Pancreatic Disease: Medical and Endoscopic Management

Question 1

Regarding the Atlanta classification for pancreatic fluid, a common complication of pancreatitis, what can interstitial edematous pancreatitis fluid be known as <4 weeks?

Answer 1

Acute peripancreatic fluid collection

Question 2

Regarding the Atlanta classification for pancreatic fluid, a common complication of pancreatitis, what can interstitial edematous pancreatitis fluid be known as >4 weeks?

Answer 2

Pseudocyst

Question 3

Regarding the Atlanta classification for pancreatic fluid, a common complication of pancreatitis, what can necrotizing pancreatitis fluid be known as <4 weeks?

Answer 3

Acute necrotic collection

Question 4

Regarding the Atlanta classification for pancreatic fluid, a common complication of pancreatitis, what can necrotizing pancreatitis fluid be known as >4 weeks?

Answer 4

Walled off necrosis

Question 5

Which complication of pancreatitis can lead to pleural effusion?

Answer 5

Pancreatico-pleural fistula

Question 6

What would be shown in the sampling of the pleural fluid to suggest the fluid had been in contact with the pancreas?

Answer 6

Very high amylase

Question 7

What is the medical management of pancreatico-pleural fistula?

Answer 7

Pleural effusion aspiration
Advise smoking and alcohol cessation
Consider Octreotide injections

Question 8

What would draining the pleural effusion help to reduce?

Answer 8

The patient’s SOB

Question 9

What is the medical management for someone with pancreatic ascites?

Answer 9

NJ tube feeding, Octreotide injection and draining of the ascites.

Question 10

If pancreatic ascites reoccurs, what can be done?

Answer 10

ERCP to insert a pancreatic duct stent

Question 11

RECAP- what is chronic pancreatitis?

Answer 11

Continuing inflammatory disease of the pancreas which impairs endocrine and exocrine function.

Question 12

What causes chronic pancreatitis?

Answer 12

Alcohol
Cystic fibrosis
Congenital anatomical abnormalities
Genetics
Hypercalcaemia
Autoimmune diseases- coeliac disease, important to rule out

Question 13

What is the main cause of chronic pancreatitis?

Answer 13

Alcohol

Question 14

What are some of the clinical features of chronic pancreatitis?

Answer 14

Abdominal pain, exocrine and endocrine insufficiency

Question 14

What may exocrine insufficiency manifest as?

Answer 14

Low BMI
Vitamin Deficiency
Osteoporosis

Question 15

What may endocrine insufficiency manifest as?

Answer 15

Diabetes

Question 16

Which investigations are the most sensitive when looking for chronic pancreatitis?

Answer 16

MRI
Endoscopic ultrasound

Question 17

Name some contributing factors to chronic pancreatitis which can be sorted via endoscopy.

Answer 17

Pancreatic duct stones
Pancreatic duct stricture

Question 18

What are some of the worrying features of a pancreatic cyst?

Answer 18

> 10mm
Jaundice
Have an enhancing nodule

Question 19

What is the preferred form of radiology for the imaging of pancreatic cystic lesions?

Answer 19

MRI, most accurate

Question 20

What are some of the clinical features of pancreatic cancer?

Answer 20

Abdominal pain
Painless obstructive jaundice
Weight loss
Anorexia/fatigue/vomiting/diahorrea or steatorrhea

Question 21

What is the most common symptom for cancer of the pancreatic tail?

Answer 21

Abdominal pain

Question 22

Where would the cancer tend to affect the pancreas for painless obstructive jaundice to be observed?

Answer 22

Pancreatic head

Question 23

Which treatment options can be considered for head of the pancreas cancer?

Answer 23

Radio Frequency Ablation

Question 24

What is one of the most effective forms of pain management in those with pancreatic cancer?

Answer 24

Coeliac plexus block

Question 25

How can coeliac plexus block be carried out?

Answer 25

Guided by endoscopic ultrasound