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GI PATHOLOGY > Pancreatic disease/surgery > Flashcards

Pancreatic disease/surgery Flashcards

1
Q

Definition of acute pancreatitis

A

Acute inflammation
Upper abdominal pain
Elevation of serum amylase

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2
Q

Causes of acute pancreatitis

A

Alcohol
Gallstones (smaller)
Trauma
Idiopathic

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3
Q

Outline the process of pancreatitis

A

Insult
Release of active digestive enzymes
Autodigestion

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4
Q

Symptoms of pancreatitis

A 
Abdominal pain
Vomiting
Fever
Paralytic ileus
Acute renal failure
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5
Q

Signs of pancreatitis

A 
Tachycardia
Jaundice
Retroperitoneal haemorrhage
Hypoxia
Hypocalcaemia
Hypergclycemia
Acites
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6
Q

What is ERCP?

A

Endoscopic retrograde cholangio pancreatography

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7
Q

What are the process of imaging in suspected pancreatitis?

A

Endoscopic ultrasound first, followed by ERCP if stones present

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8
Q

Tests given in suspected acute pancreatitis

A

Bloods
AXR + CXR
Abdominal USS
CCT

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9
Q

Bloods taken in suspected pancreatitis

A 
Amylase/lipase
FBC, U+E
LFTs
Ca2+
Glucose, Lipids
ABG
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10
Q

Scoring system used for severe pancreatitis?

A

Glasgow Criteria

Score > 3

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11
Q

What factors are tested for in the glasgow criteria for acute pancreatitis?

A 
White cell count
Glucose
Urea
AST
LDH
Albumin
Ca
Arterial O2
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12
Q

Elevated what indicates severe pancreatitis?

A

CRP >150mg/L

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13
Q

General Management of Acute pancreatitis

A 
Analgesia, Fluids, ?NG
Blood transfusion
Urine output
O2
?insulin, Ca
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14
Q

Management of pancreatic necrosis in acute pancreatitis

A

CT guided aspiration

Antibiotics +/- surgery

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15
Q

Management of gallstones in acute pancreatitis

A

USS/MRCP/ERCP

Cholecystectomy

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16
Q

Management of abscess in acute pancreatitis

A

Antibiotics

Drainage

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17
Q

What is a pseudocyst?

A

Fluid collection without an epithelium

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18
Q

Symptoms of pseudocyst

A

Persistently high amylase

May be pain

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19
Q

How is pseudocyst diagnosed?

A

Ultrasound or CT

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20
Q

Complications of pseudocyst

A

Jaundice, infection, rupture

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21
Q

When is treatment recommended for a pseudocyst?

A

Drainage or surgery

Persistent pain, complications

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22
Q

Definition of chronic pancreatitis?

A

Continuing inflammation with irreversible glandular destruction - pain and loss of function

23
Q

In what group is chronic pancreatitis most common?

A

Males, 35-50

24
Q

What are the most common causes of chronic pancreatitis?

A

Alcohol (80%)
Cystic fibrosis
Congenital
Hypercalcaemia

25
Q

What are the congenital causes of chronic pancreatitis?

A

Annular pancreas

Pancreas divisum

26
Q

What are the most recognised genes in hereditary pancreatitis?

A

PRSS1
CFTR
SPINK1

27
Q

What general processes lead to chronic pancreatitis?

A

Duct obstruction
Abnormal Oddi function
Genetic polymorphisms

28
Q

What bolus commonly cause duct obstruction?

A

Calculi
Inflammation
Protein plugs

29
Q

How can abnormal sphincter of oddi function cause pancreatitis?

A

Spasm (increasing pressure in pancreas)

Relaxation (causing duodenal reflux)

30
Q

What is the pathological process leading to chronic pancreatitis?

A 
Glandular atrophy leading to fibrosis 
Ducts dilated and strictured
Calcified secretions
Nerves exposed
Thrombosis of veins leading to portal hypertension
31
Q

What are the clinical features of chronic pancreatitis?

A

Asymptomatic

32
Q

What are the clinical features of progressed pancreatitis?

A

Abdominal pain, worse after eating
Weight loss
Steatorrhoea
Diabetes

33
Q

How does pancreatic Exocrine insufficiency present itself?

A

Steatorrhoea (fat malabsorption)
Weight loss (protein malabsorption)
Malnutrition (fat sol vits)

34
Q

How does pancreatic endocrine insufficiency present itself?

A

Diabetes

35
Q

Investigations in chronic pancreatitis?

A 
AXR - panc. calcification
USS, EUS
CT scan
Bloods
Pancreatic function tests
36
Q

What blood tests are used for chronic pancreatitis?

A

Amylase (increased)
Albumin, Ca/Mg/B12 (decreased)
LFT, Prothrombin, gluc (increased)

37
Q

What factors have to be managed in chronic pancreatitis?

A

Pain

Endocrine + exocrine function

38
Q

How is pain managed in chronic pancreatitis?

A 
Avoid alcohol
Enzyme supplements
Opiates 
Coeliac plexus block
?surgery
39
Q

How is reduced exocrine function managed in chronic pancreatitis?

A

Low fat diet
Pancreatic enzyme supps
Vitamin supplements

40
Q

How is reduced endocrine function managed in chronic pancreatitis?

A

Insulin

41
Q

Prognosis of chronic pancreatitis

A

20% mort abstinence

50% mort continued alcohol

42
Q

Carcinoma of the pancreas is most likely to effect which groups?

A

Males
60-80
Westerners

43
Q

The most common type of cancer in the pancreas?

A

Duct cell mucinous adenocarcinoma (75%)

44
Q

Clinical features of pancreatic carcinoma?

A 
ABDOMINAL PAIN
JAUNDICE
WEIGHT LOSS
Steatorrhoea 
Vomiting
Subcutaneous fat nodules
Ascites
45
Q

Physical signs of pancreatic carcinoma

A 
Hepatomegaly
Jaundice
Abdominal mass, tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
46
Q

How is suspected pancreatic carcinoma investigated?

A

USS, CT, EUS

47
Q

How is suspected pancreatic carcinoma investigated when presenting with jaundice and a mass?

A

ERCP with stent

EUS and biopsy

48
Q

How is suspected pancreatic carcinoma investigated when presenting with a mass but no jaundice?

A

EUS with biopsy

49
Q

After a carcinoma is confirmed, what must then be confirmed?

A

Whether or not the cancer is operable

50
Q

What proportion of tumours are operable?

A

<10%

51
Q

What surgery is given to operable pancreatic carcinomas?

A

Whipples procedure

pancreatoduodenectomy

52
Q

What treatment is given in pancreatic carcinoma if it is inoperable

A

Palliation - stent
Pain control
Chemotherapy is in trials

53
Q

What are the risk factors for pancreatic cancer?

A

Smoking
Chronic pancreatitis
Adult onset DM

54
Q

How does cancer at the head of the pancreas present?

A 
OBSTRUCTIVE JAUNDICE
DM
Abdominal pain
Weight loss
Vomiting
Pancreatitis

GI PATHOLOGY (20 decks)

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