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Gastrointestinal > Pancreatic Disease > Flashcards

Pancreatic Disease Flashcards

1
Q

what is pancreatitis?

A

inflammation of pancreas

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2
Q

are children or adults mainly affected by pancreatitis?

A

adults

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3
Q

types of pancreatitis?

A

chronic & acute

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4
Q

what does chronic pancreatitis mean?

A

irreversible fibrosis leading to loss of exocrine and endocrine function

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5
Q

what is the aetiology for chronic pancreatitis?

A

CAMP

  • CF
  • Alcohol
  • Malnourishment
  • Pancreatic duct obstruction
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6
Q

dx for chronic pancreatitis?

A

imaging= shows calcification & dilated pancreatic duct

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7
Q

complications of chronic pancreatitis?

A

splenic vein thrombosis, pseudoaneurysm, pancreatic cancer, fluid collection

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8
Q

aetiology of pancreatitis (general)

A

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion bite
Hypercalcaemia/ hyperlipidaemia/ hyperthyroidism 
ERCP damage
Drugs
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9
Q

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

A

polyarteritis nodosa

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10
Q

what is a drug that causes pancreatitis?

A

azathioprine

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11
Q

pathophysiology of pancreatitis?

A

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

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12
Q

recap: what do acini cells secrete?

A

pancreatic enzymes (exocrine function)

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13
Q

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

A

islets of langerhans

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14
Q

true/false…

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

A

true…

prevents auto digestion of pancreas

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15
Q

symptoms of pancreatitis?

A

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

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16
Q

signs of pancreatitis?

A

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

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17
Q

what is Cullen’s sign?

A

periumbilical brusing

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18
Q

flank bruising is…

A

Grey-Turner’s sign

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19
Q

ix for pancreatitis?

A

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

imaging- AXR, USS, CT (for severity)

20
Q

what is the main finding and diagnostic sign of pancreatitis?

A

elevated amylase

21
Q

how to assess severity of pancreatitis?

A

Glasgow Criteria

22
Q

what is the Glasgow Criteria?

A 
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

23
Q

what signs shows mild pancreatitis?

A

focal areas of necrosis in pancreas

24
Q

fat necrosis shows…

A

moderate pancreatitis

25
Q

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

A

complete pancreatic obstruction w haemorrhage and fat necrosis

26
Q

tx for pancreatitis?

A

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

27
Q

tx for chronic pancreatitis?

A

manage acute episodes
creon enzyme replacement therapy
Pustow Frey procedure

28
Q

complications of pancreatitis?

A

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

29
Q

why are pseudocysts bad?

A

can cause biliary obstruction

30
Q

why do abscesses form as a result of pancreatitis?

A

the necrotic pancreatic tissue becomes infected

31
Q

tx for retroperitoneal abscess?

A

drain & necrosectomy & lavage

32
Q

acronym for pancreatitis complications?

A 
Haemorrhage 
Disseminated intravascular coagulation 
ARDS
Multi organ failure
Necrosis
33
Q

what are the types of pancreatic tumours?

A

exocrine and endocrine tumours

34
Q

what is a pancreatic exocrine tumour?

A

adenocarcinoma- this constricts the common bile duct

35
Q

what are the endocrine tumours?

A

gastrinoma, insulinoma, glucagonoma

36
Q

how does gastrinoma present?

A

ulcers

37
Q

how does insulinoma present?

A

hypoglycaemia

38
Q

how does glucagonoma present?

A

hyperglycaemia

39
Q

aetiology of pancreatic tumours?

A

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

40
Q

s/s of pancreatic tumours?

A

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

41
Q

dx of pancreatic tumours?

A

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

42
Q

how do you stage a pancreatic tumour?

A

TNM

43
Q

tx for pancreatic tumour?

A

ERCP stent insertion, chemo/ radio

surgical: Whipple’s, total pancreatectomy

44
Q

what is palliative care for pancreatic tumour?

A

biliary bypass

45
Q

prognosis of pancreatic tumour?

A

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

46
Q

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

A
  • 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

Gastrointestinal (24 decks)

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