ultrasound

- CT

22
Q

What are the complications of a pseudocyst?

A
  • Jaundice
  • Infection
  • Haemorrhage
  • Rupture
23
Q

When will a pseudocyst resolve spontaneously?

A

<6cm diameter

24
Q

What is the treatment for a pseudocyst if there is persistent pain or complications?

A
  • Endoscopic drainage

- Surgery

25
Q

What are the different outcomes of acute pancreatitis?

A
  • Mild AP mortality<2%
  • Severe AP mortality 15%
  • Subsequent course dependent on removal of aetiological factor
26
Q

Chronic pancreatitis

A

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

27
Q

What is the epidemiology of chronic pancreatitis?

A
  • M>F
  • Age 35-50 years
  • Incidence 3.5/100,000 per year
28
Q

What is the aetiology of chronic pancreatitis?

A
  • Alcohol
  • Cystic fibrosis
  • Congenital anatomical abnormalities
  • Hereditary pancreatitis (rare autoimmune dominant)
  • Hypercalcaemia
  • Diet
29
Q

What anatomical abnormalities can result in chronic pancreatitis?

A
  • Annular pancreas

- Pancreas divisum

30
Q

What genes are associated with chronic pancreatitis?

A
  • PRSS1
  • SPINK1
  • CFTR
31
Q

What is the pathogenesis of chronic pancreatitis?

A
  • Duct obstruction (calculi, inflammation, protein plugs)
  • Abnormal sphincter of Oddi function (spasm raising intrapancreatic pressure, relaxation causing reflux of duodenal contents)
  • Genetic polymorphisms (abnormal trypsin activation)
32
Q

What is the pathology of chronic pancreatitis?

A
  • Glandular atrophy and replacement by fibrous tissue
  • Ducts become dilated, tortous and strictured
  • Inspissated secretions may calcify
  • Exposed nerves due to loss of perineural cells
  • Splenic, superior mesenteric and portal veins may thrombose leading to portal hypertension
33
Q

What are the clinical features of chronic pancreatitis?

A
  • Early disease is asymptomatic
  • Abdominal pain
  • Weight loss
  • Exocrine insufficiency
  • Endocrine insufficiency
  • Jaundice
  • Portal hypertension
  • GI haemorrhage
  • Pseudocysts
  • Pancreatic carcinoma
34
Q

Describe the exocrine insufficiency in chronic pancreatitis.

A
  • Fat malabsorption leading steatorrhoea
  • Decrease in fat soluble vitamins
  • Decrease in Ca and Mg
  • Protein malabsorption leading weight loss and decrease in vitamin B12
35
Q

What does the endocrine insufficiency in chronic pancreatitis lead to ?

A

Diabetes

36
Q

What investigations should be carried out in chronic pancreatitis?

A
  • Plain AXR
  • Ultrasound
  • EUS
  • CT
  • Blood tests
  • Pancreatic function tests
37
Q

What may be found in blood tests of chronic pancreatitis?

A
  • Serum amylase increased in acute exacerbations
  • Decrease in albumin, Ca, Mg, vit B12
  • Increase in LFTs, prothrombin time, glucose
38
Q

What is involved in pain control management for chronic pancreatitis?

A
  • Avoid alcohol
  • Pancreatic enzyme supplements
  • Opiate analgesia
  • Celiac plexus block
  • Referral to pain clinic/psychologist
  • Endoscopic treatment of pancreatic duct stones and strictures
  • Surgery in selected cases
39
Q

What is involved in the management of the endocrine and exocrine problems associated with chronic pancreatitis?

A
  • Low fat diet
  • Pancreatic enzyme supplements (may need acid suppression to prevent hydrolysis in stomach)
  • Insulin for diabetes mellitus
40
Q

What is the prognosis for chronic pancreatitis?

A
  • Death from complications of acute on chronic attacks, cardiovascular complications of diabetes, associated cirrhosis, drug dependence, suicide
  • Continued alcohol intake 50% 10yr survival
  • Abstinence 80% 10yr survival
41
Q

What is the epidemiology of carcinomas of the pancreas?

A
  • Incidence 11/100,000 per year
  • M>F
  • More common in Western countries
42
Q

What are the pathological types of pancreatic carcinomas?

A
  • Duct cell mucinous adenocarcinomas
  • Carcinosarcoma
  • Cystadenocarcinoma
  • Acinar cell
43
Q

What are the clinical features of pancreatic carcinomas?

A
  • Upper abdominal pain
  • Painless obstructive jaundice
  • Weight loss
  • Anorexia, fatigue, diarrhoea/steatorrhoea, nausea, vomiting
  • Tender subcutaneous fat nodules
  • Thrombophlebitis migrans
  • Ascites, portal hypertension
44
Q

What are the physical signs of pancreatic carcinomas?

A

-Hepatomegaly
-Jaundice
-Abdominal mass
-Abdominal tenderness
-Ascites, splenomegaly
-Supraclavicular lymphadenopathy
PRESENCE OF ABOVE SIGNS USUALLY INDICATES AN DUNRESECTABLE TUMOUR
-Palpable gallbladder (with ampullary cancer)

45
Q

What imaging is used in pancreatic carcinomas?

A
  • USS
  • CT
  • MRI
  • EUS
46
Q

What are the management options for pancreatic carcinoma?

A
  • Radical surgery
  • Palliation of jaundice
  • Pain control
  • Chemotherapy only in controlled trials
47
Q

What is the radical surgery in pancreatic carcinoma?

A
  • Pancreatoduodenectomy (Whipple)

- Patient is fit, tumour <3cm, no metastases

48
Q

What is available for palliation of jaundice?

A
  • Stent

- palliative surgery (cholechoduodenotomy)

49
Q

What pain control is there for pancreatic carcinoma?

A
  • Opiates
  • Coeliac plexus block
  • Radiotherapy
50
Q

What is the prognosis for pancreatic carcinoma?

A
  • Inoperable cases mean survival <6months with 1% 5yr survival
  • Operable cases 15% 5yr survival

Systems: Alimentary AB (37 decks)

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