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Alimentary System: Pathology SA > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What is the definition of acute pancreatitis

A

Acute inflammation of the pancreas

Recognised as upper abdominal epigastric pain occurring with no warning sign

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2
Q

What is the biomarker for acute pancreatitis

A

Elevated serum amylase levels (>4)

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3
Q

What may acute pancreatitis be associated with in severe cases

A

Multi organ failure

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4
Q

What is the aetiology of acute pancreatitis

A

Alcohol Abuse

Gall Stones

Trauma: Blunt/postoperative/post
ERCP

Drugs (Steroids, azathioprine, diuretics)

Viruses

Pancreatic carcinoma

Metabolic changes:
Increased Calcium
Increased Triglycerides
Decreased Temperature

Autoimmune

Idiopathic

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5
Q

What is the pathogenesis of acute pancreatitis

A

Primary insult happens to the pancreas, affecting the exocrine portion, this causes the release of activated pancreatic enzymes resulting in autodigestion to occur

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6
Q

What are the outcomes of auto digestion due to acute pancreatitis

A 
Pro-inflammatory cytokines 
Reactive oxygen species 
Oedema 
Fat necrosis 
Haemorrhage
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7
Q

What is the symptoms of acute pancreatitis

A

Abdominal pain

Vomiting

Significant bruising

Pyrexia

Jaundice

Tachycardia

Olguria (small amount of urine - due to renal failure)

Hypoxia - extreme case

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8
Q

What are the imaging techniques used for the diagnosis of acute pancreatitis

A

ERCP

Endoscopic ultrasound

Abdominal X ray

Chest X ray

Abdominal Ultrasound

CT scan (contrast enhanced)

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9
Q

What is the blood tests in the investigation of acute pancreatis

A 
amylase/lipase
FBC, 
U&Es, 
LFTs, 
Ca2+, (Hypocalcaemia)
glucose, (Hyperglycaemia)
arterial blood gases,
lipids, coagulation screen
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10
Q

How is the Severity of acute pancreatitis determined

A 
If have a score >3 of the following:
White cell count >15 x 109/l
Blood glucose >10 mmol/l
Blood urea >16mmol/l
AST >200 iu/l
LDH >600 iu/l
Serum albumin <32 g/l
Serum calcium <2.0 mmol/l
Arterial PO2 <7.5 kPa
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11
Q

What is the general management of acute pancreatitis

A

Analgesia (pethidine, indomethacin)

Intravenous fluids

Blood transfusion

Monitor urine output (catheter)

Naso-gastric tube

Oxygen

May require:
insulin
calcium supplements
Nutrition

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12
Q

How is pancreatic necrosis investigated and how is it managed

A

CT guided aspiration

antibiotics and surgery

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13
Q

What are two complications of acute pancreatitis

A

Abscess
Pseudocyst
(Fluid collection without an epithelial lining resulting in Hyperamylasaemia and pain)

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14
Q

How is the complication of an abscess managed in acute pancreitis

A

antibiotics and drainage

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15
Q

What is further complications caused by pseudocyst

A

Jaundice
Infection
Haemorrhage
Rupture

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16
Q

How is a pseudocyst diagnosed from acute pancreatitis

A

CT

Ultrasound

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17
Q

What is the management of Pseudocyst in acute pancreatitis

A

<6cm resolve spontaneous

Endoscopic drainage
or

Surgery due to pain or complications

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18
Q

What is the prognosis of acute pancreatitis and what does it depend upon

A

Mild AP mortality <2%

Severe AP - mortality 15%

Subsequent
course dependent on removal of aetiological factor(s)

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19
Q

What is the definition of chronic pancreatitis

A

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

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20
Q

What is the aetiology of chronic pancreatitis

A

Alcohol

CF

Congenital anatomical abnormalities:

  • annular pancreas
  • Pancrease divsum

Hereditary pancreatitis

Hypercalcaemia

Diet

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21
Q

What is annular pancreas and how does it result in

A

Caused by the second part of the duodenum being surrounded by a ring of pancreatic tissue continuous with the head of the pancreas.

This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines

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22
Q

What is pancreas divisum

A

single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts which have failed to fuse together

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23
Q

What are the 3 susceptibility genes associated with pancreatisis

A

PRSS1 – cationic trypsinogen,

SPINK1 – pancreatic secretory trypsin inhibitor,

CFTR – cystic fibrosis transmembrane conductance regulator

24
Q

What genes can be diagnose through testing for pancreatitis

A

PRSS1

CFTR- through sweat test

25
Q

What kind of gene is PRSS1

A

Autosomal dominant

with high penetrance

26
Q

What kind of gene is SPINK1

A

Disease modifying rather than disease causing

with high frequency and low penetrance

27
Q

What are the 3 pathogenesiis of chronic pancreatitis

A

Duct obstruction

Abnormal spinchter of Oddi Function

Genetic polymorphisms - abnormal trypsin activation

28
Q

What are three factors that can cause duct obstruction

A

Calculi (gallstones)

Inflammation

Protein Plugs

29
Q

What is two abnormal spinchter of Oddi functions

A

Spasms - Increasing intrapancreatic pressure

Relaxation - resulting in reflux of duodenal contents

30
Q

What is the pathology of Chronic pancreatitis

A
  1. Glandular atrophy & replacement by fibrous tissue
  2. Ducts become dilated, tortous & strictured
  3. Thicken secretions may calcify
31
Q

What is the symptoms of chronic pancreatitis

A

Early stage - asymptomatic

Abdominal pain

Weight loss

steatorrhea

Malabsorption

Diabetes

32
Q

What exasberates abdominal pain in chronic pancreatitis

A

alcohol
food

(severity decreases with time)

33
Q

What is the result of exocrine insufficiency in chronic pancreatitis

A

Fat malabsorption:
stearrohea
Decrease fat soluble vitamins (A,D,E,K)
Decrease Ca2+/Mg2+

Protein malabsorption:
Weight loss
Decreased Vitamin B 12

34
Q

What is the affect of endocrine insufficiency caused by

A

Diabetes

35
Q

What is the further complications caused by chronic pancreatitis

A

Jaundice

Portal Hypertension
-Splenic , superior mesenteric & portal veins may thrombose

GI haemorrhage,

pseudocysts,

pancreatic carcinoma

36
Q

What is the imaging techniques sued for the investigations for chronic pancreatitis

A

Abdominal Xray
Ultrasound
Endoscopic Ultrasound
CT scan

37
Q

What does a ultrasound show you in the investigation of chronic pancreatitis

A

pancreatic size,
cysts,
duct diameter, tumours

38
Q

What Do the Blood tests show in the investigation of chronic pancreatitis

A

Increased:
LFT
Prothrombin time/INR
glucose

Decreased; albumin, Ca2+/Mg2, Vitamin B12 +

39
Q

What is increases in acute exasperations of chronic pancreatitis

A

Serum amylase

40
Q

What is the name of the two pancreatic function tests

A

Lundh: Low trypsin levels

pancreolauryl

Both see if exocrine portion is functioning

41
Q

How is pain controlled in the management of chronic pancreatitis

A

Avoid alcohol

Opiate analgesia (dihydrocodeine, pethidine)

Celiac plexus blocks (injections of pain medication)

Endoscopic treatment of pancreatic duct stones and strictures

Surgery

42
Q

How is Exocrine insufficiency managed in chronic pancreatitis

A

Low-fat diet

Pancreatic enzyme supplements (eg. Creon, Pancrex)

43
Q

How is

endocrine insufficiency managed in chronic pancreatitis

A

Insulin

44
Q

What improves the prognosis of chronic pancreatitis

A

Abstinence from alcohol

45
Q

What is the pathological cell type of carcinoma of the pancreas

A

75% duct cell mutinous adenocarcinoma

carcinosarcoma
cystadenocarcinoma
Acinar cell

46
Q

What pathological cell type has the best prognosis

A

cystadenocarcinoma

47
Q

What is the specific symptoms of carcinoma of the pancrease if located in the body and tail

A

Upper adominal pain

48
Q

What is the specific symptom of carcinoma of the pancrease if located just in the head

A

Painless obstructive jaundice

49
Q

What is the overall symptoms of carcinoma of the pancreas

A 
Upper abdominal pain 
Weight loss 
anorexia 
fatigue
diarrhoea/steatorrhoea 
Nausea/vomiting
50
Q

What is the physical signs of carcinoma of the pancreas

A

Tender subcutaneous fat nodules

Thrombophlebitis migrans (vessels inflammation due to blood clot)

Hepatomegaly
Portal hypertension

Jaundice

Abdominal mass/tenderness

ascites

splenomegally

supravicular lymphadenopathy

palpable gallbladder

51
Q

What are the imaging techniques used for the investigations for carcinoma of the pancreas

A

Ultrasound scan
CT
MRI
Endoscopic US

52
Q

What is the management of carcinoma of the pancreas

A

Only <10% operable at advanced disease

Surgery:
Pancreatoduodenectomy
(whipples procedure)

Palliation of Jaundice

pain control

Chemotherapy

53
Q

When can surgery occur in carcinoma of the pancreas

A

If patient is fit
Tumour is <3cm
No metastases

54
Q

What happens in palliation of jaundice in carcinoma of pancreas

A

stent

cholechoduodenostomy (surgical formation of a communication between the common bile duct and the duodenum)

55
Q

What is examples of pain control given in carcinoma of the pancrease

A

opiates,

Celiac plexus blocks, radiotherapy

56
Q

What improves your prognosis in carcinoma of the pancreas

A

If its operable 15% 5 year survival compared to 1% 5 year survival

57
Q

Define ampullary tumour

A

rare malignant tumor originating at the ampulla of Vater, in the last centimeter of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla.
Patients typically present with symptoms related to biliary obstruction

Prognosis 30-50% 5 year survival

Alimentary System: Pathology SA (27 decks)

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