Pancreatic surgery

Question 1

Acute pancreatitis pathophys

Answer 1

hypovolaemic shock –> retroperitoneal haemorrhage –> pancreatic necrosis

Question 2

main aetiology of acute pancreatitis

Answer 2

GEI

Gallstone, ethanol, idiopathic

Question 3

Other causes of acute pancreatitis

Answer 3

IGETSMASHED
Idiopathic, gallstone, ethanol, trauma, steroids, mumps, autoimmune, ERCP, drugs, hyperlipidaemia/hypothermia/hypercalcaemia

Question 4

Drug causes of acute pancreatitis

Answer 4

Steroids 
Azathioprine 
Mesalazine 
Sodium valproate
didanosine

Question 5

Signs in acute pancreatitis

Answer 5

Cullens - periumbilical bruising

Grey turner - flank bruising

Question 6

Ix acute pancreatitis

Answer 6

Bloods - raised amylase and lipase

CT gold standard, US

Question 7

Factors for acute pancreatitis severity

Answer 7

PANCREAS
PaO2 <8kpa
Age >55
Neutrophil >15x10
Ca < 2mM - risk of poor outcome
Renal U>16
Enzymes - LDH, AST
Albumin <32
Sugar >10mM

Question 8

Mx acute pancreatitis

Answer 8

Conservative: fluid, NBM, analgesia, antibiotics if infection
ERCP if gallstones
Surgical - laparotomy

Question 9

Complication of acute pancreatitis

Answer 9

Early - Shock, renal failure, DIC, ARDS

Late - Pancreatic necrosis/infection/abscess

Question 10

Pancreatic pseudocyst

Answer 10

Collection of fluid in lesser sac
4-6 weeks after acute attack
Rx - spontaneous resolution, drain

Question 11

Cause of chronic pancreatitis

Answer 11

Alcohol
Genetic - HH, CF
Triglycerides

Question 12

Rx chronic pancreatitis

Answer 12

Diet - no alcohol, less fat
Analgesia, pancreatin, ADEK vitamins
Surgery - Whipple’s, pancreaticojejunostomy