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GI > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

What are the main functions of the pancreas?

A

Exocrine - acinar cells secrete pancreatic enzymes

Endocrine - islets of langerhans cells secrete hormones into blood

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2
Q

What are the different types of cells found in the islets of langerhans and what does each cell type secrete?

A 
Beta Cells (most common) = insulin
Alpha Cells = glucagon
Delta Cells = somatostatin
F Cells = pancreatic polypeptide
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3
Q

What regulates the secretion of pancreatic fluid?

A
  • vagus nerve

- gastrin

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4
Q

What enzymes are secreted by the acinar cells in the pancreas?

A
  • Protease
  • Lipase
  • Amylase
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5
Q

What is secreted from the epithelial cells which line the pancreatic ducts?

A
  • Bicarbonate (to neutralise gastric acid)

* Water

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6
Q

Describe the pathological stages that occur in pancreatitis?

A
  • Oedema and Hypovolaemia
  • Hypocalcaemia (as it binds to autodigested fat)
  • Retroperitoneal haemorrhage
  • Pancreatic necrosis
  • abscess formation
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7
Q

HOw do patients present with acute pancreatitis?

A
  • severe acute epigastric pain
  • radiating to back (may cause them to be doubled over)
  • N+V
  • jaundice
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8
Q

What can be found o/e of a patient with pancreatitis?

A
  • diffuse upper abdominal tenderness
  • normal bowel sounds
  • fullness in epigastrium may indicate pseudocyst
  • if severe may have widespread guarding
  • erythema abigne
  • cullen’s sign
  • Grey-turner’s sign
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9
Q

What investigations should be used for patients with suspected pancreatitis?

A
  • Bloods - amylase/lipase, CRP, lactate
  • arterial blood gas
  • XRays for pleural effusion/ sentinel bowel loop
  • US for gallstones
  • CT
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10
Q

What is involved in the Glasgow criteria for pancreatitis?

A 
PaO2 <8
Age >55
Neutrophils >15
Calcium <2
Renal function (urea >16)
Enzymes (AST/ALT or LDH)
Albumin <32
Sugar (glucose >10)

Score of >3 indicates severe pancreatitis

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11
Q

What makes up the admission Ranson criteria for pancreatitis?

A 
>55
Glucose >11mmol/l
LDH >500
AST >200 
WCC >16
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12
Q

What are the main local complications of pancreatitis?

A
  • fluid collection
  • pseudocysts
  • abscess
  • necrosis/ infection
  • ascites
  • pleural effusion
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13
Q

What systemic complications can occur as a result of pancreatitis?

A
  • pulmonary failure
  • renal failure
  • shock
  • sepsis
  • metabolic acidosis
  • hyperglycaemia/ hypocalcaemia
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14
Q

How are pancreatic abscesses treated?

A
  • drained under CT/US guidance

- drained to prevent sepsis

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15
Q

How is chronic pancreatitis treated?

A

Creon for pancreatic enzyme replacement if patients have symptoms of pancreatic insufficiency

  • bloating
  • pale, fatty stools + increased freq.
  • weight loss

Surgical procedure to connect pancreas to bowel

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16
Q

What are the potential complications of chronic pancreatitis?

A
  • splenic vein thrombosis
  • pseudoaneurysm (splenic artery)
  • pleural effusion
  • ascites
  • pancreatic cancer
  • pseudocyst
  • biliary/duodenal obstruction
17
Q

What types of pancreatic tumour can occur in the endocrine part of the pancreas?

A
  • Gastrinoma => gastrin producing
  • Insulinoma => insulin producing
  • Glucagonoma => glucagon producing
18
Q

What symptoms do each of the endocrine pancreatic tumours cause?

A

beta cell insulinoma => HYPOglycaemia
alpha cell glulcagonoma => HYPERglycaemia/ diabetes
delta cell somatostatinoma => diabetes/ steatorrhoea
gastrinoma => peptic ulcers

19
Q

What are the main symptoms of pancreatic cancer?

A

jaundice
loose pale stools (steatorrhoea)
weight loss
back pain

20
Q

What imaging modalities are used to assess suspected pancreatic cancer?

A
  • US
  • triple phase CT
  • MRI/MRCP
21
Q

What percentage of pancreatic cancers are deemed in-operable at presentation?

A

70-80%

22
Q

How are inoperable cases of pancreatic cancer managed?

A

ERCP
Stent insertion
Decompression of obstructed bile ducts

23
Q

How are operable cases of pancreatic cancer treated?

A
  • resection or palliative bypass
  • Whipple’s procedure (removes GB, duodenum and head of pancreas)
  • Distal or Total pancreas removal

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