Pancreatic Disorders Flashcards
define acute pancreatitis
acute inflammation of the pancreas that causes release of exocrine enzymes that results in self-mediated autodigestion
causes of acute pancreatitis
GET SMASHED gallstones ethanol trauma steroids mumps autoimmune scorpion sting (rare) hypecalcaemia, hypothermia or hyperlipiaemia ercp drugs
most common causes of acute pancreatitis
gallstones causing blockage of pancreatic duct and alcohol misuse
risk factors of acute pancreatitis
blunt abdominal trauma infection (e.g. mumps or mycoplasma pneumonia) autoimmune disorder surgery (near pancreas or ERCP) alcoholism
clinical features of acute pancreatitis
severe upper abdominal pain or sudden onset vomiting (LUQ)
sudden nausea and vomiting
signs of acute pancreatitis
mild pyrexia
tachycardic
epigastric guarding and tenderness
bruising around peri-umbilical area (Cullens Sign)
differentials of acute pancreatitis
renal failure
ectopic pregnancy
perforated duodenal ulcer
small bowel perforation
investigations of acute pancreatitis
ERCP - check for inflammatory fibrosis
US - look for gallstones
MRCP - assess damage degree
what would blood tests show for acute pancreatitis?
raised serum amylase and lipase levels
medical management of acute pancreatitis
IV fluids with crystalloids anti-emetics analgesia supplemental O2 calcium (if hypocalcaemic) and insulin (if pancreatic damage)
surgical management of acute pancreatitis
endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy
common complications of acute pancreatitis
pancreatic necrosis
pseudocyst
pancreatic abscess
vascular complications
definition of chronic pancreatitis
chronic inflammation and fibrosis of the exocrine and endocrine components of the pancreas
causes of chronic pancreatitis
chronic alcohol excess
genetic causes (e.g. CF)
obstructive causes (e.g. cancer)
metabolic (⬆️ triglycerides)
clinical features of chronic pancreatitis
epigastric pain (radiating to back) - worsens after eating fatty food nausea and vomiting decreased appetite exocrine dysfunction endocrine dysfunction
differentials of chronic pancreatitis
acute cholecystitis peptic ulcer disease acute hepatitis AAA acute pancreatitis
blood tests for chronic pancreatitis
FBC, U+E, creatine, LFTs, calcium, amylase and HBa1c
fasting glucose
investigations for chronic pancreatitis
AXR and CT - show/detect calcification
faecal elastase
OGTT
conservative management for chronic pancreatitis
ethanol abstinence
good diet
smoking cessation
review for drug use and management
medical management for chronic pancreatitis
pain control
insulin therapy
pancreatic enzyme replacement
surgical management and considerations of chronic pancreatitis
if medical and conservative management fails, consider coeliac plexus block or pancreatectomy
common complications of chronic pancreatitis
diabetes pseudocyst pancreatic cancer malabsorption/steatorrhoea GI tract haemorrhage
are most pancreatic cancers exocrine or endocrine?
exocrine adenocarcinomas (~90%)
risk factors for pancreatic cancer
smoking poor diet (high BMI, red meat, low fibre) chronic/hereditary pancreatitis FM of pancreatic cancer genetics (e.g. BRCA1/2)
clinical features of pancreatic cancer
epigastric/back pain - worse when supine obstructive jaundice dark urine + pale stools itching (pruritus) weight loss/reduced appetite haematemesis acute pancreatitis
findings upon examination for pancreatic cancer
ascites epigastric mass palpable gallbladder jaundice presence of tumour marker
differentials of pancreatic cancer
gallstone peptic ulceration gastric/colorectal cancer pancreatitis hepatitis/liver abscess
blood tests for pancreatic cancer
FBC - for anaemia/thrombocytosis
LFTs - to confirm jaundice through raised bilirubin, ALP + GGT
serum glucose
tumour markers (CA19-9)
initial investigations for pancreatic cancer
abdominal CT
US of abdomen (liver, bile duct and pancreas)
endoscopic US for biopsy of tumour
staging procedures for pancreatic cancer
CT with IV contrast
PET
dynamic contrast PET
what are the two types of exocrine pancreatic tumours?
primary solid non-endocrine epithelial tumour (e.g. ductal adenocarcinoma)
primary cystic non-endocrine epithelial tumours (e.g. serous cystic neoplasms)
likelihood of resectability of tumour
10-20%
management of resectable pancreatic tumours
distal pancreatectomy for tail and body tumours
whipple’s procedure for proximal tumours
adjuvant to chemotherapy
management of non-resectable tumours
palliative chemo/radiotherapy
bile duct stent to relieve obstructions
pain management
pancreatic supplements (e.g. creon)
common complications of pancreatic cancer
obstructive jaundice
duodenal obstruction
DVT
PE
