Pancreatic Disease Flashcards
What are examples of pancreatic disease?
Acute pancreatitis
Chronic pancreatitis
Pancreatic cancer
Neuroendocrine tumours
Cystic fibrosis
What is acute pancreatitis?
Acute inflammation of the pancreas
Where is the pain usually due to acute pancreatitis?
Upper abdominal pain
How does acute pancreatitis change serum levels of amylase?
Elevation of serum amylase (4x upper limit of normal)
What can acute pancreatitis be associated with in severe cases?
Multi-organ failure
What is the incidence of acute pancreatitis?
20-300 cases/million
What is the mortality of acute pancreatitis?
6-12/million
What is the aetiology of acute pancreatitis?
Gallstones
Ethanol (Alcohol)- Mostly
Trauma
Steroids
Mumps
Autoimmune disease, such as SLE
Scorpion venom (a rare and unlikely cause in most countries)
Hypercalcaemia
Endoscopic retrograde cholangio-pancreatography (ERCP)
Drugs, such as Azathioprine, NSAIDs, or Diuretics
10% Idiopathic cause
What are examples of drugs that can cause acute pancreatitis?
Steroids
Azathioprine
Diuretics
What are examples of viruses that can cause acute pancreatitis?
Mumps
Coxsackie B4
HIV
CMV
What are metabolic changes that can cause acute pancreatitis?
Increased calcium
Increased triaglycerides
Decreased temperature
Explain the pathogenesis of acute pancreatitis?
1) Primary insult
2) Release of activated pancreatic enzymes
3) Autodigestion causing pro-inflammatory cytokines, reactive oxygen species, oedema, fat necrosis and haemorrhage
What are the clinical features of acute pancreatitis?
Abdominal pain
Vomiting
Pyrexia
Tachycardia
Oliguria
Jaundice
Paralytic ileus
Retroperitoneal haemorrhage
Hypoxia (respiratory failure in most severe cases)
Hypocalcaemia
Hyperglycaemia (occsaionally diabetic coma)
Effusions
What is paralytic ileus?
Obstruction of the intestine due to paralysis of the intestinal muscles
What is oligouria?
Urine output less than:
1mL/kg/h in infants
0.5mL/kg/h in children
400ml or 500ml per 24 hours in adults
What is strange about ERCP and acute panceatitis?
ERCP is a cause and a treatment of acute pancreatitis
What investigations are done for acute pancreatitis?
Blood tests
Abdominal and chest x-ray
Abdominal ultrasound
CT scan (contrast enhanced)
What is being looked for in an abdominal ultrasound for acute pancreatitis?
Pancreatic oedema
Gallstones
Pseudocyst
What blood tests are done for acute pancreatitis?
Amylase
Lipase
FBC
LFTs
Calcium
Glucose
Arterial blood gases
Lipids
Coagulation screen
What is used to assess the severity of acute pancreatitis?
Glasgow criteria
Using the glasgow criteria, what is considered to be severe pancreatitis?
A score of 3 or more
What is assessed with the glasgow criteria?
PANCREAS:
pO2 <8kPa,
Age >55yrs,
Neutrophils (/WCC) >15×109/L,
Calcium <2mmol/L,
Renal function (Urea) >16mmol/L,
Enzymes LDH>600U/L or AST>200U/L,
Albumin <32g/L,
Sugar (blood glucose) >10mmol/L
What is LDH?
Lactate dehydrogenase
What is another indicator for severe pancreatitis that is not included in the Glasgow criteria?
CRP>150mg/L
What is the general management for acute pancreatitis?
Mainly supportive care: Treat underlying case:
Analgesia
IV fluids
Blood transfusion (Hb<10g/dL)
Monitor urine output (catheter)
Naso-gastric tube
Oxygen
May need insulin
Rarely required calcium supplements
Nutrition (enteral or parenteal) in severe cases
What is the specific management for acute pancreatitis if pancreatitic necrosis is occuring?
CT guided aspiration
Antibiotics and surgery
What is the specific management for acute pancreatitis if gallstones are present?
EUS/MRCP/ERCP
Cholecystectomy
What are possible complications of acute pancreatitis?
Abscess
Pseudocyst
What is the management of an abscess due to acute pancreatitis?
Give antibiotics and drainge
What is a pseudocyst?
Fluid collection without an epithelial lining
What is a pseudocyst diagnosed by?
Ultrasound or CT scan
What are possible complications of a pseudocyst?
Jaundice
Infection
Haemorrhage
Rupture
What is the treatment for pseudocyst?
If <6cm resolves spontaneously
If >=6cm, persistent pain or complications then endoscopic drainage or surgery