Pancreatic Disease and Surgery of Pancreatic Disease Flashcards
How does acute pancreatitis present?
Upper abdominal pain with elevated serum amylase (>4 x the upper limit of normal)
What are the two main causes of acute pancreatitis?
Alcohol abuse
Gallstones
What are some of the less common causes of acute pancreatitis?
Blunt/postoperative/post-ERCP trauma Drugs Viruses Pancreatic carcinoma Auto-immune Idiopathic
What are the symptoms of acute pancreatitis?
Nausea
Vomiting
Anorexia
Abdominal pain
What investigations should be done in cases of suspected acute pancreatitis?
Blood tests- amylase/lipase, FBC, U&Es, LFTs, Ca2+, glucose, arterial blood gases, lipids, coagulation screen
Abdominal X-ray, ultrasound and CT (contrast enhanced)
Chest X-ray
How is the severity of acute pancreatitis assessed?
Using the Glasgow Criteria: White cell count >15 x 109/l Blood glucose >10 mmol/l Blood urea >16mmol/l AST >200 iu/l LDH >600 iu/l Serum albumin <32 g/l Serum calcium <2.0 mmol/l Arterial PO2 <7.5 kPa A score > 3 indicates severe disease. CRP > 150 mg/L also indicates severe disease
What general interventions may need to be made in cases of acute pancreatitis?
Analgesia IV fluids Blood transfusion Monitor urine output (catheter) Naso-gastric tube Oxygen May need insulin Calcium supplements (rare) Nutrition in severe cases
What specific interventions may need to be made in cases of acute pancreatitis?
To fix pancreatic necrosis, CT guided aspiration, antibiotics and perhaps surgery will be necessary
Treatment of gallstones
What are the possible complications of acute pancreatitis and how are each managed?
Abscess- antibiotics + drainage
Pseudocyst- <6cm will resolve spontaneously, endoscopic drainage or surgery may be required if persistent pain
What are the causes of chronic pancreatitis?
Alcohol Cystic fibrosis Congenital anatomical abnormalities (annular pancreas + pancreas divisum) Hereditary Hypercalcaemia Diet
Describe the pathogenesis of chronic pancreatitis
Glandular atrophy occurs, resulting in cells being replaced by fibrous tissue
Ducts become dilated, tortous and strictured
Inspissated secretions may calcify
Nerves left exposed due to loss of perineural cells
Splenic, superior mesenteric and portal veins may thrombose, leading to portal hypertension
What are the symptoms of chronic pancreatitis?
Abdominal pain Weight loss Steatorrhea Diabetes Jaundice Portal hypertension GI haemorrhage
What investigations may be useful in suspected cases of chronic pancreatitis?
Plain abdominal X-ray Ultrasound EUS CT scan Blood tests Pancreatic function tests
What interventions should be made in cases of chronic pancreatitis?
Pain control
Low fat diet
Pancreatic enzyme supplements
Insulin for diabetes mellitus
What are the risk factors for carcinoma of the pancreas?
Males > females
Ageing
More common in western countries
