Pancreatic disease/surgery Flashcards
Definition of acute pancreatitis
Acute inflammation
Upper abdominal pain
Elevation of serum amylase
Causes of acute pancreatitis
Alcohol
Gallstones (smaller)
Trauma
Idiopathic
Outline the process of pancreatitis
Insult
Release of active digestive enzymes
Autodigestion
Symptoms of pancreatitis
Abdominal pain Vomiting Fever Paralytic ileus Acute renal failure
Signs of pancreatitis
Tachycardia Jaundice Retroperitoneal haemorrhage Hypoxia Hypocalcaemia Hypergclycemia Acites
What is ERCP?
Endoscopic retrograde cholangio pancreatography
What are the process of imaging in suspected pancreatitis?
Endoscopic ultrasound first, followed by ERCP if stones present
Tests given in suspected acute pancreatitis
Bloods
AXR + CXR
Abdominal USS
CCT
Bloods taken in suspected pancreatitis
Amylase/lipase FBC, U+E LFTs Ca2+ Glucose, Lipids ABG
Scoring system used for severe pancreatitis?
Glasgow Criteria
Score > 3
What factors are tested for in the glasgow criteria for acute pancreatitis?
White cell count Glucose Urea AST LDH Albumin Ca Arterial O2
Elevated what indicates severe pancreatitis?
CRP >150mg/L
General Management of Acute pancreatitis
Analgesia, Fluids, ?NG Blood transfusion Urine output O2 ?insulin, Ca
Management of pancreatic necrosis in acute pancreatitis
CT guided aspiration
Antibiotics +/- surgery
Management of gallstones in acute pancreatitis
USS/MRCP/ERCP
Cholecystectomy
Management of abscess in acute pancreatitis
Antibiotics
Drainage
What is a pseudocyst?
Fluid collection without an epithelium
Symptoms of pseudocyst
Persistently high amylase
May be pain
How is pseudocyst diagnosed?
Ultrasound or CT
Complications of pseudocyst
Jaundice, infection, rupture
When is treatment recommended for a pseudocyst?
Drainage or surgery
Persistent pain, complications
Definition of chronic pancreatitis?
Continuing inflammation with irreversible glandular destruction - pain and loss of function
In what group is chronic pancreatitis most common?
Males, 35-50
What are the most common causes of chronic pancreatitis?
Alcohol (80%)
Cystic fibrosis
Congenital
Hypercalcaemia
What are the congenital causes of chronic pancreatitis?
Annular pancreas
Pancreas divisum
What are the most recognised genes in hereditary pancreatitis?
PRSS1
CFTR
SPINK1
What general processes lead to chronic pancreatitis?
Duct obstruction
Abnormal Oddi function
Genetic polymorphisms
What bolus commonly cause duct obstruction?
Calculi
Inflammation
Protein plugs
How can abnormal sphincter of oddi function cause pancreatitis?
Spasm (increasing pressure in pancreas)
Relaxation (causing duodenal reflux)
What is the pathological process leading to chronic pancreatitis?
Glandular atrophy leading to fibrosis Ducts dilated and strictured Calcified secretions Nerves exposed Thrombosis of veins leading to portal hypertension
What are the clinical features of chronic pancreatitis?
Asymptomatic
What are the clinical features of progressed pancreatitis?
Abdominal pain, worse after eating
Weight loss
Steatorrhoea
Diabetes
How does pancreatic Exocrine insufficiency present itself?
Steatorrhoea (fat malabsorption)
Weight loss (protein malabsorption)
Malnutrition (fat sol vits)
How does pancreatic endocrine insufficiency present itself?
Diabetes
Investigations in chronic pancreatitis?
AXR - panc. calcification USS, EUS CT scan Bloods Pancreatic function tests
What blood tests are used for chronic pancreatitis?
Amylase (increased)
Albumin, Ca/Mg/B12 (decreased)
LFT, Prothrombin, gluc (increased)
What factors have to be managed in chronic pancreatitis?
Pain
Endocrine + exocrine function
How is pain managed in chronic pancreatitis?
Avoid alcohol Enzyme supplements Opiates Coeliac plexus block ?surgery
How is reduced exocrine function managed in chronic pancreatitis?
Low fat diet
Pancreatic enzyme supps
Vitamin supplements
How is reduced endocrine function managed in chronic pancreatitis?
Insulin
Prognosis of chronic pancreatitis
20% mort abstinence
50% mort continued alcohol
Carcinoma of the pancreas is most likely to effect which groups?
Males
60-80
Westerners
The most common type of cancer in the pancreas?
Duct cell mucinous adenocarcinoma (75%)
Clinical features of pancreatic carcinoma?
ABDOMINAL PAIN JAUNDICE WEIGHT LOSS Steatorrhoea Vomiting Subcutaneous fat nodules Ascites
Physical signs of pancreatic carcinoma
Hepatomegaly Jaundice Abdominal mass, tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy
How is suspected pancreatic carcinoma investigated?
USS, CT, EUS
How is suspected pancreatic carcinoma investigated when presenting with jaundice and a mass?
ERCP with stent
EUS and biopsy
How is suspected pancreatic carcinoma investigated when presenting with a mass but no jaundice?
EUS with biopsy
After a carcinoma is confirmed, what must then be confirmed?
Whether or not the cancer is operable
What proportion of tumours are operable?
<10%
What surgery is given to operable pancreatic carcinomas?
Whipples procedure
pancreatoduodenectomy
What treatment is given in pancreatic carcinoma if it is inoperable
Palliation - stent
Pain control
Chemotherapy is in trials
What are the risk factors for pancreatic cancer?
Smoking
Chronic pancreatitis
Adult onset DM
How does cancer at the head of the pancreas present?
OBSTRUCTIVE JAUNDICE DM Abdominal pain Weight loss Vomiting Pancreatitis
