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GASTROENTEROLOGY > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

Acute pancreatitis:

Pathophysiology

What does the inflammation lead to? - 3

What happens in severe disease?

A

Intra-pancreatic activation of pancreatic enzymes and auto-digestion

Oedema
Fluid shifts
Hypovolaemia

Erosion of vessel wall and intra-abdominal bleeding

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2
Q

Acute pancreatitis:

Causes mneumonic - I GET SMASHED

A

Idiopathic

Gallstones - more common in women
Ethanol - alcohol - more common in men
Trauma

Steroids 
Mumps and malignancy 
Autoimmune
Scorpion sting 
Hyperlipidaemia and hypercalcaemia 
ERCP 
Drugs e.g. valproate, azathioprine, thiazides
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3
Q

Acute pancreatitis - Presentation:

Pain:

  • site - 2
  • onset
  • severity
  • radiation
  • what makes it better
  • associated symptoms? - 2
A

Epigastric or LUQ or central

Sudden

Severe/gradual

To back

Sitting forward

N&V, anorexia

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4
Q

Acute pancreatitis - Presentation:

What may also be there if it is a result of gallstones?

IF VERY SEVERE:

Why do you get a pleural effusion?

You can also get ascites. Why?

A

Jaundice

A transdiaphragmatic lymphatic blockage or pancreaticopleural fistulae secondary to leak and disruption of the pancreatic duct or pseudocyst

When pancreatic secretions collect in the peritoneum as a result of a pancreatic duct injury.
It most often follows necrotizing pancreatitis with major pancreatic duct injury or via fistula formation which communicates with the peritoneum.

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5
Q

Acute pancreatitis:

What is Grey-turner’s sign?

What is Cullen’s sign?

What do they indicate?

A

Bruising over both flanks

Bruising around the umbilicus

Haemorrhagic pancreatitis

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6
Q

Acute pancreatitis - Investigations:

What 3 things are needed for diagnosis?

Why is lipase better than amylase?

A

Compatible history/exam - acute epigastric pain

Raised amylase or lipase (>3 times upper limit)

Slightly more sensitive and specific and elevated for longer

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7
Q

Acute pancreatitis - Investigations - Bloods:

What does:

  • raised WBC
  • raised RBC
  • lowered RBC
  • raised CRP
  • raised LFTs

indicate?

A 
Infection 
Dehydration - less water in the blood 
Haemorrhage 
Inflammation 
Gallstones
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8
Q

Acute pancreatitis - Investigations - Bloods:

What may an ABG show? - 2

What electrolyte tends to fall in severe pancreatitis?

A

Lactic acidosis and low oxygen

Calcium - hypocalcaemia

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9
Q

Acute pancreatitis - Investigations - Imaging:

Abdo XR may show a sentinal loop and no psoas shadow. What do these both mean?

What is the relevance of a CXR? - 2

A

Dilation of small bowel around area of pancreatitis

Increased retroperitoneal fluid - inflammation around the psoas muscle

Pleural effusion and pneumoperitoneum if perforation

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10
Q

Acute pancreatitis - Investigations - Imaging:

What is the main purpose of doing a USS?

What are the 2 gold standard imaging methods for diagnosis that are only used if there is uncertainty?

A

To find gallstones even though pancreatic inflammation can be seen

Abdo CT or MRCP

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11
Q

Acute pancreatitis - Management:

What should be done first?

A

ABCDE - supportive care, including fluids, catheterisation and fluid balance.
Analgesia
Antiemetics - as vomiting is a persistent symptom

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12
Q

Acute pancreatitis - Management:

Risk stratification is done with the Glasgow Prognostic Score using mneumonic:

PANCREAS

Write it out?

What score within 48 hrs would be severe and need ITU/HDU admission?

What does the Ranson criteria measure?

A

PaO2 < 8kPA - low oxygen in blood

Age > 55 yrs

N - neutrophilia - raised WBC

Ca - low <2mmol/L - severe disease

Renal impairment - urea >16 mmol/L

Enzymes - raised LDH and AST

Albumin

3

The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis.

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13
Q

Acute pancreatitis - Management:

What should be instructed to the patient? - 1

What can be done for nutrition if there is severe vomiting? - 2

What electrolyte replacement may need to be given?

What should be given if it is due to alcohol?

A

NBM

NG or NJ

Benzodiazepines
Micronutrients (thiamine, folate, B12)

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14
Q

Acute pancreatitis - Management:

Interventional treatment:

What is a necrosectomy and why is it used?

A pseudocyst might need to be drained. How may this be done? - 2

What if it is due to gallstones?

A

Removal of necrotic tissue and placement of irrigation tubes

Endoscopic US-guided or surgical

Cholecystectomy
ERCP after recovery

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15
Q

Acute pancreatitis - Complications:

What does a rising CRP suggest? - 2

What may happen to the pancreas after? - 3

What is a pseudocyst?

Severe complications

A

Pancreatic necrosis and infection

Pancreatic abscess, insufficiency or chronic pancreatitis

Fluid in lesser peritoneal sac

Sepsis and DIC
AKI
ARDS
Paralytic ileus

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16
Q

Chronic pancreatitis:

The symptoms are pretty much the same as acute and come in episodes. What else distinguishes it from an acute episode? - 2

What is the most common cause?

Other causes:

  • genetic disease
  • iron
  • pancreatic duct obstruction from what - 2
A

Exocrine (Pertaining to the secretion of a substance out through a duct. The exocrine glands include the salivary glands, sweat glands and glands within the gastrointestinal tract)

Or endocrine dysfunction

CF
Haemochromatosis
Stone / tumour

17
Q

Chronic pancreatitis:

Pain:

  • Onset
  • Site
  • Radiation

What does exocrine pancreatic insufficiency cause?

What else may be caused as a result of it?

A

Recurrent or chronic
Epigastric
Back

Steatorrhoea
Malnutrition

DM

18
Q

Chronic pancreatitis:

Investigations

Why do you do blood glucose?

What scans do you do to look for pancreatic calcifications? - 2

A

Looking for DM as a result of chronic disease

USS
CT (ideal)

19
Q

Chronic pancreatitis:

Management - 5

A 
Analgesia 
Enzyme supplements 
DM management 
Dietician support
Manage alcohol problems
20
Q

ERCP:

What does it stand for?

What does it involve?

What can be done as a result of it? - 3

A

Endoscopic retrograde cholangiopancreatography

Upper GI endoscopy with an injection of radiocontrast into the biliary tree and pancreas

Biliary or pancreatic sphincterotomy - used for strictures (PBC)
Stone clearance
Biliary or pancreatic stenting

21
Q

ERCP:

Indications - 2

Why is MRCP better for just diagnostic purposes in some cases?

A

CBD stones
Acute cholangitis

ERCP comes with its risk so better to be used for therapeutic purposes

22
Q

ERCP:

Complications:

Inflammatory - 2

Traumatic - 3

What can be done this those with hilar obstruction - obstruction of the ampulla of vater?

A

Acute pancreatitis
Cholangitis

Bleeding - usually told to stop any anticoags/antiplatelets
GI perforation
Bile duct injury

PTC - percutaneous transhepatic cholangiography

GASTROENTEROLOGY (54 decks)

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