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2ND YEAR SYSTEMS: GI > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

mortality rate associated with acute pancreatitis?

A

1 in 5 that get acute pancreatitis can die

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2
Q

What is acute pancreatitis

A

acute inflammation of the pancreas

sudden onset

upper abdominal pain - usually epigastric region

elevation of serum amylase due to inflammation

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3
Q

what does the serum amylase level have to be to make a diagnosis of acute pancreatitis?

A

4 times the normal level

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4
Q

common causes of acute pancreatitis

A
  1. excessive alcohol intake 60-75%
  2. gallstones 25-40%

not so common:-

trauma - road traffic accident, post op

misc - drugs, viruses (tend to be self limiting), pancreatic carcinoma

idopathic

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5
Q

Describe pathogenesis of acute pancreatitis

A

primary insult - alcohol, gallstone etc

causes a release of activated pancreatic enzymes

which can cause autodigestion leading to either oedema, fat necrosis, haemorrhage as a result or the release of reactive O2 species or pro-inflammatory cytokines

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6
Q

Clinical features of acute pancreatitis (7)

A 
Abdominal pain (may radiate to back)
Vomiting
Pyrexia - fever 
Tachycardia, hypovolaemic shock (severe blood loss)
Oliguria, acute renal failure
Jaundice
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7
Q

what is an ERCP? what does it do?

A

endoscopic retrograde cholangio-pancreatography

an endoscope put through your mouth to your pancreas. It lets you examine the pancreatic and bile ducts

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8
Q

What other method other than ERCP is commonly used for acute pancreatitis

A

Endoscopic ultrasound

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9
Q

what investigations would a patient undergo to diagnose or assess for acute pancreatitis (4)

A

blood tests - amylase/lipase, FBC, LFT, U&E, Ca2+, arterial blood gases

AXR (abdominal x ray) or CXR

Abdominal ultrasound - looking for pancreatic oedema, gallstones, pseudocyst

CT scan

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10
Q

What does the Glasgow-Imrie criteria state for assessment of the severity of acute pancreatitis?

A

you need an overall score of >3 to diagnose within 48 hours of admission

it’s based on 8 lab values:-

  1. WCC > 15x10^9/L
  2. Blood glucose >10 mmol/L
  3. Blood urea >16 mmol/L
  4. AST >200 iu/L
  5. LDH >600 iu/L
  6. Serum albumin <32 g/L
  7. Serum calcium <2.0 mmol/L
  8. Arterial PO2 <7.5 kPa
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11
Q

A CRP level of >150 mg/L also indicated what?

A

severe pancreatitis

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12
Q

General management of acute pancreatitis

A 
Analgesia (pethidine, indomethacin)
IV fluids 
Blood transfusion (Hb <10 g/dl) if anaemic etc
Monitor urine output (catheter)
Naso-gastric tube 
O2
May need insulin 
Nutrition
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13
Q

Specific management when dealing with pancreatic necrosis?

A

CT guided aspiration

antibiotics and maybe surgery

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14
Q

Specific management when dealing with Gallstones

A

EUS/ERCP/MRCP

Cholecystectomy

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15
Q

What complications can arise when dealing with acute pancreatitis

A

abscess - antibiotics and drainage required

pseudocyst - fluid collection without an epithelial lining

  • -> persistent pain or hyperamylasaemia
  • -> jaundice, infection, haemorrhage

if collection is less than 6 cm diameter then resolves spontaneously
endoscopic drainage or surgery if persistent

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16
Q

Mortality difference between mild and sever ap

A

Mild AP - 75-80% of cases only have a mortality rate of 2%

sever AP has a mortality rate of 15%

17
Q

what is chronic pancreatitis

A

continuing inflammatory disease of the pancreas

irreversible glandular destruction
pain
permanent loss of function perhaps
wall of pancreas gets destroyed over time

18
Q

Causes of chronic pancreatitis (4)

A

alcohol 80%
Smoking
Autoimmune

cystic fibrosis - high freq. of CFTR gene mutations in chronic pancreatitis
congenital anatomical abnormalities - annular pancreas or pancreas divisum

hereditary pancreatitis - rare
hypercalcaemia

19
Q

Key genes associated with pancreatitis (3)

A

PRSS1 - test
SPINK1 - no test
CFTR - sweat chloride test

20
Q

Pathogenesis of chronic pancreatitis

A

duct obstruction - calculi (stones), inflammation, protein plugs

abnormal sphincter of oddi function

21
Q

pathology of chronic pancreatitis (4)

A

Glandular atrophy & replacement by fibrous tissue

Ducts become dilated, tortous & strictured

‘Exposed’ nerves due to loss of peri-neural cells

Splenic, superior mesenteric & portal veins may thrombose leading to portal hypertension

22
Q

Clinical features of chronic pancreatitis

A

Early disease is asymptomatic

Abdominal pain (85-95%)
exacerbated by food &amp; alcohol; severity decreases with time

Weight loss (pain, anorexia, malabsorption)

Exocrine insufficiency
fat malabsorption causing steatorrhoea

decrease in fat soluble vitamins (A,D,E,K)

protein malabsorption => weight loss - decreased vit B12

Endocrine insufficiency

Misc.: jaundice, portal hypertension, GI haemorrhage, pseudocysts, ?pancreatic carcinoma

23
Q

investigations for chronic pancreatitis (6)

A

Plain AXR (30% have calcification of pancreas)

Ultrasound: pancreatic size, cysts, duct diameter, tumours

Endoscopic Ultrasound

CT scan

Blood tests
Serum amylase increases in acute exacerbations
decreased albumin, Ca2+/Mg2+, vit B12
increased LFTs, Prothrombin time (vit K), glucose

Pancreatic function tests (Lundh, pancreolauryl)

24
Q

How can pain caused by chronic pancreatitis be controlled (5)

A

avoid alcohol
pancreatic enzyme supplements

opiate analgesia

coeliac plexus block

endoscopic treatment of pancreatic stones and strictures

surgery in some cases

25
Q

Types of carcinoma of the pancreas

A

75% are duct cell mucinous adenocarcinoma

other types - carcinocarcoma, cystadenocarcinoma, acinar cell

26
Q

Clinical features of pancreatic cancer (7+)

A

Upper abdominal pain (75%) -

Painless obstructive jaundice

Weight loss (90%)

Anorexia, fatigue, diarrhoea/steatorrhoea, nausea, vomiting

Tender subcutaneous fat nodules (like erythema nodosum) due to metastatic fat necrosis

Thrombophlebitis migrans (vessel inflammation)

Ascites, portal hypertension

27
Q

Physical signs of pancreatic cancer (8)

A 
hepatomegaly
jaundice
abdominal tenderness 
abdominal mass
ascites, splenomegaly
supraclavicular lymphadenopathy
palpable gallbladder
28
Q

Imaging used for carcinoma of the pancreas

A

USS
EUS
CT
MRI

29
Q

Management of pancreatic cancer

A

most patients have advanced disease at presentation - less than 10% are operable

radical surgery - if patient is fit, tumour is <3cm, no metastases

palliation of jaundice - stent, palliative surgery

pain control - opiates, radiotherapy, coeliac plexus block

chemo

30
Q

Prognosis for pancreatic cancer?

A

inoperable cases - <6 months, 1% 5 year survival

operable cases - 15% 5yr survival

2ND YEAR SYSTEMS: GI (38 decks)

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