Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI - Year 2 > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the incidence of acute pancreatitis?

A

20-300 cases/million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the mortality rate for acute pancreatitis?

A

6-12 /million

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of acute pancreatitis?

A 
Alcohol abuse (60-75%)
Gallstones (25-40%)
Trauma (blunt/post-op/post-ERCP)
Drugs (steroids, azathioprine, diuretics)
Viruses (mumps, coxsackie B4, HIV, CMV)
Pancreatic carcinoma
Metabolic (increased Ca/triglycerides, decreased temp)
Autoimmune
Idiopathic (~10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of acute pancreatitis?

A 
Abdominal pain
Vomiting
Pyrexia
Tachycardia, hypovolaemic shock
Oliguria, acute renal failure
Jaundice
Paralytic ileus
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hyperglycaemia
Effusions (ascitic + pleural)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangio- Pancreatography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does EUS stand for?

A

Endoscopic UltraSound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of blood tests are done for acute pancreatitis?

A 
Amylase/lipase
FBC
U&Es 
LFTs
Ca2+
Glucose
Arterial blood gases
Lipids
Coagulation screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aside from blood tests what other investigations are done for acute pancreatitis?

A

AXR (ileus)
CXR (pleural effusion)
Abdominal ultrasound
CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What score on the glasgow criteria indicates severe pancreatitis within 48 hours of admission?

A

> 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What CRP level indicates severe pancreatitis?

A

> 150mg/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is acute pancreatitis managed?

A 
Analgesia
IV fluids
Blood transfusion
Monitor urine output (catheter)
Naso-gastric tube
Oxygen
May need insulin
Rarely require Ca supplements
Nutrition (enteral or parenteral) in severe cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is pancreatic necrosis managed?

A

CT guided aspiration

Antibiotics + surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are gallstones managed?

A

EUS/MRCP/ERCP

Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of acute pancreatitis that can occur during management?

A

Abscess

Pseudocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is an abscess managed?

A

Antibiotics + drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a pseudocyst?

A

Fluid collection without an epithelial lining

Persistent hyperamylasaemia/pain

18
Q

How is a pseudocyst diagnosed?

A

By ultrasound or CT scan

19
Q

What are the complications of a pseudocyst?

A

Jaundice
Infection
Haemorrhage
Rupture

20
Q

How is a pseudocyst managed?

A

If < 6cm diameter = resolves spontaneously

Endoscopic drainage or surgery if persistent pain/complications

21
Q

What is the mortality rate of acute pancreatitis?

A

Mild AP = <2%

Severe = 15%

22
Q

What is the incidence of chronic pancreatitis?

A

3.5/100,000 pop./year

23
Q

What are the causes of chronic pancreatitis?

A

Alcohol (80%)
Cystic fibrosis (CP in 2%)
Congenital anatomical abnormalities (e.g. annular pancreas/pancreas divisum)
Hereditary pancreatitis (rare - auto. dom)
Hypercalcaemia
Diet

24
Q

What are some of the genes associated with pancreatitis?

A

PRSS1 (cationic trypsinogen)
SPINK1 (pancreatic secretory trypsin inhibitor)
CFTR (cystic fibrosis transmembrane conductance regulator)

25
Q

What happens in chronic pancreatitis?

A

Duct obstruction due to calculi, inflammation, protein plugs
Abnormal sphincter of Oddi function - spasm/relaxation
Genetic polymorphisms - abnormal trypsin activation

26
Q

What is the pathology of chronic pancreatitis?

A

Glandular atrophy + replacement by fibrous tissue
Ducts become dilated, tortous, strictured
Inspissated secretions may calcify
Exposed nerves due to loss of perineural cells
Splenic, SMV + portal veins may thrombose -> portal hypertension

27
Q

What are the clinical features of chronic pancreatitis?

A 
Asymptomatic
Abdominal pain
Weight loss
Exocrine insufficiency
Endocrine insufficiency
Jaundice, portal hypertension, GI haemorrhage, pseudocysts, pancreatic carcinoma
28
Q

What are the investigations for chronic pancreatitis?

A 
Plain AXR
Ultrasound
EUS
CT scan
Blood tests (serum amylase, albumin, LFTs, glucose, vit K)
Pancreatic function tests
29
Q

How is chronic pancreatitis pain controlled?

A 
Avoid alcohol
Pancreatic enzyme supplements
Opiate analgesia
Coeliac plexus block
Referral to pain clinic/psychologist
Endoscopic treatment (pancreatic duct stones and strictures)
Surgery
30
Q

How is the exocrine and endocrine insufficiencies managed in chronic pancreatitis?

A

Low fat diet
Pancreatic enzyme supplements
Vitamin supplements
Insulin for diabetes mellitus

31
Q

What is the prognosis of chronic pancreatitis?

A

Death from complications of acute-on chronic attacks, CV complications from diabetes, cirrhosis, drug dependence, suicide
Continued alcohol intake = 50% 10 year survival
Abstinence = 80% 10 year survival

32
Q

What is the incidence of carcinoma of the pancreas?

A

11/ 100,000 pop/year

33
Q

What are the types of carcinoma in the pancreas?

A

Duct cell mucinous adenocarcinoma (75%) - head 60%, body 13%, tail 5%, multiple 22%
Carcinosarcoma
Cystadenocarcinoma
Acinar cell

34
Q

What are the clinical features of pancreatic carcinoma?

A 
Upper abdominal pain
Painless obstructive jaundice
Weight loss
Anorexia, fatigue, diarrhoea, vomiting
Tender subcutaneous fat nodules
Thrombophlebitis migrans
Ascites, portal hypertension
35
Q

What are the physical signs of pancreatic carcinoma?

A 
Hepatomegaly
Jaundice
Abdominal mass
Abdominal tenderness
Ascites, splenomegaly
Supraclavicular lymphadenopathy
Palpable gallbladder
36
Q

What imaging is used for pancreatic carcinoma?

A

USS
CT
MRI
EUS

37
Q

What is the investigation process for pancreatic carcinoma?

A
  1. Suspicion
  2. Abdominal USS/CT scan/EUS
  3. Jaundice with/without mass –> ERCP
    Mass without jaundice –> EUS/biopsy
  4. Carcinoma detected
  5. CT scan/EUS/Laparoscopy/Laparotomy to determine if carcinoma is operable or inoperable
38
Q

How is pancreatic carcinoma managed?

A

Majority of patients inoperable
Radical surgery if patient is fit, tumour <3cm, no metastases
Palliation of jaundice (stent, cholechoduoenostomy)
Pain control
Chemotherapy

39
Q

What is the prognosis in inoperable cases of pancreatic carcinoma?

A

survival ~6 months

1% 5 year survival

40
Q

What is the prognosis in operable cases of pancreatic carcinoma?

A

15% 5 year survival

Ampullary tumours 30-50% 5 year survival

GI - Year 2 (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions