Pancreatic Disease Flashcards
What are the main functions of the pancreas?
Exocrine - acinar cells secrete pancreatic enzymes
Endocrine - islets of langerhans cells secrete hormones into blood
What are the different types of cells found in the islets of langerhans and what does each cell type secrete?
Beta Cells (most common) = insulin Alpha Cells = glucagon Delta Cells = somatostatin F Cells = pancreatic polypeptide
What regulates the secretion of pancreatic fluid?
- vagus nerve
- gastrin
What enzymes are secreted by the acinar cells in the pancreas?
- Protease
- Lipase
- Amylase
What is secreted from the epithelial cells which line the pancreatic ducts?
- Bicarbonate (to neutralise gastric acid)
* Water
Describe the pathological stages that occur in pancreatitis?
- Oedema and Hypovolaemia
- Hypocalcaemia (as it binds to autodigested fat)
- Retroperitoneal haemorrhage
- Pancreatic necrosis
- abscess formation
HOw do patients present with acute pancreatitis?
- severe acute epigastric pain
- radiating to back (may cause them to be doubled over)
- N+V
- jaundice
What can be found o/e of a patient with pancreatitis?
- 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
What investigations should be used for patients with suspected pancreatitis?
- Bloods - amylase/lipase, CRP, lactate
- arterial blood gas
- XRays for pleural effusion/ sentinel bowel loop
- US for gallstones
- CT
What is involved in the Glasgow criteria for pancreatitis?
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
What makes up the admission Ranson criteria for pancreatitis?
>55 Glucose >11mmol/l LDH >500 AST >200 WCC >16
What are the main local complications of pancreatitis?
- fluid collection
- pseudocysts
- abscess
- necrosis/ infection
- ascites
- pleural effusion
What systemic complications can occur as a result of pancreatitis?
- pulmonary failure
- renal failure
- shock
- sepsis
- metabolic acidosis
- hyperglycaemia/ hypocalcaemia
How are pancreatic abscesses treated?
- drained under CT/US guidance
- drained to prevent sepsis
How is chronic pancreatitis treated?
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
What are the potential complications of chronic pancreatitis?
- splenic vein thrombosis
- pseudoaneurysm (splenic artery)
- pleural effusion
- ascites
- pancreatic cancer
- pseudocyst
- biliary/duodenal obstruction
What types of pancreatic tumour can occur in the endocrine part of the pancreas?
- Gastrinoma => gastrin producing
- Insulinoma => insulin producing
- Glucagonoma => glucagon producing
What symptoms do each of the endocrine pancreatic tumours cause?
beta cell insulinoma => HYPOglycaemia
alpha cell glulcagonoma => HYPERglycaemia/ diabetes
delta cell somatostatinoma => diabetes/ steatorrhoea
gastrinoma => peptic ulcers
What are the main symptoms of pancreatic cancer?
jaundice
loose pale stools (steatorrhoea)
weight loss
back pain
What imaging modalities are used to assess suspected pancreatic cancer?
- US
- triple phase CT
- MRI/MRCP
What percentage of pancreatic cancers are deemed in-operable at presentation?
70-80%
How are inoperable cases of pancreatic cancer managed?
ERCP
Stent insertion
Decompression of obstructed bile ducts
How are operable cases of pancreatic cancer treated?
- resection or palliative bypass
- Whipple’s procedure (removes GB, duodenum and head of pancreas)
- Distal or Total pancreas removal
