Pancreatic Disease Flashcards
What is the main diagnostic investigation for acute pancreatitis?
Elevation of serum amylase
What are the symptoms of acute pancreatitis?
Upper abdominal pain that radiates to the back
Vomiting
Pyrexia
What are the signs of acute pancreatitis?
Hypoxic
Renal failure
Jaundice
Tachycardia
What is the pathology for acute pancreatitis?
Acute inflammation of the pancreas
Primary insult
Release of activated pancreatic enzymes resulting in auto-digestion
Leading to oedema, fat necrosis and haemorrhage
What is the aetiology for acute pancreatitis?
I GET SMASHED Idiopathic Gallstones Ethanol abuse Trauma Steroids Mumps virus Autoimmune diseases Scorpion Stings Hypertriglyceridemia & hypercalcaemia ERCP Drugs
What are the non-
radiological investigations for acute pancreatitis?
Amylase Lipase Arterial BG FBC: U&E's LFT's Glucose Lipids Coagulation screen
What are the radiological investigations for acute pancreatitis?
CT
AXR
USS
ERCP
What is the aetiology for chronic pancreatitis?
Males>females Middle aged Alcohol CF Hereditary pancreatitis Hypercalceamia
Describe the pathology of chronic pancreatitis
Continuing inflammatory disease of the pancreas
Irreversbile glandular destruction
Permanent loss of function
What are the symptoms of chronic pancreatitis?
Abdominal pain
Weight loss
Exorcrine insufficiency
Fat in poo
What are the signs of chronic pancreatitis?
Jaundice Portal hypertension Steatorrhoea Diabetes Decrease in Vitamin B12
Why could someone with chronic pancreatitis present with diabetes?
Loss of glandular function would mean their release of insulin and glucagon would be compromised
Why would someone with chronic pancreatitis present with steatorrhoea?
Their production and release of pancreatic lipase would be compromised
Therefore their ability to digest and absorb fat would be compromised
The fat would consequently not be absorbed and pass out at the other end
What is the treatment for acute pancreatitis?
Analgesia IV fluids Blood transfusion (hb<10g/dl) Monitor urine output NG tube Oxygen Insulin Rarely Ca supplements Nutrition in severe cases
Gallstones cause:
Cholecystectomy
What is the treatment for chronic pancreatitis?
Alcohol cessation Pancreatic enzyme supplements Nutritional support Coeliac plexus blocks Endoscopic treatment of pancreatic duct Surgery in selected cases
What are the non-radiological investigations for chronic pancreatitis?
Serum amylase
Albumin
LFT’s
What are the risk factors the pancreatic cancer?
Male >70 Smoking Obesity Chronic pancreatitis Liver cirrhosis DM
What is the most common type of cancer in the pancreas?
Adenocarcinoma
What are the symptoms of pancreatic carcinoma?
Mid-epigastric pain Nausea Fatigue Vomiting Weight loss Anorexia Steatorrhoea
What are the physical signs of pancreatic carcinoma?
Ascites Portal hypertension Hepato/splenomegaly Abdominal mass Supraclavicular lymphadenopathy Palpable galbladder Obstructive Jaundice
Where would a pancreatic tumour be likely obstructing if jaundice was a presenting sign?
Common bile duct
What are imaging techniques used for in pancreatic carcinoma?
Diagnosis and staging
What are the imaging techniques used for pancreatic carcinoma?
USS
CT
MRI
EUS
What is an alarm sign for pancreatic carcinoma?
Unintentional weight loss
Why does pancreatic cancer have such a poor prognosis?
Due to the fact it often presents as late disease
Often very asymptomatic
What is acute pancreatitis?
Acute inflammation of the pancreas
What is a major symptoms in AP?
Upper abdominalpain that radiates to the back
What is a major diagnostic signs of AP?
Elevation of serum amylase
Which procedure can provide a route for infection leading to AP?
ERCP
Recent endoscopy procedures
Which criteria is used to assess the severity of AP?
Glasgow criteria
What score is required with the glasgow criteria to have AP?
> 3
What is the criteria for WCC in the glasgow criteria?
> 15x10(9)
What is the treatment for AP
Analgesia - morphine IV fluids blood transfusion Monitor urine Naso-gastric tube Cholycystectomy (if gall stones are present) Oxygen May need insulin Sometimes Ca supplements Nutritional support
What are some complications of AP?
Abscess
Pseudocyst
How should a cyst in AP be treated?
With drainage
And with AB
What is chronic pancreatitis?
Continuing inflammatory disease of the pancreas
How is CP characterised?
By irreversible glandular destruction and typically causing pain and or permanent loss of function
What are the major aetiological factors for CP?
Alcohol CF Hereditary Hypercalcaemia Diet
What happens to ducts in CP?
Dilated, tortorous and strictured
What is presentation of CP?
Early disease is asymptomatic Abdo pain Weight loss Exocrine insufficiency Endocrine insufficiency Jaundice Portal hypertension GI haemorrhage
Why is diabetes present in 30% of those with CP?
Due to endocrine insufficiency
What investigations should be carried out in suspected in CP?
USS CT Amylase Albumin LFT's
What is the management for CP?
Avoid alcohol Pancreatic enzyme supplements Coelia plexus block Referral to pain clinic Low fat diet Insulin for DM
Is pancreatic cancer more common in M or F?
M
What is the presentation of pancreatic cancer?
Upper abdo pain Painless obstructive jaundice Weight loss Anorexia Vomiting Fatigue Recurrent bouts of pancreatitis Diarrhoea Tended subcutaneous fat nodules Ascites Portal hypertension
What are the signs of pancreatic cancer?
Hepatomegaly Jaundice Abdominal mass Abdominal tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder
What investigations should be done for pancreatic cancer?
CT MRI USS PET EUS
What is the treatment for pancreatic cancer?
Radical surgery
Palliation of jaundice
Pain control
Chemotherapy
What are risk factors or pancreatic cancer?
M >70yrs Smoking Obesity Alcohol Chronic pancreatitis Liver cirrhosis DM
What should be closely monitored in a patient with AP?
Pulse BP Urine output CVP Arterial Line
If cholelithiasis is the cause of AP what treatment should be undertake?
Cholecystectomy
If alcohol is the cause of AP what treatment should be given?
Abstinence and counselling
If hyperlipidaemia is the cause of AP what treatment should be given?
Diet control
Statins
If the patients medication is the cause of AP what should be done?
Medication should be stopped
Temporarily at least
Why do patients present with stearrohoea in pancreatic problems?
As there can be a pancreatic enzyme deficiency
PaO2 cut off Glasgow Criteria
<8kPa
Age risk in Glasgow criteria
> 55yrs
Calcium cut off Glasgow criteria
<2mmol/L
BG sugar cut off glasgow criteria
> 10mmol/L
Urea cut off glasgow criteria
> 16mmol/L
What is Grey Turner’s Sign
Flank bruising
What is Cullen’s Sign
Periumbilical bruising
What are grey turners and cullens signs of?
Acute pancreatitis
