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Digestive System > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

Pancreatic Disease Pancreatic Surgery

1
Q

what are the two most common causes of acute pancreatitis?

A

Gallstones

Alcohol

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2
Q

what is an important diagnostic sign in acute pancreatitis?

A

raised serum amylase

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3
Q

what are some of the less common causes of acute pancreatitis?

A 
idiopathic
trauma
drugs
viruses
auto-immune
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4
Q

what is the pathogenesis of acute pancreatitis?

A
  • insult on pancreas causes sudden release of pancreatic enzymes
  • enzymes cause inflammation, release of oxygen free radicals, necrosis, autodigestion
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5
Q

what are some of the possible symptoms of acute pancreatitis?

A 
tachycardia
tachypnoea
jaundice
paralytic ileus
abdominal pain, radiating to back
vomiting
shock
pyrexia
oliguria
kidney failure
effusions
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6
Q

how can acute pancreatitis be classified (ie mild, severe)? identify some of the criteria

A

Glasgow Pancreatitis Score >3

  • raised WCC
  • raised blood glucose
  • raised blood urea
  • low serum calcium
  • low serum albumin
  • low pO2
  • raised AST
  • raised LDH
  • raised CRP
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7
Q

what is the management of acute pancreatitis?

A

general: treat symptoms
specific: treat underlying cause

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8
Q

what are some examples of general management of acute pancreatitis?

A
  • analgesia
  • insulin for hyperglycaemia
  • albumin infusion
  • oxygen
  • IV fluids
  • monitor urine output
  • nutrition (enteral or parenteral)
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9
Q

what are some examples of specific management of acute pancreatitis?

A
  • if necrosis: CT guided aspiration, antibiotics and surgery

- if gallstones: ERCP/MRCP, cholecystectomy

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10
Q

what are the main diagnostic investigations for acute pancreatitis?

A
  • imaging: ERCP, USS, AXR, CXR, CT contrast

- bloods: FBC, U&E, pancreatic enzymes, glucose, calcium, ABG, urea

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11
Q

what are possible long-term complications which may present after acute pancreatitis?

A
  • abscess

- pseudocyst

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12
Q

which clinical features of acute pancreatitis would indicate the need for an ERCP?

A
  • jaundice

- obstructed bile duct

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13
Q

what is the main cause for chronic pancreatitis?

A

alcohol abuse

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14
Q

what are some of the less common causes for chronic pancreatitis?

A
  • autoimmune
  • obstruction of duct
  • cystic fibrosis
  • genetic abnormalities
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15
Q

what are the main symptoms of chronic pancreatitis?

A
  • abdominal pain (especially when eating fatty foods)
  • weight loss
  • steatorrhoea
  • malabsorption
  • diabetes
  • jaundice
  • portal hypertension
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16
Q

what is the management of chronic pancreatitis?

A
  • MDT management
  • pain management
  • alcohol counselling
  • pancreatic enzyme supplements
  • low fat diet
  • management of diabetes (insulin)
17
Q

what investigations should be done to diagnose chronic pancreatitis?

A
  • blood tests (pancreatic enzymes, glucose, calcium, LFT, albumin)
  • stool test: fecal elastase
  • imaging: AXR, USS, EUS, CT scan
18
Q

what are some of the pathogenic causes of chronic pancreatitis?

A
  • duct obstruction

- abnormal Sphincter of Oddi function

19
Q

what might show up on AXR in cases of chronic pancreatitis?

A

calcified pancreas due to calcified thickened secretions

20
Q

in which type of pancreatitis is serum amylase a useful diagnostic sign?

A

acute pancreatitis

21
Q

which type of pancreatic carcinoma is more likely to occur as a result of chronic pancreatitis?

A

pancreatic tumours in multiple sites

22
Q

what type of cancer is pancreatic carcinoma usually?

A

adenocarcinoma of duct cells

23
Q

what happens to the pancreatic duct during chronic pancreatitis?

A

it becomes tortuous and strictured

24
Q

which types of pancreatic cancer are most common?

A
  • cancer of head of pancreas

- mixed cancer in different areas of pancreas

25
Q

what are the main symptoms of pancreatic cancer?

A
  • abdominal pain, late onset
  • tiredness, fatigue, lethargy
  • weight loss
  • jaundice (painless)
  • supraclavicular lymphadenopathy
  • subcutaneous fat nodules
26
Q

when is jaundice a possible sign of cancer? which type of cancer is most likely the case?

A

obstructive jaundice WITH NO PAIN

sign of pancreatic cancer

27
Q

what investigations should be done to diagnose pancreatic cancer?

A
  • EUS
  • ultrasound
  • CT scan
  • MRI
28
Q

what are possible clinical signs of pancreatic cancer?

A
  • hepatomegaly
  • splenomegaly
  • portal hypertension
  • painless jaundice
  • abdominal mass
  • enlarged supraclavicular lymph nodes
29
Q

what is the management of pancreatic carcinoma?

A
  • if resectable: surgery (pancreatoduodenectomy)
  • often palliative, only 10% resectable
  • pain management
  • stenting for pancreatic/bile duct obstruction
  • palliative radiotherapy
30
Q

why is the prognosis for pancreatic carcinoma so low?

A

because symptoms normally present late

31
Q

how is pancreatic cancer diagnosed?

A

EUS and percutaneous needle biopsy

32
Q

what is the surgical procedure called for resectable pancreatic carcinoma?

A

Whipple’s procedure - pancreatoduodenectomy

33
Q

what is the average survival time for patients with non-resectable pancreatic cancer?

A

less than 6 months

1% survival over 5years

34
Q

what are two commonly performed operations to resect pancreatic cancer?

A

Whipple’s procedure

PPPD (pylorus preserving pancreaticoduodenectomy)

35
Q

which imaging test is most commonly used first line to assess acute pancreatitis?

A

CT scan

Digestive System (6 decks)

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