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Alimentary System > Pancreatic Disease/Surgery of Pancreatic Disorders > Flashcards

Pancreatic Disease/Surgery of Pancreatic Disorders Flashcards

1
Q

What is acute pancreatitis and how does it present?

A

Acute inflammation of the pancreas presenting with upper abdominal pain and elevation of serum amylase

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2
Q

What is the normal level of elevated serum amylase in acute pancreatitis?

A

4 times the normal upper limit

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3
Q

What are the two main causes of acute pancreatitis?

A

Alcohol abuse

Gallstones

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4
Q

Give the less common causes of acute pancreatitis

A 
Trauma 
Drugs
Viruses 
Pancreatic carcinoma 
Metabolic disorders 
Autoimmune disorders 
Idiopathic
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5
Q

Other than abdominal pain, what are the typical presentations of acute pancreatitis?

A 
Nausea and vomiting 
Collapse due to fluid loss 
Pyrexia 
Dehydration 
Abdominal tenderness 
Circulatory failure
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6
Q

What is the first line treatment in suspected acute pancreatitis?

A

ERCP

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7
Q

What would an endoscopic ultrasound be useful for showing in acute pancreatitis?

A

Gallstones/obstruction of the bile or pancreatic ducts, pancreatic oedema or pseudocysts

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8
Q

Name 3 other investigations done in suspected acute pancreatitis

A

Amylase and lipase
Bloods - FBC, ABGs, U+Es, calcium, glucose, lipids, coagulations screen
AXR/CXR
Contrast CT

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9
Q

What scoring system is used to determine the severity of acute pancreatitis and what score would indicate severe pancreatitis?

A

The Glasgow Criteria Score

Severe if score > 3

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10
Q

What treatments are used in the general management of acute pancreatitis?

A 
Analgesia 
IV fluids 
Blood transfusion 
Urine output monitoring 
Naso-gastric tube if unable to eat
Nutrition 
Oxygen 
Occasionally insulin
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11
Q

If pancreatic necrosis is present in pancreatitis, what treatment is necessary?

A

CT guided aspiration, antibiotics and/or surgery

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12
Q

If the cause of acute pancreatitis is gallstones, what may be used to treat?

A

EUS, MRCP or ERCP

Cholecystectomy

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13
Q

What surgical treatment is indicated in acute pancreatitis presenting with jaundice or cholangitis?

A

Cholecystectomy

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14
Q

When would a necrosectomy be indicated?

A

In acute pancreatitis with necrosis

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15
Q

What treatment is indicated for a pseudocyst in acute pancreatitis?

A

Diagnosis via ultrasound or CT then endoscopic drainage or surgery if persistent pain or complications

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16
Q

At would diameter would a pseudocyst normally resolve without medical/surgical treatment?

A

< 6cm

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17
Q

What is chronic pancreatitis?

A

Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function

18
Q

What is the major cause of chronic pancreatitis?

A

Alcohol abuse

19
Q

What is the pathogenesis of chronic pancreatitis?

A

Duct obstruction leading to calculi formation, inflammation and protein plugs

20
Q

What happens to the pancreatic ducts in chronic pancreatitis?

A

Become dilated, tortuous and strictured, calcification may occur

21
Q

What veins may thrombose and cause portal hypertension as a result of chronic pancreatitis?

A

Splenic, superior mesenteric and portal veins

22
Q

What is the typical presentation of chronic pancreatitis?

A 
Upper abdominal pain and weight loss 
Endocrine and exocrine insufficiencies 
Jaundice 
Portal hypertension 
GI haemorrhage 
Pseudocysts 
Pancreatic carcinoma
23
Q

What features of abdominal pain are indicative of chronic pancreatitis?

A

Pain aggravated by binge drinking

Pain more frequent and less treatable by abstinence

24
Q

What investigations are done in suspected chronic pancreatitis?

A 
Abdominal x-ray 
Ultrasound 
EUS 
CT 
Bloods 
Pancreatic function tests
25
Q

What are the main treatments of chronic pancreatitis?

A

Pain control is central to management - opiates, coeliac plexus block, referral to pain clinic or psychologist
Abstinence from alcohol and cigarettes
Endoscopic treatment of stones and strictures
Treatment of endocrine or exocrine insufficiencies

26
Q

Why should patients with chronic pancreatitis abstain from cigarettes?

A

Cigarettes won’t cause chronic pancreatitis but will aggravate it once it is established

27
Q

Under what circumstances would surgical treatment of chronic pancreatitis be given?

A

Suspicion of malignancy

End stage disease with intractable pain

28
Q

What is the prognosis of chronic pancreatitis in patients who continue to drink alcohol?

A

50% 10 year survival rate

29
Q

What is the main histological type of pancreatic carcinoma?

A

Duct cell mucinous adenocarcinoma (75%)

30
Q

What location in the pancreas is the most common site of carcinomas?

A

Head of the pancreas (60%)

31
Q

What are the histological types of pancreatic carcinoma?

A

Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell carcinoma

32
Q

What histological type of pancreatic cancer has the best prognosis?

A

Cystadenocarcinoma

33
Q

What are the three main common presentations of pancreatic carcinoma?

A 
Upper abdominal pain (75%)
Painless obstructive jaundice (25%) 
Weight loss (90%)
34
Q

What are the possible physical signs of pancreatic carcinoma?

A 
Hepatomegaly 
Jaundice 
Abdominal mass and/or tenderness 
Ascites
Splenomegaly 
Supraclavicular lymphadenopathy 
Palpable gall bladder (ampullary carcinoma)
35
Q

What investigations would be done if suspecting pancreatic carcinoma?

A 
USS/EUS 
CT 
MRI 
ERCP 
Percutaneous needle biopsy 
Laparoscopic/laparotomy investigation
36
Q

What percentage of pancreatic carcinomas are operable at the stage of presentation?

A

10%

37
Q

What is are the main treatments of pancreatic carcinoma?

A

Palliative care for jaundice - stent, palliative surgery

Pain control - opiates, coeliac plexus block, radiotherapy

38
Q

What is the mean survival of patients with inoperable pancreatic carcinoma?

A

< 6 months

39
Q

What is the 5 year survival rate of patients with ampullary tumours?

A

30-50%

40
Q

What are the surgical management options for pancreatic carcinoma?

A

PPPD
Palliative drainage via ERCP, PTC stenting, or palliative bypass
Palliative bypass or duodenal stent for duodenal obstruction
Palliative bypass at the time of surgery in the event of a failed resection

Alimentary System (29 decks)

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