Pancreatic Disease

Question 1

what is pancreatitis?

Answer 1

inflammation of pancreas

Question 2

are children or adults mainly affected by pancreatitis?

Answer 2

adults

Question 3

types of pancreatitis?

Answer 3

chronic & acute

Question 4

what does chronic pancreatitis mean?

Answer 4

irreversible fibrosis leading to loss of exocrine and endocrine function

Question 5

what is the aetiology for chronic pancreatitis?

Answer 5

CAMP

• CF
• Alcohol
• Malnourishment
• Pancreatic duct obstruction

Question 6

dx for chronic pancreatitis?

Answer 6

imaging= shows calcification & dilated pancreatic duct

Question 7

complications of chronic pancreatitis?

Answer 7

splenic vein thrombosis, pseudoaneurysm, pancreatic cancer, fluid collection

Question 8

aetiology of pancreatitis (general)

Answer 8

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hypercalcaemia/ hyperlipidaemia/ hyperthyroidism 
ERCP damage
Drugs

Question 9

what is an example of an autoimmune disease that causes pancreatitis?

Answer 9

polyarteritis nodosa

Question 10

what is a drug that causes pancreatitis?

Answer 10

azathioprine

Question 11

pathophysiology of pancreatitis?

Answer 11

CBD obstruction >bile reflex into pancreas > pancreatic duct epithelial injury> acini hyperstimulation & release enzymes > auto-digestion of pancreas

Question 12

recap: what do acini cells secrete?

Answer 12

pancreatic enzymes (exocrine function)

Question 13

recap: hormones (hence endocrine function) are secreted by…

Answer 13

islets of langerhans

Question 14

true/false…

digestive enzymes secreted by acini cells in pancreas are secreted inactive and then activated later on

Answer 14

true…

prevents auto digestion of pancreas

Question 15

symptoms of pancreatitis?

Answer 15

severe acute epigastric pain that radiates to back, nausea, vomiting, jaundice, pyrexia

Question 16

signs of pancreatitis?

Answer 16

shocked, upper ab tenderness & guarding, erythema abinge, Cullen & Grey-Turner signs

Question 17

what is Cullen’s sign?

Answer 17

periumbilical brusing

Question 18

flank bruising is…

Answer 18

Grey-Turner’s sign

Question 19

ix for pancreatitis?

Answer 19

bloods- FBC, LFTs, U &Es, clotting, CRP

imaging- AXR, USS, CT (for severity)

Question 20

what is the main finding and diagnostic sign of pancreatitis?

Answer 20

elevated amylase

Question 21

how to assess severity of pancreatitis?

Answer 21

Glasgow Criteria

Question 22

what is the Glasgow Criteria?

Answer 22

PaO2 (<8pKa)
Age (>55)
Neutrophils (WBC >15x109/l)
Calcium (<2mmol/l)
Renal function (Urea >16mmol/l)
E (AST:ALT >200 or LDH >600)
Albumin (<32g)
Sugar (glucose >10mmol/l)

ANY 3= severe pancreatitis

Question 23

what signs shows mild pancreatitis?

Answer 23

focal areas of necrosis in pancreas

Question 24

fat necrosis shows…

Answer 24

moderate pancreatitis

Question 25

other than 3 points of the Glasgow Criteria, what signs are indicative of severe pancreatitis?

Answer 25

complete pancreatic obstruction w haemorrhage and fat necrosis

Question 26

tx for pancreatitis?

Answer 26

surgical: ERCP, cholecystectomy conservative: fluids, electrolytes, antibiotics

Question 27

tx for chronic pancreatitis?

Answer 27

manage acute episodes creon enzyme replacement therapy Pustow Frey procedure

Question 28

complications of pancreatitis?

Answer 28

pseudocysts, abscess, necrosis ascites, pleural ef due to excess fluid systemic: pulmonary failure, renal failure, sepsis, acidosis, hypocalcaemia

Question 29

why are pseudocysts bad?

Answer 29

can cause biliary obstruction

Question 30

why do abscesses form as a result of pancreatitis?

Answer 30

the necrotic pancreatic tissue becomes infected

Question 31

tx for retroperitoneal abscess?

Answer 31

drain & necrosectomy & lavage

Question 32

acronym for pancreatitis complications?

Answer 32

``` Haemorrhage Disseminated intravascular coagulation ARDS Multi organ failure Necrosis ```

Question 33

what are the types of pancreatic tumours?

Answer 33

exocrine and endocrine tumours

Question 34

what is a pancreatic exocrine tumour?

Answer 34

adenocarcinoma- this constricts the common bile duct

Question 35

what are the endocrine tumours?

Answer 35

gastrinoma, insulinoma, glucagonoma

Question 36

how does gastrinoma present?

Answer 36

ulcers

Question 37

how does insulinoma present?

Answer 37

hypoglycaemia

Question 38

how does glucagonoma present?

Answer 38

hyperglycaemia

Question 39

aetiology of pancreatic tumours?

Answer 39

smoking, charred meat, obesity, diabetes (1&2)

Question 40

s/s of pancreatic tumours?

Answer 40

jaundice, steatorrhea, dark urine, wt loss, back pain

Question 41

dx of pancreatic tumours?

Answer 41

hx, exam, bloods, imaging (USS, CT, MRI)

Question 42

how do you stage a pancreatic tumour?

Answer 42

TNM

Question 43

tx for pancreatic tumour?

Answer 43

ERCP stent insertion, chemo/ radio | surgical: Whipple's, total pancreatectomy

Question 44

what is palliative care for pancreatic tumour?

Answer 44

biliary bypass

Question 45

prognosis of pancreatic tumour?

Answer 45

poor due to its anatomical location it invades local organs easily (especially liver)

Question 46

what is the holy trinity symptoms of intra and extra hepatic duct obstruction and why?

Answer 46

- pale & greasy (steatorrhea) stool = bilirubin given stool dark colour and bile contains enzymes that break down fats so bile cannot reach small intestine hence pale greasy stool is formed - dark urine= bile containing bilirubin backs up and haemorrhages into blood stream and travels to kidneys to be filtered as urine and so dark urine - jaundice= due to bile presence in blood