Pancreatic Problems

Question 1

What is the exocrine function of the pancreas?

Answer 1

acinar cells secrete pancreatic enzymes

Question 2

What is the endocrine function of the pancreas?

Answer 2

Islets of Langerhans secrete hormones into the blood

Question 3

Which hormones do which Islets of Langerhans secrete?

Answer 3

beta - insulin
alpha - glucagon
delta - samatostatin
F cells

Question 4

What pancreatic enzymes do acinar cells secrete?

Answer 4

protease (trypsin and chymotrypsin)
pancreatic amylase
pancreatic lipase

Question 5

What do epithelial cells lining the duct produce?

Answer 5

bicarbonate

water

Question 6

What are the possible physiological causes of pancreatitis?

Answer 6

bile reflux into pancreas cause gallstones
hyperstimulation of pancreatic acinar cells with cholecytokinin
activated enzymes autodigest pancreas

Question 7

What are the classic stomach clinical signs of pancreatitis?

Answer 7

Cullens sign
Erythema Abigne
Gray Turners sign

Question 8

What does a CRP of over 150 on admission indicate?

Answer 8

severe pancreatitis

Question 9

What are CXR complications of pancreatitis?

Answer 9

pleural effusions

sentinel loop

Question 10

What is an abnormal bile duct size?

Answer 10

greater than 1cm

Question 11

What criteria is used for pancreatitis? What is severe?

Answer 11

Glasgow Criteria
More than 3 is severe

Ransons is less used

Question 12

How is pancreatitis managed?

Answer 12

IV fluids

antibiotics and oxygen

Question 13

What is a pancreatic pseudocyst?

Answer 13

complication of acute and chronic pancreatitis
causes biliary and gastric outlet obstruction

Treatment: endoscopic drainage

Question 14

Describe chronic pancreatitis?

Answer 14

loss of exocrine and endocrine function

progressive and irreversible damage

Question 15

What are the genetic predisposing factors of chronic pancreatitis?

Answer 15

Cystic fibrosis

alpha 1-antitrypsin

Question 16

What is the managemetn of chronic pancreatitis?

Answer 16

Creon as enzyme replacement therapy if pancreatic insufficiency
Surgery - frey and putsow procedure

Question 17

What are the complications of chronic pancreatitis?

Answer 17

Ascites
Pancreatic cancer
Pleural effusions
Psuedocysts 
Psudoaneurysm
Splenic vein thrombosis 
Duodenal obstruction
Biliary obstruction

Question 18

What are the exocrine pancreatic tumours?

Answer 18

adenocarcinoma - most common

Question 19

What are the endocrine pancreatic tumours?

Answer 19

gastrinoma
insulinoma
glucagonoma

Question 20

What are the risk factors for pancreatic cancer?

Answer 20

Type 1 and 2 diabetes
Smoking
Charred meat
Obesity

Question 21

What are the investigations for pancreatic cancer?

Answer 21

Ultrasound
CT
MRI and MRCP

Question 22

What is the management of an inoperable case of pancreatic cancer?

Answer 22

decompression of obstructed biliary ducts

ERCP or PTC and stent insertion

Question 23

What is the management of an operable case of pancreatic cancer?

Answer 23

laparoscopy and staging
ERCP stent
resection or bypass

Question 24

How is pancreatic staging done?

Answer 24

Laprascopy

Question 25

What are the resection options for pancreatic cancer?

Answer 25

Whipples procedure
Distal pancreatectomy
Total pancreatectomy