Pancreatic disease Flashcards
how does acute pancreatitis present ?
upper abdominal pain
often associated with excess alcohol intake
what causes acute pancreatitis ?
alcohol abuse gall stones trauma drugs virus - HIV CMV mumps
what is abnormal in a blood test in acute pancreatitis ?
raised serum amylase
what are the clinical features of acute pancreatitis ?
abdominal pain vomiting pyrexia tachycardia oliguria jaundice retroperitoneal haemorrhage (grey turners and Cullen's sign)
how is acute pancreatitis diagnosed ?
high serum amylase
xray
USS
CT
what is the diagnostic score for pancreatitis ?
the glasgow criteria
>3 is severe
how is acute pancreatitis managed ?
if necrosis - CT guided aspiration, antibiotics and surgery
if gallstones - EUS/MRCP/ERCP, cholecystectomy
analgesia IV fluid blood transfusion catheter NG tube oxygen calcium supplement nutrition
what are complications of acute pancreatitis ?
abscess - treat with Abx and drainage
pseudocyst - collection of fluid in the lesser sac
what causes chronic pancreatitis ?
alcoholism
CF
pancreatic duct obstruction
congenital anatomical abnormality
what is the pathology of chronic pancreatitis ?
glandular atrophy and replacement by fibrous tissue
ducts become dilated, tortuous and strictured
can result in portal hypertension due to head expansion on splenic vessels
what are the clinical features of chronic pancreatitis ?
asymptomatic abdominal pain weight loss exocrine insufficiency - steatorrhoea, fat soluble vitamin and protein deficiency endocrine insufficiency - diabetes
what are the investigations of chronic pancreatitis ?
AXR USS EUS CT bloods - increased amylase, decreased albumin, increased LFTs pancreatic function test
how is chronic pancreatitis managed ?
pain control
exocrine and endocrine - vitamin supplements, low fat diet, insulin
what is the most common histological type of pancreatic cancer ?
duct cell mucinous adenocarcinoma
what are clinical features of pancreatic cancer ?
abdominal pain
painless jaundice
weight loss
anorexia, fatigue, diarrhoea/steatorrhoea, nausea/vomiting
