pancreatic disease

Question 1

morphological abnormalities of the pancreas causes

Answer 1

congenital-pancreas divisum/ annular pancreas
trauma
inflammatory= pancreatitis
tumours

Question 2

functional abnormalities of the pancreas
exocrine
endocrine
tumours names

Answer 2

exocrine insufficiency= chronic pancreatitis

endocrine= DM
functioning

tumours=insulinoma, gastrinoma

Question 3

acronym for acute pancreatitis

Answer 3

I GET SMASHED
idiopathic 
gallstones
ethanol
trauma/ ercp 
scorpion stings
mumps
autoimmune
steroids
hypertriglyceride/ca/thermia
ERCP
drugs

Question 4

what drugs cause acute pancreatitis 4

Answer 4

steroids

• azathioprine
• mesalazine
• furosemide

Question 5

in order 3 main causes of pancreatitis

Answer 5

1. alcohol
2. post ercp
3. gallstones

Question 6

presentation of acute pancreatitis

Answer 6

variable

• epigastric, umbilical pain=severe
• radiates to back
• vomiting
• fever and tachycardia
• organ failure
• jaundice and cholangitis
• Cullen sign
• grey turner sign
• ARDS

Question 7

dx of acute pancreatitis

1st

Answer 7

• 3-4 times the elevated serum amylase
• lipase high
• lft
• uss

Question 8

what is the autoantibody tested

Answer 8

IgG4

Question 9

2nd and third line test for acute pancreatitis

Answer 9

secondary tests
-lipid levels
-calcium levels
-viral titres
-autoantibody 
-mrcp/ct
third
repeat uss
endoscopic uss
ercp
sphincter of oddi manometry

Question 10

diff dx of acute pancreatitis

Answer 10

biliary colic
perforated peptic ulcer
acute MI
mesenteric iscaemia
basal pneumonia

Question 11

3 scales for acute pancreatitis

Answer 11

ranson
Glasgow
apache

Question 12

prognosis worse for pancreatitis if

Answer 12

BMI>30
pleural effusion on cxr
crp
glucose >10
age>55

Question 13

management of acute pancreatitis

Answer 13

fluid resuscitation
analgesia
nutrition 
- nil by mouth 
monitor early signs
critical care support

Question 14

surgery for acute pancreatitis

Answer 14

• cholecystectomy tend to wait 2 months but may be done if very ill
• necosectomy: MIRP minimally invasive retropancreatic necrosectomy to debride necrosis

Question 15

complictions of acute pancreatitis

Answer 15

• fluid
• necrosis
• abscess
• pseudocyst
• obstruction
• renal fail/resp fail
• malnutrition

Question 16

what causes early and late death in acute pancreatitis

Answer 16

early=multi-organ system failure

late=infected pancreatic necrosis

Question 17

MODS means

Answer 17

multiple organ dysfunction syndrome

Question 18

definition of chronic pancreatitis

Answer 18

continuing inflammatory disease of the pancreas with irreversible morhphological changes

• progressive
• irreversible
• necrosis and fibrosis

Question 19

signs of chronic pancreatitis

Answer 19

anorexia
chronic pain
radiates to back
nausea dn vomiting
DM
steatorrhoea
malabsorption
livedo reticularis on flank

Question 20

management of chronic pancreatitis

Answer 20

nutritional 
morphology scans
pancreatic function testing 
analgesia 
alcohol counselling

Question 21

surgery for chronic pancreatitis

Answer 21

• Puestow’s lateral pancreatico-jejunostomy
• hepatico-jejunostomy
• whipple
• distal pancreatectomy

Question 22

causes of chronic pancreatitis and acronym

Answer 22

TIGARO
toxic-metabolic eg alcohol, calcium
Idiopathic
Genetic: hereditary pancreatitis cationic trypsinogen or CF
Autoimmune
Reccurent and severe acute
Obstructive eg tumour/ congenital

Question 23

what are frey and beger procedure

Answer 23

frey=take out parts of diseased head

beger=pancreatic head and duodenum

Question 24

most common pancreatic tumour

Answer 24

pancreatic ductal adenocarcinoma 80%

Question 25

pancreatic tumours 6

Answer 25

pancreatic ductal adenocarcinoma
pancreatic acini
endocrine
connective tissue
metastases
neuroendocrine tumour

Question 26

issues with presenting pancreatic carcinoma

Answer 26

late
non specific symptoms
jaundiced 
weight loss
back pain