Pancreatic disease Flashcards
What is acute pancreatitis?
Acute inflammation of the pancreas causing upper abdomen pain and elevation of serum amylase
What is the aetiology of acute pancreatitis?
Mainly alcohol abuse Gallstones Trauma Drugs, viruses, pancreatic carcinoma, metabolic, autoimmune Idiopathic
What forms of trauma can cause acute pancreatitis?
Blunt
Post op
Post ERCP
What is the pathogenesis of acute pancreatitis?
Primary insult causes release of pancreatic enzymes, causing auto digestion and inflammation
What does the endocrine portion of the pancreas cause in acute pancreatitis?
Oedema
Fat necrosis
Haemorrhage
What does the exocrine portion of the pancreas secrete during acute pancreatitis?
Pro inflammatory cytokines
Reactive oxygen species
What are the clinical features of acute pancreatitis?
Abdo pain Vomiting Pyrexia Tachycardia Oliguria Jaundice Laralytic ileus Retroperitoneal haemorrhage Hypoxia Hypocalcaemia Hyperglycaemia Effusions
Where may effusions occur in acute pancreatitis?
Ascitic and pleural
What investigations are carried out for acute pancreatitis?
Blood tests AXR CXR Abdo ultrasound Contrast enhanced CT
What blood tests are run for acute pancreatitis?
Amylase/lipase FBC U+E LFT Ca Glucose ABG Lipids Coagulation screen
What does a CXR look for in acute pancreatitis?
Pleural effusion
What does an abdominal ultrasound look for in acute pancreatitis?
Pancreatic oedema
Gallstones
Psudocyst
How is acute pancreatitis managed generally?
Analgesia IV fluids Blood transfusion Monitor urine output Nasogastric tube O2 May require- insulin, Ca supplements, nutritional support
How is pancreatic necrosis in acute pancreatitis managed?
Investigate with CT guided aspiration
Treat with antibiotics and possible surgery
How are gallstones in acute pancreatitis managed?
Investigate with endoscopic ultrasound/MRCP/ERCP
Treat with cholecystectomy
What are the complications of acute pancreatitis?
Abscess
Psuedocyst
How is an bless as a result of acute pancreatitis treated?
Antibiotics and drainage
How is a psuedocyst as a result of acute pancreatitis managed?
Ultrasound/CT
Endoscopic drainage
Surgery if persistent pain or complications
What are the complications of a pseudocyst?
Jaundice
Infection
Haemorrhage
Rupture
What is the prognosis of acute pancreatitis?
Mild- mortality 2%
Severe- mortality 15%
What is chronic pancreatitis?
Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function
What is the cause of pancreatitis?
Alcohol Cystic fibrosis Congenital anatomical abnormalities Hereditary pancreatitis Hypercalcaemia Diet
What are the major effects of chronic pancreatitis?
Duct obstruction
Abnormal sphincter of Oddi
Genetic polymorphisms
How ar the ducts obstructed in pancreatitis?
Caluculi
Inflammation
Protein plugs
How does the sphincter of Oddi function change in chronic pancreatitis?
Spasm causes increase in pancreatic pressure
Relaxation causes reflux of duodenal contents
What is the pathology of pancreatitis?
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
What are the clinical features of chronic pancreatitis?
Abdo pain Weight loss Steatorrhoea Decrease in Ca, Mg and vit A, D, E, K Jaundice Portal hypertension GI haemorrhage Psuedocysts Pancreatic carcinoma
What are the features of abdominal pain in chronic pancreatitis?
Exacerbated by food and alcohol
Severity decreases with time
What can exocrine insufficiency in chronic pancreatitis cause?
Diabetes in 30%
What investigations are carried out for chronic pancreatitis?
AXR Ultrasound Endoscopic ultrasound CT Blood tests Pancreatic function tests
What does an AXR look for in chronic pancreatitis?
Calcification of pancreas
What does an ultrasound look for in chronic pancreatitis?
Pancreatic size
Cysts
Duct diameter
Tumours
What do blood test results look like in chronic pancreatitis?
Serum amylase increased in acute exacerbations
Decreased albumin, Ca, Mg, vit B12
Increases LFTs, prothrombin time, glucose
How is chronic pancreatitis managed?
Pain control
Low fat diet
Pancreatic enzyme supplements
How is pain control achieved in chronic pancreatitis?
Avoid alcohol Opiate analgesia Celiac plexus block Referral to pain clinic Endoscopic treatment of pancreatic duct stones and strictures Surgery in selected cases
What is the prognosis for chronic pancreatitis?
Death from acute exacerbations Cardiovascular complications of diabetes Associated cirrhosis Drug dependence Suicide
What are the types of pancreatic cancer?
Duct cell mutinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell carcinoma
What are the clinical features of pancreatic cancer?
Upper abdo pain Painless obstructive jaundice Weight loss Anorexia, fatigue, diarrhoea, steatorrhoea, nausea, vomiting Tender subcutaneous fat nodules Thrombophlebitis migrant Ascites, portal hypertension
What are the physical signs of pancreatic cancer?
Hpatomegaly Jaundice Adbo mass and tenderness Ascites, splenomegaly SUpraclavicular, lymphadenopathy Palpable gallbladder
What investigations are carried out for pancreatic cancer?
Abdo ultrasound
CT
Endoscopic ultrasound
