Pancreatic Problems Flashcards
What is the exocrine function of the pancreas?
acinar cells secrete pancreatic enzymes
What is the endocrine function of the pancreas?
Islets of Langerhans secrete hormones into the blood
Which hormones do which Islets of Langerhans secrete?
beta - insulin
alpha - glucagon
delta - samatostatin
F cells
What pancreatic enzymes do acinar cells secrete?
protease (trypsin and chymotrypsin)
pancreatic amylase
pancreatic lipase
What do epithelial cells lining the duct produce?
bicarbonate
water
What are the possible physiological causes of pancreatitis?
bile reflux into pancreas cause gallstones
hyperstimulation of pancreatic acinar cells with cholecytokinin
activated enzymes autodigest pancreas
What are the classic stomach clinical signs of pancreatitis?
Cullens sign
Erythema Abigne
Gray Turners sign
What does a CRP of over 150 on admission indicate?
severe pancreatitis
What are CXR complications of pancreatitis?
pleural effusions
sentinel loop
What is an abnormal bile duct size?
greater than 1cm
What criteria is used for pancreatitis? What is severe?
Glasgow Criteria
More than 3 is severe
Ransons is less used
How is pancreatitis managed?
IV fluids
antibiotics and oxygen
What is a pancreatic pseudocyst?
complication of acute and chronic pancreatitis
causes biliary and gastric outlet obstruction
Treatment: endoscopic drainage
Describe chronic pancreatitis?
loss of exocrine and endocrine function
progressive and irreversible damage
What are the genetic predisposing factors of chronic pancreatitis?
Cystic fibrosis
alpha 1-antitrypsin
What is the managemetn of chronic pancreatitis?
Creon as enzyme replacement therapy if pancreatic insufficiency
Surgery - frey and putsow procedure
What are the complications of chronic pancreatitis?
Ascites Pancreatic cancer Pleural effusions Psuedocysts Psudoaneurysm Splenic vein thrombosis Duodenal obstruction Biliary obstruction
What are the exocrine pancreatic tumours?
adenocarcinoma - most common
What are the endocrine pancreatic tumours?
gastrinoma
insulinoma
glucagonoma
What are the risk factors for pancreatic cancer?
Type 1 and 2 diabetes
Smoking
Charred meat
Obesity
What are the investigations for pancreatic cancer?
Ultrasound
CT
MRI and MRCP
What is the management of an inoperable case of pancreatic cancer?
decompression of obstructed biliary ducts
ERCP or PTC and stent insertion
What is the management of an operable case of pancreatic cancer?
laparoscopy and staging
ERCP stent
resection or bypass
How is pancreatic staging done?
Laprascopy
What are the resection options for pancreatic cancer?
Whipples procedure
Distal pancreatectomy
Total pancreatectomy
