Pancreatic Disease Flashcards
Describe the aetiology of acute pancreatitis.
- Alcohol Abuse (60-75%)
- Gallstones (25-40%)
- Trauma
Miscellaneous; - Drugs
- Viruses
- Pancreatic carcinoma
- Autoimmune
- Idiopathic
Describe the pathogenesis of acute pancreatitis.
Primary insult --> release of activated pancreatic enzymes --> auto digestion --> Pro-inflammatory cytokines Reaction O2 species --> Oedema Fat necrosis Haemorrhage
Describe the presentation of acute pancreatitis.
- Abdominal pain (may radiate to lower back)
- Vomiting
- Pyrexia
- Tachycardia (hypovolemic shock)
- Oliguria (acute renal failure)
- Jaundice
- Paralytic ileus
- Pleural effusion, ascites
Hypoxia –> resp. failure
Hypocalcaemia –> tetany (rare)
Hyperglycaemia –> diabetic coma
Describe the investigation of acute pancreatitis.
- Bloods: serum amylase elevated (up to 4x)
- AXR, CXR
- CT (USS not helpful)
Describe the general management of acute pancreatitis.
- Assess severity: Glasgow criteria >3 = severe
- Analgesia
- IV fluids
- Blood transfusions
- Catheter (monitor output)
- Nasogastric tube
- Oxygen
- ?Insulin, calcium, nutrition
Describe the complications of acute pancreatitis and how to treat them.
Pancreatic necrosis –> CT-guided aspiration –> antibiotics +/- surgery
Gallstones –> EUS/ERCP/MRCP –> cholecystectomy
Abscess –> drainage and surgery
Pseudocyst –> UCC/CT –> drainage or surgery
Describe the prognosis of acute pancreatitis.
- Mild pancreatitis: <2%
- Severe: 15%
What is the definition of chronic pancreatitis?
Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function.
Is chronic pancreatitis more common in males or females? And in what age group?
M>F.
35-50 years.
Describe the aetiology of chronic pancreatitis.
- Alcohol (80%)
- CF
- Congenital anatomical abnormalities e.g. pancreas divisum in 7%
- Hereditary pancreatitis
- ?Diet
Name the associated genes of chronic pancreatitis.
- PRSS1: cationic trypsinogen
- SPINK1: pancreatic secretory trypsin inhibitor
- CFTR: CF transmembrane conductance regulator
Describe the pathogenesis of chronic pancreatitis.
Duct obstruction;
- Calculi
- Inflammation
- Protein plugs
?Abnormal sphincter of Oddi function;
- Spasm: increase in intrapancreatic pressure
- Relaxation: reflux of duodenal contents
Genetic polymorphisms;
- Abnormal trypsin activation
Describe the pathology of chronic pancreatitis.
- Glandular atrophy and fibrosis
- Ducts become dilated, tortuous and strictured
- Secretions may calcify
- Demyelinated nerves due to loss of perineurial cells
- Splenic, sup. mesenteric and portal veins may thrombose –> portal hypertension
Describe the presentation of chronic pancreatitis.
Early disease is asymptomatic.
Abdominal pain (85-95%);
- Exacerbated by food and alcohol
- Severity decreases over time
Weight loss;
- Pain
- Anorexia
- Malabsorption
Exocrine insufficiency;
- Fat malabsorption –> steatorrhoea
- Decrease in fat-soluble vitamins (A, D, E, K)
- Decrease in Ca2+, Mg+
Endocrine insufficiency –> diabetes (30%).
Miscellaneous;
- Jaundice
- Portal hypertension
- GI bleed
- Pseudocysts
- ?Pancreatic carcinoma
Describe the investigations of chronic pancreatitis.
- AXR –> pancreatic calcification (30%)
- USS: size, diameter, ducts, cysts, tumours
- EUS
- CT
Bloods;
- Elevated serum amylase in acute cases
- Low albumin, Ca2+/Mg+, vitamins
- Pancreatic function tests
Describe the management of pain control in chronic pancreatitis.
- Avoid alcohol
- Opiate analgesics
- Coeliac plexus block
- Refer to pain clinic/psychologist
- Endoscopy: pancreatic stones and strictures
- Surgery in selected cases
Describe the management of endocrine/exocrine insufficiency in chronic pancreatitis.
- Low fat diet
- Pancreatic enzyme supplements
- May need acid suppression
- Insulin for DM
(- Vit supplements usually not needed)
Describe the prognosis of chronic pancreatitis.
Continued alcohol intake –> 10YS 50%
Abstinence –> 10YS 80%
Is pancreatic carcinoma more common in males or females? And in what age group?
- M>F
- 80% 60-80 years
Describe the pathology of pancreatic carcinoma.
- Duct cell mutinous adenocarcinoma (75%)
Others;
- Carcinosarcoma
- Cystaadenocarcinoma (better prognosis)
- Acinar cell (aggressive)
Describe the symptoms of pancreatic carcinoma.
- Upper abdo pain (75%)
- Painless obstructive jaundice (25%)
- Weight loss (90%)
Above are alarm symptoms! - Anorexia, fatigues, diarrhoea/steatorrhoea, nausea, vomiting
- Tender subcut. fat nodules due to metastatic fat necrosis
- Thrombocytopenia migrans
- Ascites, portal hypertension
- Recurrent pancreatitis
Describe the signs of pancreatic carcinoma.
- Hepato/splenomegaly
- Jaundice
- Abdo mass, tenderness
- Ascites
- Supraclavicular lymphadenopathy
Above indicate unresectablee tumour. - Palpable gallbladder
Describe the investigations of pancreatic carcinoma.
USS/CT/EUS
- -> Jaundice with mass
- -> ERCP +/- stent
- -> ?Surgery
- -> Jaundice without mass
- -> EUS/biopsy
- -> CT/EUS/laparoscopy/laparotomy
- -> ?Surgery
Describe the management of pancreatic carcinoma.
- <10% are inoperable
- Pacreaduodectomy
- Pain control
Describe the prognosis of pancreatic carcinoma.
Inoperable;
- Mean survival <6 months
- 5YS 1%
Operable;
- 5YS 15%
