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Alimentary Clinical medicine > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

what is the basic pathophysiology of acute pancreatitis?

A

primary injury to pancreas causes release of pancreatic enzymes
this causes autodigestion
results in release of pro inflammatory cytokines and reactive 02 species
also fat necrosis, oedema and haemorrhage

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2
Q

what are the causes/aetiology of pancreatitis?

A 
alcohol
gallstones
trauma - blunt, post op, post-ERCP
drugs i.e. steroids
viruses i.e. CMV and mumps
autoimmune 
pancreatic carcinoma 
metabolic i.e. hypercalcaemia, hypertriglyceride, hypothermia)
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3
Q

what are the main symptoms of acute pancreatitis?

A

abdominal pain (may radiate to the back)
nausea/vomiting
collapse
dehydration

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4
Q

what can some people with acute pancreatitis present with? (clinical signs)

A 
abdominal tenderness
painful jaundice 
pyrexia 
hypocalcaemia/hypertriglyceride
oliguria - acute renal failure 
retroperitoneal haemorrhage 
effusions - ascites and pleural, with high amylase 
circulatory failure
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5
Q

what investigations are used for detecting acute pancreatitis?

A 
blood tests: 
FBC, U&E's, ABG, amylase, CRP, coagulation screen, Ca, lipids
ERCP 
EUSS
abdominal US (for ascites)
CXR for pleural effusions/mets if cancer
CT scan
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6
Q

what are the basic treatments for patients with acute pancreatitis?

A 
analgesia 
02
iv fluids
blood transfusion
calcium supplements if hypocalcaemia 
may need insulin if hypoglycaemic 
nutrition in severe cases
monitor urine output
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7
Q

what main investigations are required and the treatment for acute pancreatitis with fat necrosis?

A

CT guided aspiration
Antibiotics
surgery

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8
Q

what are the main investigations and treatment for acute pancreatitis caused by gallstones?

A

ERCP/MRCP/EUS

cholecystectomy

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9
Q

why may a blood transfusion be required in someone with acute pancreatitis?

A

their Hb can fall <10g/dl

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10
Q

what criteria is used for measuring the severity of acute pancreatitis?

A

modified glasgow criteria

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11
Q

in the glasgow criteria, what indicates severe acute pancreatitis?

A

a score > or equal to 3

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12
Q

apart from a glasgow score above 3, what other indication is severe pancreatitis?

A

CRP >150mg/l

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13
Q

when investigating acute pancreatitis, why is a coagulation screen carried out?

A

disseminated inter vascular coagulation can occur as a result of acute pancreatitis

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14
Q

what individual markers may be used for indicating severity of acute pancreatitis?

A

CXR
CRP
IL 6
TAP

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15
Q

wat are the complications of acute pancreatitis?

A

pancreatic pseudocyst
pancreatic abscess
pancreatic necrosis

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16
Q

what are the complications of a pseudocyst as complication of acute pancreatitis?

A

haemorrhage
infection
jaundice
rupture

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17
Q

what is the prognosis for mild and severe acute pancreatitis?

A

mild AP - mortality <2%

severe AP - mortality 15%

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18
Q

what is the treatment for a pseudocyst?

A

endoscopic drainage

19
Q

what is the pathophysiology of chronic pancreatitis?

A

continuing inflammation of the pancreas
irreversible glandular destruction
glandular atrophy
causes pain and permanent loss of function
ducts become dilated, tortuous and stricture

20
Q

what sex is chronic pancreatitis most common in and what age group?

A

males > female

age 35-50

21
Q

what is the aetiology of chronic pancreatitis?

A 
Obstruction;
- tumour
- sphincter of oddi dysfcuntion
- pancreatic divisum
- duodenal diverticulum
Autoimmune
Toxins
- alcohol
- drugs
- ethanol
Idiopathic
Genetic
- PRSS1
- SPINK1
- CFTR
Environmental
- tropical CP
Recurrent injury
- billiary
- hypercalcaemia
- hyperlipidaemia
22
Q

what is the clinical presentation of chronic pancreatitis?

A

most present asymptomatic

abdominal pain
weight loss
exocrine insuffiency - steattorhoea, protein malabsorption
endocrine insufficiency - iabetes
jaundice
upper GI haemorrhage
Portal hypertension
duodenal obstruction
pancreatic carcinoma
pseuodcysts
23
Q

what blood tests are carried out to diagnose chronic pancreatitis?

A

blood tests:
increase in amylase, Ca, Mg, Vit B12
decrease in LFT’s, INR, glucose
pancreatic function tests

24
Q

apart from blood tests what other investigations are carried out for diagnosing chronic pancreatitis?

A 
Abdominal XR
CT scan
MRCP/ERCP
EUSS
faecal elastase test
pancreolauryl test
25
Q

what genes are associated with chronic pancreatitis?

A

CFTR
SPINK1
PRSS1

26
Q

what is the treatment for exocrine insufficiency due to chronic pancreatitis?

A

avoid high fat, high protein diet

pancreatic enzyme supplement i.e. creon, pancrex

27
Q

when is surgery for chronic pancreatitis considered?

A 
suspect malignancy 
intractable pain 
complications i.e.
- pseudocysts
- SM vein, splenic vein and portal vein thrombosis
- gastric varices
- biliary tract obstruction
- duodenal stenosis
- pancreatic duct stenosis
- colonic stricture
28
Q

what are the surgical options for treatment of pancreatic duct stenosis and obstruction due to chronic pancreatitis?

A

lithotripsy
dilatation
endoscopic pancreatic duct sphincetorotomy

29
Q

what are the different procedures for resection of the pancreas?

A

whipple
freys procedure
PPPD
DPPHR (beger)

30
Q

what is the prognosis of chronic pancreatitis?

A

mortality 50% over 20-25yrs

20% die of complications

31
Q

what sex and age group is pancreatic carcinoma most common in?

A

males > females

most common in 60-80yrs

32
Q

what are the different pathological types of pancreatic carcinomas?

A

duct cell mutinous adenocarcinoma
carcinosarcoma
cystadenocarcinoma
acinar cell

33
Q

what are the risk factors for pancreatic carcinoma?

A

smoking
chronic pancreatitis
hereditary pancreatitis
inherited predisposition

34
Q

what condition is periampullary cancer associated with?

A

FAP

35
Q

what are the clinical features of pancreatic carcinoma?

A 
painless obstructive jaundice
abdominal/back pain
weight loss
anoreia
vomiting
diarrhoea
steattorhoea 
recurrent blunts of pancreatitis
36
Q

what are some of the physical signs of pancreatic carcinoma?

A 
hepatomegaly
splenomegaly
abdominal mass
jaundice
ascites
supraclavicular lymphadenopathy
tender subcutaneous fat nodules
portal hypertension
thrombophlebitis migrant
37
Q

what investigations are carried out to diagnose pancreatic cancer?

A 
EUSS
CT/MRI
MRCP/ERCP
percutaneous needle biopsy
CXR
38
Q

what tumour marker is tested for pancreatic carcinoma?

A

CA 19-9

39
Q

WHAT SIZE DOES THE TUMOUR HAVE TO BE IN ORDER TO BE OPERATABLE?

A

< 3cm

40
Q

what is the prognosis of inoperable and operable pancreatic cancer?

A

5yr survival 1%

5yr survival 15% (operable)

41
Q

what are the different treatments for pancreatic cancer?

A 
pain control
chemotherapy
radio frequency ablation
palliative bypass/stent 
surgery
42
Q

what 2 surgical procedures are used for treating pancreatic cancer?

A

whipple

pylorus preserving pancreas duodectomy

43
Q

if there is duodenal obstruction in someone with pancreatic cancer, how is this treated?

A

palliative bypass or duodenal stent

44
Q

what are the procedure options for treating chronic pancreatitis ?

A

obstruction - endoscopic PD sphincterotomy, lithotripsy, stenting/bypass
drainage - Puestows, PD sphincteroplasty
resection- PPPD, DPPHR (Begers), Freys, Whipple

Alimentary Clinical medicine (23 decks)

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