pancreatic disease Flashcards
morphological abnormalities of the pancreas causes
congenital-pancreas divisum/ annular pancreas
trauma
inflammatory= pancreatitis
tumours
functional abnormalities of the pancreas
exocrine
endocrine
tumours names
exocrine insufficiency= chronic pancreatitis
endocrine= DM
functioning
tumours=insulinoma, gastrinoma
acronym for acute pancreatitis
I GET SMASHED idiopathic gallstones ethanol trauma/ ercp scorpion stings mumps autoimmune steroids hypertriglyceride/ca/thermia ERCP drugs
what drugs cause acute pancreatitis 4
steroids
- azathioprine
- mesalazine
- furosemide
in order 3 main causes of pancreatitis
- alcohol
- post ercp
- gallstones
presentation of acute pancreatitis
variable
- epigastric, umbilical pain=severe
- radiates to back
- vomiting
- fever and tachycardia
- organ failure
- jaundice and cholangitis
- Cullen sign
- grey turner sign
- ARDS
dx of acute pancreatitis
1st
- 3-4 times the elevated serum amylase
- lipase high
- lft
- uss
what is the autoantibody tested
IgG4
2nd and third line test for acute pancreatitis
secondary tests -lipid levels -calcium levels -viral titres -autoantibody -mrcp/ct third repeat uss endoscopic uss ercp sphincter of oddi manometry
diff dx of acute pancreatitis
biliary colic perforated peptic ulcer acute MI mesenteric iscaemia basal pneumonia
3 scales for acute pancreatitis
ranson
Glasgow
apache
prognosis worse for pancreatitis if
BMI>30 pleural effusion on cxr crp glucose >10 age>55
management of acute pancreatitis
fluid resuscitation analgesia nutrition - nil by mouth monitor early signs critical care support
surgery for acute pancreatitis
- cholecystectomy tend to wait 2 months but may be done if very ill
- necosectomy: MIRP minimally invasive retropancreatic necrosectomy to debride necrosis
complictions of acute pancreatitis
- fluid
- necrosis
- abscess
- pseudocyst
- obstruction
- renal fail/resp fail
- malnutrition
what causes early and late death in acute pancreatitis
early=multi-organ system failure
late=infected pancreatic necrosis
MODS means
multiple organ dysfunction syndrome
definition of chronic pancreatitis
continuing inflammatory disease of the pancreas with irreversible morhphological changes
- progressive
- irreversible
- necrosis and fibrosis
signs of chronic pancreatitis
anorexia chronic pain radiates to back nausea dn vomiting DM steatorrhoea malabsorption livedo reticularis on flank
management of chronic pancreatitis
nutritional morphology scans pancreatic function testing analgesia alcohol counselling
surgery for chronic pancreatitis
- Puestow’s lateral pancreatico-jejunostomy
- hepatico-jejunostomy
- whipple
- distal pancreatectomy
causes of chronic pancreatitis and acronym
TIGARO toxic-metabolic eg alcohol, calcium Idiopathic Genetic: hereditary pancreatitis cationic trypsinogen or CF Autoimmune Reccurent and severe acute Obstructive eg tumour/ congenital
what are frey and beger procedure
frey=take out parts of diseased head
beger=pancreatic head and duodenum
most common pancreatic tumour
pancreatic ductal adenocarcinoma 80%
