Pancreatic Disorders Flashcards
What is the pathology of Pancreatic cancer?
Ductal adenocarcinoma
60% head
25% body
15% tail
What types of pancreatic cancer have better prognosis?
Ampullary tumours
Tumours of pancreatic islet cells
What is the genetics of pancreatic cancer?
95% have mutations in the KRAS2 gene
What are the risk factors for pancreatic cancer?
Smoking
Alcohol
Carcinogens
DM
Chronic pancreatitis
Inherited predisposition
What is the common presentation of pancreatic cancer?
Painless obstructive Jaundice
Epigastric pain
Palpable gall bladder
Anorexia
Weight loss
Vomiting
Hepatomegaly
Splenomegaly
Lymphadenopathy
Ascites
What investigations are done for pancreatic cancer?
Bloods
Tumour markers
US
CT
ERCP/MRCP
EUS
What is the staging algorithm for potentially resectable pancreatic cancer?
USS -> ERCP+Stent -> Spiral CT/MRI -> Laparscopy -> Lapartomy -> Resection
What is the treatment options for pancreatic cancer?
Surgery: Resection (Pancreatoduodenectomy; Whipple)
Laparoscopic excision
Post op chemo
Palliation of jaundice: stent insertion
Palliative bypass for duodenal obstruction
What is the prognosis of pancreatic cancer?
Mean survival <6 months
5 year survival 3%
What are the 2 main causes of acute pancreatitis?
Gallstones
Alcohol
How does alcohol cause acute pancreatitis?
Direct injury
Or increased sensitivity to stimulation
How do gallstones cause acute pancreatitis?
Raised pancreatic ductal pressure
What are the symptoms of acute pancreatitis?
- Abdominal pain
- Nausea, vomiting
- Collapse
What are the signs of acute pancreatitis?
- Pyrexia
- Dehydration
- Abdominal tenderness
- Circulatory failure
What are the local complications of acute pancreatitis?
- Acute fluid collection
- Pseudocyst
- Pancreatic abscess
- Pancreatic necrosis
What is the definitive management of acute pancreatitis?
Manage gall stones
Alcohol abstinence
Fluid collection
Management of necrosis
What is chronic pancreatitis?
Irreversible morphological changes leading to chronic pain and impairment of exocrine/endocrine pancreatic function
What does o-a-tiger stand for?
Obstruction
Autoimmune
Toxin
Idiopathic
Genetic
Environmental
Recurrent illness
What percentage of chronic pancreatitis is caused by alcohol?
70%
What percentage of chronic pancreatitis is due to idiopathic causes?
20%
What are the other causes of chronic pancreatitis?
Tumour
Trauma
Duodenal obstruction
Pancreas divisum
Fibrosis
Sphincter of Oddi dysfunction
CF
Hyperlipidaemia
What is the most significant symptom of chronic pancreatitis?
Pain
What are the surgical options for chronic pancreatitis?
Pancreatectomy
Pancreatojejunostomy (duct drainage procedure)
What are the complications of chronic pancreatitis?
Pseudocyst
Diabetes
Biliary obstruction
Local arterial aneurysm
Splenic vein thrombosis
Gastric varices
Pancreatic carcinoma
