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GI AM > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas causing upper abdomen pain and elevation of serum amylase

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2
Q

What is the aetiology of acute pancreatitis?

A 
Mainly alcohol abuse
Gallstones
Trauma
Drugs, viruses, pancreatic carcinoma, metabolic, autoimmune
Idiopathic
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3
Q

What forms of trauma can cause acute pancreatitis?

A

Blunt
Post op
Post ERCP

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4
Q

What is the pathogenesis of acute pancreatitis?

A

Primary insult causes release of pancreatic enzymes, causing auto digestion and inflammation

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5
Q

What does the endocrine portion of the pancreas cause in acute pancreatitis?

A

Oedema
Fat necrosis
Haemorrhage

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6
Q

What does the exocrine portion of the pancreas secrete during acute pancreatitis?

A

Pro inflammatory cytokines

Reactive oxygen species

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7
Q

What are the clinical features of acute pancreatitis?

A 
Abdo pain
Vomiting
Pyrexia
Tachycardia
Oliguria
Jaundice
Laralytic ileus
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hyperglycaemia
Effusions
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8
Q

Where may effusions occur in acute pancreatitis?

A

Ascitic and pleural

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9
Q

What investigations are carried out for acute pancreatitis?

A 
Blood tests
AXR
CXR
Abdo ultrasound
Contrast enhanced CT
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10
Q

What blood tests are run for acute pancreatitis?

A 
Amylase/lipase
FBC
U+E
LFT
Ca
Glucose
ABG
Lipids
Coagulation screen
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11
Q

What does a CXR look for in acute pancreatitis?

A

Pleural effusion

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12
Q

What does an abdominal ultrasound look for in acute pancreatitis?

A

Pancreatic oedema
Gallstones
Psudocyst

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13
Q

How is acute pancreatitis managed generally?

A 
Analgesia
IV fluids
Blood transfusion
Monitor urine output
Nasogastric tube
O2
May require- insulin, Ca supplements, nutritional support
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14
Q

How is pancreatic necrosis in acute pancreatitis managed?

A

Investigate with CT guided aspiration

Treat with antibiotics and possible surgery

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15
Q

How are gallstones in acute pancreatitis managed?

A

Investigate with endoscopic ultrasound/MRCP/ERCP

Treat with cholecystectomy

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16
Q

What are the complications of acute pancreatitis?

A

Abscess

Psuedocyst

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17
Q

How is an bless as a result of acute pancreatitis treated?

A

Antibiotics and drainage

18
Q

How is a psuedocyst as a result of acute pancreatitis managed?

A

Ultrasound/CT
Endoscopic drainage
Surgery if persistent pain or complications

19
Q

What are the complications of a pseudocyst?

A

Jaundice
Infection
Haemorrhage
Rupture

20
Q

What is the prognosis of acute pancreatitis?

A

Mild- mortality 2%

Severe- mortality 15%

21
Q

What is chronic pancreatitis?

A

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

22
Q

What is the cause of pancreatitis?

A 
Alcohol
Cystic fibrosis
Congenital anatomical abnormalities
Hereditary pancreatitis
Hypercalcaemia
Diet
23
Q

What are the major effects of chronic pancreatitis?

A

Duct obstruction
Abnormal sphincter of Oddi
Genetic polymorphisms

24
Q

How ar the ducts obstructed in pancreatitis?

A

Caluculi
Inflammation
Protein plugs

25
Q

How does the sphincter of Oddi function change in chronic pancreatitis?

A

Spasm causes increase in pancreatic pressure

Relaxation causes reflux of duodenal contents

26
Q

What is the pathology of pancreatitis?

A

Glandular atrophy and replacement by fibrous tissue
Ducts become dilated, tortuous and structured
Inspissated secretions may calcify
Exposed nerves due to perineural loss
Splenic, s mesenteric and portal veins may thrombus

27
Q

What are the clinical features of chronic pancreatitis?

A 
Abdo pain
Weight loss
Steatorrhoea
Decrease in Ca, Mg and vit A, D, E, K
Jaundice
Portal hypertension
GI haemorrhage
Psuedocysts
Pancreatic carcinoma
28
Q

What are the features of abdominal pain in chronic pancreatitis?

A

Exacerbated by food and alcohol

Severity decreases with time

29
Q

What can exocrine insufficiency in chronic pancreatitis cause?

A

Diabetes in 30%

30
Q

What investigations are carried out for chronic pancreatitis?

A 
AXR
Ultrasound
Endoscopic ultrasound
CT
Blood tests
Pancreatic function tests
31
Q

What does an AXR look for in chronic pancreatitis?

A

Calcification of pancreas

32
Q

What does an ultrasound look for in chronic pancreatitis?

A

Pancreatic size
Cysts
Duct diameter
Tumours

33
Q

What do blood test results look like in chronic pancreatitis?

A

Serum amylase increased in acute exacerbations
Decreased albumin, Ca, Mg, vit B12
Increases LFTs, prothrombin time, glucose

34
Q

How is chronic pancreatitis managed?

A

Pain control
Low fat diet
Pancreatic enzyme supplements

35
Q

How is pain control achieved in chronic pancreatitis?

A 
Avoid alcohol
Opiate analgesia
Celiac plexus block
Referral to pain clinic
Endoscopic treatment of pancreatic duct stones and strictures
Surgery in selected cases
36
Q

What is the prognosis for chronic pancreatitis?

A 
Death from acute exacerbations
Cardiovascular complications of diabetes
Associated cirrhosis
Drug dependence
Suicide
37
Q

What are the types of pancreatic cancer?

A

Duct cell mutinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell carcinoma

38
Q

What are the clinical features of pancreatic cancer?

A 
Upper abdo pain
Painless obstructive jaundice
Weight loss
Anorexia, fatigue, diarrhoea, steatorrhoea, nausea, vomiting
Tender subcutaneous fat nodules
Thrombophlebitis migrant
Ascites, portal hypertension
39
Q

What are the physical signs of pancreatic cancer?

A 
Hpatomegaly
Jaundice
Adbo mass and tenderness
Ascites, splenomegaly
SUpraclavicular, lymphadenopathy
Palpable gallbladder
40
Q

What investigations are carried out for pancreatic cancer?

A

Abdo ultrasound
CT
Endoscopic ultrasound

GI AM (34 decks)

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