Pancreatic Lecture Flashcards
What are the 2 functions of the pancreas
Exocrine function
Endocrine function
What do the islet cells produce
Hormones
What do a islet cells produce
Glucagon
What do B islet cells produce
Insulin
Define acute pancreatitis
Acute inflammation process of the pancreas, with variable involvemnet of other regional tissues or remote organ systems
Define mild acute pancreatitis
It is associated with minimal organ dysfunction and an uneventful recovery
Predominant feature is interstitial oedema of the gland
Define severe acute pancreatitis
Associated with organ failure and or local complications such as necrosis, pseudocyst or abscess
Expression of the developent of pancreatic necrosis although patient with oedamatous pancreatitis may manfiest clnical features of a severe attack
What are 3 obstructive factors for pancreatitis
Biliary disease
Benign pancreatic duct stricture
Tumours of the ampulla or pancreas
What are 2 main toxic factors
Alcohol Viral infection (mumps)
What are the 2 metabolic factors of pancreatitis
Hyperparathyroidism
Hyperlipiproteinaemia
What does GETSMASHED stand for
Gall stones Ethanol Trauma Steroid Mumps Autoimmune Spider Bites Hyperparathyroidism ERCP Drugs
What are common findings on examination
Tenderness, peritonism, distention, bowel sounds, skin markings
What blood tests should be carried out for pancreatitis
FBC Clotting U&E LFT Amylase CRP Glucose Ca
What imaging is carried out to diagnose pancreatitis
CXR/ AXR, AUS
CT pancreas
MRI
ERCP
Why does every patient with acute pancreatitis need an AUS
To rule out biliary pancreatitis
What is a complication of pancreatitis that might be seen in a CXR
Pleural Effusion
What is the most important scan of pancreatitis
CT Scan
Allows to assess severity and follow up
What are 5 complications of pancreatitis that can be seen on CT
Fluid collections Pancreatic / peripancreatic necrosis Ascites Bleeding Abscess formation
Is ERCP a diagnostic tool for pancreatitis
No - just for intervention
How many factors of the Glasgow prognostic score means acute severe pancreatitis
3
What happens to your risk of survival as the grade of pancreatitis increases from A to E
It decreases
What are 7 symptoms of Pancreatitis
Epigastric diffuse abdominal pain radiating to the back Nausea and vomiting Indigestion Abdominal tenderness Loss of appetite and weight loss temperature jaundice
What are 6 local complications
Fluid collection Pseudocysts Abscess Necrosis and infection Ascites Pleural Effusion
What are 8 systemic complications
Pulmonary failure Renal faulure Shock Sepsis Metabolic acidosis Hyperglycaemia Hypocalcaemia MODS
What are the 2 most important things to do for a patient with pancreatitis
Give fluids and oxygen
What will be seen on a CT straight away in necrotising pancreatitis. What do we do about this
Nothing
Prevent scanning too early
What is a pseudocyst
A complication of AP and CP - biliary obstruction, and compresses the gastric outlet
What do we do for a mature pseudocyts (9weeks+)
Drain it via surgery or ERCP
What is a pancreatitc abscess
Infected fluid in and around the pancreas
What is the modern approach of a pancreatic abscess
CT and US to find collection and then drain the abscess
IV antibiotics
What are some symptoms of haemorrhage of acute pancreatitis
Sever pain
Low BP
Tachycardic
SEPTIC
What does the amylase do if it is spilt into the peritoneal cavity
Digest everything - vessels, organs, body walls etc.
What is chronic pancreatitis
Progressive and irreversible destruction of pancreatic tissue
What does chronic pancreatitis result in?
Permanent loss of endocrine and exocrine function
What is the most common reason for chronic pancreatitis
Alcohol abuse
What are 2 other causes of chronic pancreatitis
Idiopathic
Pancreatic duct obstruction
Where are common places to develop tropical pancreatitis
Indonesia, Asia
What is the cause of autoimmune pancreatitis
Increased IfgG4 subclass
What is there a high incidence of in hereditary chronic pancreatitis
Cancer
What are 5 findings on examination for chronic pancreatitis
Tenderness Peritonism Mass Ascites Jaundice
What may be seen on AXR of tropical pancreatitis
Calcification of the pancreatic duct
What analgesia is used in pancreatitis
Pacracetamol and opioids
What are the benefits of the Pustow Procedure
Drains the pancreatic juice into the small bowel
Reduces pressure
Restores endocrine and exocrine function
Relieves pain
What are 7 complications of chronic pancreatitis
Splenic vein thrombosis Pseudocyts Pseudoaneurysms Pancreatic Cancer Pleural Effusion Pancreatic ascites Bile duct or duodenal obstruction
How do we treat a biliary obstruction
Stenting
Bypass
Resect
What are the 2 types of pancreatic cancer
Exocrine and Endocrine
What are the most common types of exocrine pancreatic cancer
Adenocarcinoma
What happens to the incidence rate as age increases
It also increases
What are 4 symptoms of pancreatic cancer
Jaundice
Weight loss
Back pain or abdo pain
What are the risk factors for pancreatic cancer
SMOKING Charred meat Obesity Sendentary lifestyle Diabetes
How do we stage pancreatic cancer
TNM system
What is the treatment for pancreatic cancer
Chemotherapy
Radiotherapy
Combinations
Curative or palliative
What imaging technique do we use to diagnose pancreatic cancer
CT scanning
