Pancreatic Diseases

Question 1

How alcohol affects pancreas

Answer 1

It stimulates pancreatic cells to secrete lytic enzymes which results in autolysis of the pancreas

Question 2

Medications associated with pancreatitis

Answer 2

1-metronidazole
2-azathioprine
3-tetracycline
4-pentamidine
5-(6-mercaptopurine)
6-didanosine
7-sulphonamides,
8-Octeriotide
9-furosemide
10-valproic acid

Question 3

Causes of pancreatitis

Answer 3

1-Gall stones (more in 👩🏻‍🦰)
2-alcohol (>👱🏼‍♂️)
3-Hypertriglycedimia 
4-Drugs
5-Genetic 

Miscellaneous causes:

Trauma
Post ERCP pancreatitis
Hypercalcemia
Viral infection, e.g. mumps and cytomegalovirus

Question 4

Complications of pancreatitis

Answer 4

Local complications include

1-Pancreatic pseudocyst
2-Acute necrosis
3-Acute peripancreatic fluid collection
4-Portosplenomesenteric venous thrombosis
5-Infection

Question 5

Imagining in pancreatitis

Answer 5

*Abdominal ultrasound: enlargement or edema, fluid, gall stone disease.

*Abdominal CT scan with contrast :
severity and extent of inflammation, necrosis, causes

*MRI :
enlargement and necrosis.

*ERCP: can be diagnostic and therapeutic in gall stone pancreatitis.
Papillotomy can be performed endoscopically in cases where surgery is contraindicated

Question 6

Pain killers for acute pancreatitis

Answer 6

fentanyl or meperidine is indicated for the severe abdominal pain.

Morphine should be avoided in cases with gall stone pancreatitis as it increases the pressure of the spincter of Oddi.

Question 7

Rule of Antibiotics in pancreatitis

Answer 7

Antibiotic therapy is mainly for patients with infection.

1-Imipenem
2- cilastatin

Question 8

Pancreatic pseudocyst

Answer 8

It is persistent peripancreatic fluid collection. They lack epithelialized wall but are surrounded by adjacent structures such as pancreas, colon, omentum and stomach.

Pseudocysts are usually asymptomatic but sometimes they present with dull pain and dyspepsia. Intestinal obstruction with nausea and vomiting due to expansion of large cysts may develop. Digestion of the wall of blood vessels can lead to pseudoaneurysms and GI bleeding.

Question 9

Acute pancreatitis after ERCP mechanism

Answer 9

ERCP causes either mechanical damage to the duct or post-intervention edema of the duct. This leads to accumulation of pancreatic enzymes in the duct and eventually outpouring in and around the parenchyma. This leads to damage to the organ and the surrounding structures.

Question 10

Low serum calcium level in acute pancreatitis

Answer 10

The release of pancreatic enzyme from the gland damages the surrounding mesenteric fat by digesting it. The free fatty acids released combine with calcium to form calcium salt of fatty acids, thereby decreasing serum calcium levels.

Question 11

What is the most common complication of ERCP?

Answer 11

acute pancreatitis. It often is self-limiting, but, if severe, it can be life-threatening

Question 12

Enzymes that increase in acute pancreatitis

Answer 12

1-Glucose
2- amylase
3- lipase
4- trypsinogen
5- CRP