Pancreatic disease Flashcards
Define acute pancreatitis
The acute inflammation of the pancreas which may be associated with multi-organ failure
What are the main causes of acute pancreatitis?
alcohol
gallstones
trauma, infection, post op, drugs, autoimmune, carcinoma, idiopathic
Is it the exocrine or endocrine part associated with acute pancreatitis?
exocrine
What is the brief pathology behind acute pancreatitis?
insult to the pancreas leading to enzyme release from the pancreas - autodigestion - leading to oedema, fat necrosis, haemorrhage
What are some clinical features of AP?
abdominal pain radiating to the back, vomiting, fever, tachycardia, jaundice, retroperitoneal haemorrhage
What do EUS look for in AP?
gallstones not picked up by CT
What blood tests are useful in AP?
serum amylase, FBC, U+E, LFTs
What imaging techniques are useful in AP?
contrast enhanced CT, abdominal ultrasound, AXR, CXR
What is the contraindication of contrast enhanced CT in AP?
many patients also have renal disease
What is important to assess in AP before treating?
severity
A score over what in the Glasgow criteria suggests severe pancreatitis?
3
A CRP over what mg indicates severe pancreatitis?
150mg
What are some things taken into consideration for the Glasgow criteria?
white cell count, blood glucose, blood urea, AST, albumin and arterial PO2
general management for AP?
analgesia, IV fluids, blood transfusion, NG tube, catheter to monitor urine output, oxygen, insulin
Management for pancreatic necrosis in AP?
antibiotics, drainage - CT guided aspiration, surgery
Management for gallstones in AP?
EUS/MRCP/ERCP
Cholecystectomy
Complications of AP?
abscess, pseudocyst
What is a pseudocyst?
fluid collection without an epithelial lining
define chronic pancreatitis
continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function
What are some causes of chronic pancreatitis?
alcohol, CF due to CFTR mutation, congenital, diet
What are the 3 pathologies leading to chronic pancreatitis?
duct obstruction - gallstone
sphincter of oddi function abnormal
genetic polymorphisms
Describe the pathology of chronic pancreatitis
glandular atrophy and fibrous replacement
ducts strictured and calcified secretions
exposed nerves and portal hypertension
Symptoms of chronic pancreatitis
abdominal pain, vomiting, weight loss, diabetes due to endocrine in-sufficiency, steathorrea
What investigations for chronic pancreatitis and explain what used for
AXR - calcification of pancreas
US - size, cysts, ducts, tumours
EUS, CT, blood for amylase, albumin, LFT
Pain management of chronic pancreatitis
alcohol avoidance, pancreatic enzyme supplements, celiac plexus block, endoscopy, surgery
Exocrine and endocrine management of chronic pancreatitis
low fat diet, pancreatic enzyme supplements, control diabetes
prognosis for CP?
better if alcohol is stopped
usually if they die its from complications
Epidemiology of pancreatic cancer
males, 60-80 yrs, 11/1000000 pa
What are 75% of pancreatic cancers?
duct cell mucinous adenocarcinoma
What part of the pancreas are most tumours?
head
clinical features of pancreatic cancer
abdominal pain, weight loss, jaundice, ascites, steathorrea
Physical signs of pancreatic ca.
hepatomegaly, splenomegaly, jaundice, supraclavicular lymphadenopathy, palpable gallbladder, tender mass
Imaging for cancer
USS, CT, MRI, EUS
Investigations for cancer?
ERCP with a stent if jaundice and mass
biopsy by needle aspiration
Management for cancer
stent, pancreatoduodenectomy, palliate jaundice, chemotherapy and pain control
prognosis for pancreatic cancer?
bad
<1% 5YS most die in 6 months although if operable 15% 5YS
