Pancreatic Disease Flashcards
what is pancreatitis?
inflammation of pancreas
are children or adults mainly affected by pancreatitis?
adults
types of pancreatitis?
chronic & acute
what does chronic pancreatitis mean?
irreversible fibrosis leading to loss of exocrine and endocrine function
what is the aetiology for chronic pancreatitis?
CAMP
- CF
- Alcohol
- Malnourishment
- Pancreatic duct obstruction
dx for chronic pancreatitis?
imaging= shows calcification & dilated pancreatic duct
complications of chronic pancreatitis?
splenic vein thrombosis, pseudoaneurysm, pancreatic cancer, fluid collection
aetiology of pancreatitis (general)
Idiopathic
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion bite Hypercalcaemia/ hyperlipidaemia/ hyperthyroidism ERCP damage Drugs
what is an example of an autoimmune disease that causes pancreatitis?
polyarteritis nodosa
what is a drug that causes pancreatitis?
azathioprine
pathophysiology of pancreatitis?
CBD obstruction >bile reflex into pancreas > pancreatic duct epithelial injury> acini hyperstimulation & release enzymes > auto-digestion of pancreas
recap: what do acini cells secrete?
pancreatic enzymes (exocrine function)
recap: hormones (hence endocrine function) are secreted by…
islets of langerhans
true/false…
digestive enzymes secreted by acini cells in pancreas are secreted inactive and then activated later on
true…
prevents auto digestion of pancreas
symptoms of pancreatitis?
severe acute epigastric pain that radiates to back, nausea, vomiting, jaundice, pyrexia
signs of pancreatitis?
shocked, upper ab tenderness & guarding, erythema abinge, Cullen & Grey-Turner signs
what is Cullen’s sign?
periumbilical brusing
flank bruising is…
Grey-Turner’s sign
ix for pancreatitis?
bloods- FBC, LFTs, U &Es, clotting, CRP
imaging- AXR, USS, CT (for severity)
what is the main finding and diagnostic sign of pancreatitis?
elevated amylase
how to assess severity of pancreatitis?
Glasgow Criteria
what is the Glasgow Criteria?
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
what signs shows mild pancreatitis?
focal areas of necrosis in pancreas
fat necrosis shows…
moderate pancreatitis
other than 3 points of the Glasgow Criteria, what signs are indicative of severe pancreatitis?
complete pancreatic obstruction w haemorrhage and fat necrosis
tx for pancreatitis?
surgical: ERCP, cholecystectomy
conservative: fluids, electrolytes, antibiotics
tx for chronic pancreatitis?
manage acute episodes
creon enzyme replacement therapy
Pustow Frey procedure
complications of pancreatitis?
pseudocysts, abscess, necrosis ascites, pleural ef due to excess fluid
systemic: pulmonary failure, renal failure, sepsis, acidosis, hypocalcaemia
why are pseudocysts bad?
can cause biliary obstruction
why do abscesses form as a result of pancreatitis?
the necrotic pancreatic tissue becomes infected
tx for retroperitoneal abscess?
drain & necrosectomy & lavage
acronym for pancreatitis complications?
Haemorrhage Disseminated intravascular coagulation ARDS Multi organ failure Necrosis
what are the types of pancreatic tumours?
exocrine and endocrine tumours
what is a pancreatic exocrine tumour?
adenocarcinoma- this constricts the common bile duct
what are the endocrine tumours?
gastrinoma, insulinoma, glucagonoma
how does gastrinoma present?
ulcers
how does insulinoma present?
hypoglycaemia
how does glucagonoma present?
hyperglycaemia
aetiology of pancreatic tumours?
smoking, charred meat, obesity, diabetes (1&2)
s/s of pancreatic tumours?
jaundice, steatorrhea, dark urine, wt loss, back pain
dx of pancreatic tumours?
hx, exam, bloods, imaging (USS, CT, MRI)
how do you stage a pancreatic tumour?
TNM
tx for pancreatic tumour?
ERCP stent insertion, chemo/ radio
surgical: Whipple’s, total pancreatectomy
what is palliative care for pancreatic tumour?
biliary bypass
prognosis of pancreatic tumour?
poor due to its anatomical location it invades local organs easily (especially liver)
what is the holy trinity symptoms of intra and extra hepatic duct obstruction and why?
- 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
